In 1991, the man assumed administrative duties at a nursing home. He became its principal operator in 1995. A New York Criminal Lawyer said at all relevant times, the nursing home was a participant in the Medicaid programs and was reimbursed through such programs for services provided to each state’s residents who were Medicaid recipients residing within its facility.
In 1993, the man, on behalf of the nursing home, submitted rate reports to the state setting forth the nursing home state rate. He thereafter certified that the nursing home was also going to provide physical, occupational and speech therapy services, as well as dental services, to the state’s Medicaid recipients but that the cost of such services was not included in the home state rate. Based upon the said reports, the state calculated the nursing home’s daily rate and then included add-on payments for the specified ancillary services.
In 1998, the state advised the nursing home that they going to review the services they provided to the state’s Medicaid recipients by out-of-state providers. They also requested the nursing home to make available for inspection all patient records dating back 1992. Following the said investigation, the man and the nursing home were each charged with two counts of grand larceny in the first degree and two counts of grand larceny in the second degree.
Based on records, the count one alleged that the nursing home submitted numerous claims for services they provided to the state’s Medicaid recipients which falsely certified that the amounts listed thereon were due when the nursing home were receiving duplicate reimbursement for certain ancillary services. The counts two and three alleged that the nursing home submitted numerous claims for occupational and speech therapy services and falsely certified that the entire amounts listed therein were due even though such services were not provided to the recipients. Lastly, the count four alleged that the nursing home submitted claims for dental services and falsely certified that the entire amounts listed thereon were due even though such services were not provided.
Following a nonjury trial, the man and the nursing home were convicted of the crime. The nursing home was fined $10,000 and given an unconditional discharge for the remaining counts. The man was sentenced to a term of imprisonment aggregating 3 to 12 years, and was ordered to pay compensation in the amount of $1 million. The man and the nursing home then filed a motion on the decision.
Consequently, the court finds no merit to the man and the nursing home contention that the charges are time-barred. Based on records, it is well settled that the grand larceny may be charged as a series of single larcenies governed by a common fraudulent scheme or plan even though the successive takings extended over a long period of time. The court also finds that a valid line of reasoning and permissible inferences which rationally led Supreme Court, as the fact finder, to the conclusion that the man and the nursing home intentionally undertook to obtain additional reimbursement for the costs of physical, occupational and speech therapy services, as well as dental services, by falsely certifying to the state that the costs were not included in the home state rate.
Several witnesses, including a witness for the defense, testified that the man was familiar with the state’s regulations, understood the schedule for allowable costs and had utilized the provider manual and the regulations in other efforts at reimbursement. The evidence also showed that the man attended at least one educational seminar in his administrative capacity during which the billing and reimbursement practices were explained.
Consequently, a Long Island Criminal Lawyer said that after the court reviewed the man and the nursing home’s remaining contentions, the court found it unpreserved or lacking in merit. The court then affirmed the decision.
Some of us are being accused of things that we did not do. Others even file for formal complaint but it is merely wrongful allegation. If you happen to get yourself involve in a wrongful accusation and you want to fight for your rights, whether it involves theft, sex crimes or drug possession, you can ask help from the NY Criminal Lawyer. You can also call the New York City Grand Larceny Attorney for legal assistance. You can reach them at Stephen Bilkis and Associates office.