St. Margaret's Center, a healthcare facility in Albany, New York, will pay $1.3 million following allegations of improper billing for care, according to First Assistant United States Attorney John A. Sarcone III. The settlement emphasizes the expectation that nursing homes provide appropriate care for residents, including seriously ill children, when public healthcare funding is involved. In a statement from the United States Attorney's Office, Sarcone noted that the agreement reflects the requirement for nursing homes to meet their responsibilities to residents and the taxpayers who support them.
The allegations cover the period from January 1, 2018, through December 31, 2023, during which New York State surveys identified SMC’s failure to provide certain required care. Observed deficiencies included staffing shortages and gaps in respiratory care, resulting in SMC being placed in immediate jeopardy status by the New York State Department of Health (NYSDOH) for more than a month in 2022. Although SMC received federal and state Medicaid funding contingent on maintaining compliance programs to ensure quality care, the facility’s compliance officer stated unawareness of potential risks and the facility’s critical status, as noted in the government’s case against SMC.
As part of the financial settlement, SMC entered into a five-year Corporate Integrity Agreement with the United States Department of Health and Human Services, Office of Inspector General (HHS-OIG). The agreement is designed to improve the quality of care and ensure the safety of SMC’s residents, with the goal of preventing similar deficiencies in the future.
The case was initiated by two former SMC employees through a whistleblower lawsuit under the qui tam provisions of the False Claims Act. The whistleblowers are set to receive approximately $247,000 from the settlement for their role in bringing the issues to light. The lawsuit was filed under docket number 1:22-cv-0004 in the U.S. District Court for the Northern District of New York. According to Assistant U.S. Attorney Christopher Moran, the joint investigation by the United States Attorney’s Office and the New York Attorney General’s Medicaid Fraud Control Unit was conducted to ensure the integrity of patient care and the appropriate use of public healthcare funds.
