Connecticut Questions Not-For-Profit Senior Care Agency’s Medicaid Billing Practices

Connecticut officials are investigating whether the state's "largest not-for-profit health care agency for the elderly," the Masonic Geriatric Healthcare Center, improperly billed the state's Medicaid program for $10 million in services not covered by the program, the Hartford Courant reports. The center, run by Masonicare, is a 548-bed facility housing a traditional nursing home, an acute care hospital and an inpatient psychiatric facility. The dispute results from $10 million that the nursing home received in Medicaid reimbursements during the past decade, a figure that comprises 8% of the nursing facility's $120 million overall Medicaid reimbursement in that period. According to Masonicare President and CEO Barry Spero, the "alleged overcharges stem from disputes with the state over whether Medicaid regulations cover certain services," but not whether Masonicare failed to offer the services in question. "There was no intention to do anything. The dollars we received went to patient care," he said. Some of the discrepancies include whether Medicaid should cover "spiritual care" and whether the nursing home improperly billed the state for "shared services with other Masonicare facilities." Spero attributed the problem to Masonicare's "rapid growth," disagreement with the state over covered services and the complexity of reimbursement forms for nursing homes. "Mistakes were made. Hopefully, we'll be able to sit down with the state and come to amicable settlement to this," Spero said. Connecticut Attorney General Richard Blumenthal (D) "said he would not disagree" with Spero's "characterization" of the dispute, but pointed out that the investigation was continuing. He added, "All I can say is there are a number of issues that need to be addressed, including whether specific costs were reimbursable and what specific services were provided. Obviously, $10 million is a lot of money by any standard. But we haven't reached any conclusions, and I don't want to cast any aspersions as to the severity or size of the problems." The state's inquiry is not expected to be completed until late January, the Courant reports (Julien, Hartford Courant, 12/20).