Americare Refutes Accusations of Unethical Medicaid Billing Practices - The Jewish Voice
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Americare Refutes Accusations of Unethical Medicaid Billing Practices

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Elly Kleinman, CEO of Americare, is highly regarded by the Jewish community for his notable philanthropic endeavors on behalf of numerous organizations providing vital social services.

The popular Brooklyn home health care agency Americare is refuting the accusations made against it in a report in the New York Daily News, which raised questions about its Medicaid billing practices. Americare’s CEO Elly Kleinman is highly regarded for his ongoing charitable endeavors on behalf of various social service organizations within the Orthodox Jewish community, including Agudath Israel of America and Ohel Children’s Home and Family Services.

According to the Daily News, three “whistleblowers” are filing lawsuits against the firm, alleging that a highly placed Americare official recommended to a Flatbush couple that they build a dividing wall in their home to create the appearance of two separate residences, and thereby obtain Medicaid payments for two home healthcare aides instead of the traditionally mandated maximum of one aide per home. “It was suggested,” the daughter of Jack and Goldie Gold told the newspaper.

“I understand that they will be living in two separate apartments so I will just need clarification as to the apartment numbers since the address is the same,” Americare’s intake director Judith Northover wrote in an e-mail in May 2010, according to the News. While ultimately the elderly couple did not put up the dividing wall, they did receive a second home health aide during daytime hours from October 2011 until January 2012, according to company records.

The three whistleblowers brought their charges against Americare to the New York State Attorney General and the Brooklyn U.S. Attorney’s office in 2010. Although the state decided not to prosecute the Brooklyn agency, it gave the accusers permission to bring cases on behalf of the government.

According to the Daily News, this is not the first time that questions have been raised about Americare’s billing practices. In 2005, then-Attorney General Eliot Spitzer levied a $7 million fine against the company when his office’s investigators discovered that Americare had falsely billed for hours at adult homes for eight years. When Andrew Cuomo served as New York State’s attorney general prior to becoming governor, he reportedly fined Americare $8 million in 2008 for dishonestly stating that home health aides had been trained to provide care for Medicaid patients.

In an exclusive interview with the Jewish Voice, Americare spokesman Fred Winters said, “These are seriously erroneous interpretations of the facts, carried, unfortunately, by the Daily News. Americare is now aware that these allegations are the work of terminated for cause disgruntled employees.” Responding to the current charge that Americare suggested skirting Medicaid’s tendency to only approve one home aide per household, Winters emphasized, “Americare’s compliance department vigorously investigated this allegation and found absolutely no evidence of any questionable suggestions by any employee. That allegation is simply unsupported by the facts. That said, however, we can state that Medicaid does not bar the assignment of aides to husband and spouse in those rare situations when it is medically appropriate and ordered by a physician.”

In his comments to the Jewish Voice, Winters additionally clarified the report about previous fines levied against Americare for improper billing of services. “The Attorney General did not fine Americare $7 million in 2005,” the spokesman insisted. “These funds represent a settlement of a civil suit on overpayments to Americare by Medicaid as a result of good faith disagreement on whether certain services provided by Americare were reimbursable. Americare settled rather than incur the cost of litigation.”

Winters also posted two responses in the Comments section following the article on the Daily News website, wherein he outlined specific responses to the accusations stated in the article.

In one lengthy response, Winters wrote as follows:

“The Daily News, in “Medicaid Warfare” (Dec. 14, 2012) has taken aim at Americare, a proprietary home health care agency and one of New York’s more efficient. In fact, thanks to vigorous quality assurance and highly professional staff, it is widely recognized as a provider of last resort that admits patients whose cases are “too complex” for other agencies.

Reporter Reuven Blau based the article on the dubious claims of an unidentified “source” and three alleged whistleblowers, all fired for good cause, but in personal litigation against Americare. The whistleblowers each brought their stories to then New York State Attorney General Eliot Spitzer and the Brooklyn US Attorney, both of whom refused to bring charges, again, with good cause.”

Focusing on the alleged ruse to create two residences for the Golds, Winters wrote, “The main complaint against Americare seems to be that an unnamed “company bigwig” advised a very ill elderly couple to build a wall dividing their home to qualify for two Medicaid-reimbursed home health aides. No “bigwig” more prominent than a mid-level manager cc’d on the email on which this allegation was based was even involved in this case, and it is widely believed that this embittered former employee who is suing Americare for $1M and was fired for eminently good cause is the primary source for this article and may in fact have made the suggestion to build a wall himself.

What is known, however, is that the daughter of the patients, who is cited in the article, saying that the idea of building a wall “was suggested” told Americare that she felt that the caller (she could not remember if it was Mr. Blau or the former employee) was putting words in her mouth and she hung up on him.

In fact, this infirm elderly couple did get a second home health aide, but on the legitimate basis of doctor’s orders, not a wall that was never built and which, given the doctor’s written order, would have been entirely unnecessary. However, early on, when a supervisor heard that the couple was living in separate apartments, she wrote asking for their individual addresses and identified in the email to the family the precise regulation on which she based her question.”

Winters concluded his comments on the Daily News website by stating, “Americare really does have zero tolerance for any questionable behavior by its officers and employees, and the proof of this highly regarded company’s commitment is that a compliance review has still not found any evidence of inappropriate actions.”

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