In one scheme, the former administrator allegedly paid a hospital supervisor for patient referrals.
Morris Park Nursing Home, a skilled nursing facility in the Bronx, New York, has been found to have violated the False Claims Act and Anti-Kickback Statue.
According to the civil fraud lawsuit, cash payments were allegedly made to a supervisor at a nearby hospital for patient referrals from January 2017 to December 2019. A statement on the settlement said Morris Park paid the supervisor $150 for each referred patient admitted to the facility, coming to a total of approximately $5,000-$10,000, according to a press release from the U.S. Attorney’s Office, Southern District of New York.In addition to the cash payments, Morris Park also gave the supervisor tickets to New York Yankees baseball games, invited them and their staff to a holiday party sponsored by the facility, and arranged for food to be delivered to their office.
From January 2018 to December 2019, at the direction of former administrator Tzodik “Justin” Weinberg, residents were disenrolled from their self-selected Medicare Advantage plans and enrolled in original Medicare without their consent.
In the summer of 2018, Morris Park retained Maier Arm, a friend of Weinberg's, to assist with the improper disenrollments. Arm was paid $1,000 for each resident he switched to original Medicare, with Weinberg pocketing half.
As part of the settlement, Weinberg and Arm will have to pay $495,000 and $115,000, respectively. The estate of the owner of Morris Park at the time these events occurred will have to pay $2.85 million.
For skilled nursing facilities, which rely on Medicaid reimbursements to maintain operations, admitting residents enrolled in Original Medicare (Medicare Parts A and B) is more profitable than admitting those enrolled in Medicare Part C Advantage Plans—also known as MA Plans. With Original Medicare, the Centers for Medicare & Medicaid Services (CMS) directly reimburse providers on a fee-for-service basis. MA Plans have a fixed, capitated amount reimbursed each month for each beneficiary.
Switching a resident's coverage could potentially change their co-payments and deductibles, meaning they could lose the supplemental coverage they had with their MA Plan. There could even be limitations on when the resident would be able to re-enroll in their MA Plan should they leave Morris Park.
"The misconduct that occurred at Morris Park exhibits the prioritization of profits over residents' best interests," Naomi Gruchacz, U.S. Department of Health and Human Services, Office of the Inspector General Special Agent in Charge, said in a statement.
"This nursing home paid illegal kickbacks to manipulate the resident referral process and changed patients' health coverage selections without properly obtaining their consent, with no apparent concern for how these events could negatively impact residents."
“This nursing home paid illegal kickbacks to manipulate the resident referral process and changed patients' health coverage selections without properly obtaining their consent, with no apparent concern for how these events could negatively impact residents.”
Naomi Gruchacz, U.S. Department of Health and Human Services, Office of the Inspector General Special Agent in Charge
Jasmyne Ray is the revenue cycle editor at HealthLeaders.
KEY TAKEAWAYS
The former administrator of Morris Park Nursing Home paid a hospital supervisor for patient referrals.
The administrator also switched residents' Medicare coverage from MA plans to Original Medicare since the latter is more profitable for skilled nursing facilities.