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Monday, December 17, 2012

Americare advised ‘War of the Roses’-style ploy for Flatbush Medicaid recipients


Whistleblowers are on the warpath against Americare.

The Flatbush home care agency with a troubled past is back to its old Medicaid billing tricks, they charged — with one ploy right out of “The War of the Roses.”

A company bigwig advised Jack and Goldie Gold to divide their Flatbush home with a wall so Medicaid would pay for two home healthcare aides.

“It was suggested,” the elderly couple’s daughter Chani Gold told the Daily News.

New York state tries to control Medicaid costs by limiting coverage to one health aide per home.

Three different whistleblowers have made Medicaid fraud allegations to law-enforcement groups, sources told the News.

The state Attorney General and the Brooklyn U.S. Attorney’s office declined to prosecute the Kings Highway firm in 2010, but allowed the accusers to bring cases on the government’s behalf.

One has filed a lawsuit; the other two are hiring lawyers and plan to sue, sources said.

The suits will take aim at Americare CEO Elly Kleinman - a major player in the Orthodox Jewish community with close ties to the state’s top Jewish lobbyist organization, Agudas Yisroel.

Americare has been in the hot seat before over Medicaid billing practices.

Then-Attorney General Eliot Spitzer fined the company a whopping $7 million in 2005 after his investigators found Americare billed for bogus hours at adult homes for eight years.

As attorney general, Cuomo also fined Americare $8 million in 2008 for falsely claiming home health aides had been trained to care for Medicaid patients.

At least one Americare official apparently thought the Golds were going to build the dividing wall in their E. 19th St. home.

“I understand that they will be living in two separate apartments so I will just need clarification as to the apartment numbers since the address is the same,” intake director Judith Northover wrote in a May 2010 email The News obtained.

The Golds didn’t construct the divider but still got a second aide during the day from October 2011 until January 2012, records show.

An extra health aide costs up to $150,000 annually.

The ploy Americare suggested to the Golds recalls the 1989 film “War of the Roses” in which Michael Douglas and Kathleen Turner play warring lovebirds who split their house while still living in it.

Americare spokesman Fred Winters said whistleblowers pointing fingers at the firm have got it wrong.

The company has “zero tolerance for questionable actions by any of its employees,” he said.

An Americare review of the Golds’ case has not found any “inappropriate actions,” said Winters. The state qualified them for Medicaid based on “doctor’s orders,” he added.







By Reuven Blau / NEW YORK DAILY NEWS

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