Attorney General James Secures Over $10 Million from Health Care Companies for Failing to Provide Care to New Yorkers

 

RiverSpring and ElderServe Collected Millions in Medicaid Payments for Services They Never Provided to Seniors in New York City and Surrounding Counties

New York Attorney General Letitia James announced a $10.1 million settlement with health care companies RiverSpring Living Holding Corp. (RiverSpring) and ElderServe Health, Inc. d/b/a RiverSpring at Home (ElderServe) for failing to provide vulnerable New York seniors with personalized health care services while continuing to bill New York’s Medicaid program for those services. For years, RiverSpring and ElderServe collected millions of dollars in Medicaid payments while members of the RiverSpring Managed Long Term Care Plan in New York City and Westchester, Nassau, and Suffolk counties did not receive the care they were promised. The settlement is the result of a joint investigation between the Attorney General’s Medicaid Fraud Control Unit (MFCU), and the United States Attorney’s Office for the Southern District of New York (USAO-SDNY). Under the settlement, approximately $6 million will be returned to the New York State Medicaid Program.

“Instead of caring for their vulnerable patients, RiverSpring and ElderServe used them to drain millions of dollars from Medicaid,” said Attorney General James. “New Yorkers should be able to trust that the organizations in charge of their health care are providing the services they promise, not taking advantage of them. My office will not tolerate any failure to provide proper care to vulnerable New Yorkers.” 

RiverSpring is a New York not-for-profit corporation that provides administrative support to The Hebrew Home for the Aged at Riverdale and affiliated organizations. ElderServe is a New York not-for-profit corporation that administers a Managed Long Term Care Plan (the RiverSpring MLTCP) for Medicaid beneficiaries. Services provided under the RiverSpring MLTCP are specific to each member’s needs and can include home health aide services, nurse visits, social adult day care services, and other community-based services.

An investigation by MFCU found that from 2012 to 2017, the RiverSpring MLTCP collected Medicaid payments for services it never provided to its members. In many cases, RiverSpring either did not provide its members with qualifying services or did not adequately document that the services were provided. Despite this, RiverSpring received millions of dollars in Medicaid payments for these services.

As a result of the settlement, RiverSpring and ElderServe must pay $10,159,130 to federal and state Medicaid programs. $6,095,478 of the settlement funds will be returned to New York’s Medicaid program.

The case against RiverSpring was initiated by a former employee, who will receive a portion of the settlement because the former employee filed a whistleblower lawsuit under the qui tam provisions of the federal and New York False Claims Act. This Act allows people to file civil actions under seal on behalf of the government and share in any recovery.

The investigation and settlements were the result of a coordinated effort between OAG and USAO-SDNY. Attorney General James thanks the USAO-SDNY for their partnership and assistance.

The investigation by the Attorney General’s MFCU was conducted by Senior Auditor-Investigator Emily Brissette under the supervision of Stacey Millis, Chief Auditor of MFCU’s Civil Enforcement Division. MFCU Lead Data Scientist Si Lok Chao provided data analytics assistance. The case was investigated by Assistant Attorney General Anthony I. Giacobbe, Jr. under the direction of MFCU Civil Enforcement Division Chief Alee N. Scott. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney. The Division for Criminal Justice is overseen by Chief Deputy Attorney General José Maldonado and under the oversight of First Deputy Attorney General Jennifer Levy.

Reporting Medicaid Provider Fraud: MFCU defends the public by addressing Medicaid provider fraud and protecting nursing home residents from abuse and neglect. If an individual believes they have information about Medicaid provider fraud or about an incident of abuse or neglect of a nursing home resident, they can file a confidential complaint online or call the MFCU hotline at (800) 771-7755. If the situation is an emergency, please call 911.

MFCU’s total funding for federal fiscal year (FY) 2023 is $65,717,936. Of that total, 75 percent, or $49,288,452, is awarded under a grant from the U.S. Department of Health and Human Services. The remaining 25 percent, totaling $16,429,484 for FY 2023, is funded by New York state. Through MFCU’s recoveries in law enforcement actions, it regularly returns more to the state than it receives in state funding.