State Attorney General Eliot L. Spitzer has sued a Western New York nursing home, accusing it of overbilling the state by $1 million during a period when the state's own faulty computer system had resulted in overpayment of Medicaid claims.
Operators of the Rosa Coplon Jewish Nursing Home & Infirmary in Getzville dispute the state's claims. In fact, they claim the state underpaid the home for other health care services it provided.
"I don't believe they've done anything wrong. There was no intent. It's just a very complicated process, and because it's so complicated, people make mistakes on both sides -- and eventually it gets rectified," said Samuel L. Shapiro, a lawyer for the 180-bed nursing home on the 70-acre Harry and Jeannette Weinberg Campus.
Spitzer is not alleging any fraud. He said the state overpaid the home $970,000 between 1998 and 2003 because of inflated hourly rates for services and non-reimbursable costs, such as bad debts, advertising and certain salaries.
Including such costs, according to the lawsuit filed in State Supreme Court in Albany County, incorrectly raised the home's 2001 rate for personal care services to $27.36 per hour from $21.81 per hour, resulting in excess state payments of $153,000, Spitzer alleges.
"The size and complexity of the Medicaid program can sometimes result in the improper expenditure of taxpayers funds even in the absence of fraud," Spitzer said in a statement.
The state's complaint filed with the court notes that, at the time, the state was using a computer program that led to billing problems.
"The problem with the computer program resulted in substantial overpayments" across the state, the complaint said, including the Coplon Home.
Since 2002, Spitzer said the state has gotten back $34 million from 16 nursing facilities.
"Pretty much, everyone rolled over and said 'Where do I send the checks?' " Shapiro said.
The nursing home, in its court papers, says any Medicaid overpayments "were the result of an error of judgment by the state."
Shapiro also said a statute of limitations had expired on some of the payments.
He also disputed the state's allegation that certain costs should not have been included in the formula to calculate Medicaid reimbursements.
Shapiro further noted that Western New York gets less state money than any other part of the state for Medicaid costs. "No one would ever dream in their right minds that the (state) Health Department was overpaying somebody," Shapiro said.
In the end, Shapiro predicted, the state likely will end up paying the facility money when the disputes are resolved. In court papers, the home claims the state owes it $961,000 in disputed Medicaid payments.
State officials have been scrambling to appear increasingly tough on Medicaid overpayments and fraud. Spitzer, who is running for governor next year, has come under fire by Republicans in the State Senate, who claim the attorney general's Medicaid fraud unit has not acted aggressively enough. Two legislative hearings on the issue were held last week in Albany.
The lawsuit against the Coplon Home, announced Wednesday by Spitzer's office, had been filedJuly 29.