Abbott reaches settlement with facilities allegedly defrauding Medicaid

The SE Texas Record Aug. 28, 2007, 6:53am

Greg Abbott

AUSTIN – Texas Attorney General Greg Abbott reached a Medicaid fraud settlement with one of the nation's largest assisted living facility operators in Texas.

Seattle-based Emeritus Corp. has remitted $1.86 million to Texas to resolve the company's false and inaccurate billing to the Medicaid program. Dowlen Oaks in the 200 block of Dowlen Road in Beaumont is among assisted living facilities owned by Emeritus Corp.

According to the Attorney General's investigation, Emeritus deprived its residents of legally required amenities and services.

"State contractors have a legal obligation to accurately bill for services actually rendered," said Abbott. "Texans will not tolerate waste, fraud and abuse in the Medicaid system. Taxpayers and senior citizens can rest assured we will continue cracking down on Medicaid providers who do not follow the law."

The Attorney General's Medicaid Fraud Control Unit and Civil Medicaid Fraud Section, together with the Texas Department of Aging and Disability Services, uncovered improper billing practices at 11 of Emeritus' 19 Texas-based facilities.

Under the Medicaid-eligible Community Based Alternatives (CBA) program for assisted living care, Emeritus is required to provide either single- or double-occupancy living quarters with specific floor dimensions, full kitchen areas and storage spaces. Because of Emeritus' false billings, the state paid for amenities and services that were never available to Medicaid residents.

The settlement with the Attorney General requires Emeritus to repay 150 percent of the funds it improperly received from the state. In addition, Emeritus substantially remodeled its facilities to comply with this law. The recovered funds will benefit eligible citizens who are currently on waiting lists for the CBA program.

To save taxpayer dollars, Attorney General Abbott has dramatically expanded both the Civil Medicaid Fraud Section and the Medicaid Fraud Control Unit. Since Attorney General Abbott took office, the civil and criminal Medicaid fraud sections have recovered almost $190 million.

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