A Bronx, NY, skilled nursing facility settled a lawsuit with the Department of Justice for almost $8 million for intentionally switching residents’ healthcare coverage to boost its Medicare reimbursements. As part of the settlement, the parties admitted that staff members often did not obtain the consent of residents or their authorized representatives before disenrolling them from Medicare Advantage plans.
“Skilled nursing facility residents have the right to choose their own healthcare insurance coverage. Plaza Rehab Center frequently changed the insurance of its residents without their consent or knowledge, and without explaining how the change could impact their out-of-pocket costs and the scope of their healthcare coverage,” U.S. Attorney Damian Williams stated in a press release about Plaza Rehab and Nursing Center and Citadel Care Centers.
As part of the settlement, Citadel also agreed to take steps to ensure that all Citadel SNFs comply with applicable guidance on Medicare health plan disenrollments and enrollments. Plaza Rehab and Citadel also entered into a corporate integrity agreement with the New York Regional Office of the U.S. Department of Health and Human Services Office of the Inspector General.
Requests for comment left by McKnight’s with both Plaza Rehab and Citadel were not returned by the production deadline.
