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The Government’s Complaint alleges that WMC billed Medicaid for millions of dollars of outpatient services at its mental health center that lacked the core documentation required by Medicaid regulations. The settlement, approved Wednesday in Manhattan federal court by U.S. District Judge Colleen McMahon, requires WMC to pay $7 million in civil damages under the False Claims Act.

Manhattan U.S. Attorney Preet Bharara stated: “Medicaid is a vital resource for people who suffer from physical and mental illnesses and related conditions. We have absolutely no tolerance for those who fail to comply with the program, particularly in these lean times when budgets are stretched thin and belts are being tightened. We will continue to work with our federal and state partners to protect the Medicaid program against waste, fraud and abuse.”

According to the Complaint filed Wednesday in Manhattan federal court, here are the details of what the Medical Center did:

WMC, a public hospital located in Valhalla, New York, is home to one of the largest public mental health facilities in the County, the Behavioral Health Center (the “BHC”). The BHC operates as a hospital-based mental health and hygiene provider licensed by the New York State Office of Mental Health (“OMH”) and the New York State Department of Health (“DOH”).

The BHC also provides outpatient behavioral health services to children, adolescents and adults who are mentally ill or suffer from psychiatric or emotional conditions.

Medicaid, which reimburses providers for the cost of care for its recipients, paid millions of dollars in reimbursement for claims submitted by WMC for these mental health services. As such, it must comply with Medicaid regulations. Those regulations expressly require that mental health outpatient clinics maintain certain documents, including progress notes and treatment plans, to ensure that billed services are actually provided, and that the providers are in compliance with the regulations.

From August 2001 through June 2010, WMC repeatedly billed Medicaid for outpatient mental health services without having the core documentation required by the Medicaid regulations in order to bill for those services.

Further, WMC management knew for years that the outpatient mental health clinics were missing documentation.

Until at least June 2010, WMC failed to take any but the most insignificant steps to address the problem, or to conduct any systematic audit of the clinics’ records.

WMC also did not return funds it received from the Medicaid program despite knowing it had been substantially overpaid as a result of having billed for services for which it lacked proper documentation. As a result of this billing fraud, WMC was paid millions of dollars by the Medicaid program to which it was not entitled.

Under Medicaid, the federal and state governments share the costs of care for its recipients. Accordingly, WMC is also entering into a settlement agreement today with New York State that provides for the payment from WMC to the state of its share of the Medicaid funds.

*                      *                      *

The case is being handled by the Office’s Civil Frauds Unit. Mr. Bharara established theCivil Frauds Unit in March 2010 to bring renewed focus and additional resources to combating financial fraud.

The Civil Frauds Unit works in coordination with President Barack Obama’s Financial Fraud Enforcement Task Force, on which Mr. Bharara serves as a Co-Chair of the Securities and Commodities Fraud Working Group. President Obama established the interagency Financial Fraud Enforcement Task Force to wage an aggressive, coordinated, and proactive effort to investigate and prosecute financial crimes. The task force includes representatives from a broad range of federal agencies, regulatory authorities, inspectors general, and state and local law enforcement who, working together, bring to bear a powerful array of criminal and civil enforcement resources. The task force is working to improve efforts across the federal executive branch, and with state and local partners, to investigate and prosecute significant financial crimes, ensure just and effective punishment for those who perpetrate financial crimes, combat discrimination in the lending and financial markets, and recover proceeds for victims of financial crimes.

Mr. Bharara praised the audit work of the New York State Office of the Medicaid Inspector General that was instrumental to the federal investigation.

This case is being handled by the Office’s Civil Frauds Unit. Assistant U.S. Attorneys Heidi A. Wendel and Mara E. Trager are in charge of the case.

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WPCNR COUNTY CLARION-LEDGER. From the Westchester County Department of  Communications.(EDITED) October 18, 2012:

A month before the release of his proposed 2013 budget, County Executive Robert P. Astorino today reaffirmed his pledge not to raise county property taxes or raid the county’s reserve fund next year and appealed to the county’s employee unions to help him minimize layoffs by agreeing to contribute to the cost of their health care.

“Here is the stark reality: Our revenues do not keep pace with automatic spending increases,” Astorino said at a news conference where he described the challenges of balancing a budget that, without spending cuts, would have an $86 million hole next year due mainly to state-mandated costs that will go up automatically on Jan. 1. “The job before us is to figure out a responsible way to maintain services at a cost affordable to taxpayers.”

Astorino must submit his proposed 2013 budget to the Board of Legislators by Nov. 15. The board then has until Dec. 27 to adopt a final spending plan. Under county law, the budget must be balanced.

The Westchester Business Council issued a statement supporting the County Executive’s policy, saying:

Since taking office, Astorino has cut county spending by $100 million and the county property tax levy has been reduced by 2 percent.

            Plugging the $86 million shortfall could require as many as 800 layoffs, or a 16 percent reduction in the workforce. Astorino said such a number is unacceptable and he would propose some measures to bring it down. However, he said he would need help from the unions as well.  

            As he has done repeatedly, he urged the Civil Service Employees Association (CSEA), the Police Benevolent Association (PBA)  and the three other county unions (the Superior Officers of the PBA, the New York State Nurses Association and the District Attorney’s Investigators PBA) currently without contracts  to agree to his “jobs for savings” plan, where they pay a portion of their health care costs as a way to save jobs.

            Health care for employees cost the county about $120 million this year and is projected to increase to $125 million in 2013. Three other county unions have, through collective bargaining, already agreed to contribute to their health care: Teamsters Local 456, which represents middle-level management; the Correction Officers Benevolent Association (COBA); and the Corrections Superior Officers Association (SOA). Also, non-union managers at the county, including Astorino and his staff, have been paying for health care since Astorino instituted the reform shortly after taking office.

            Astorino said that the county and representatives of the CSEA – the county’s largest union with approximately 3,300  members –  will be meeting with a state mediator next week to try to resolve the contract. The CSEA’s last contract expired Dec. 31, 2011, and because of the state’s Triborough Amendment remains in effect until new terms are negotiated and ratified.  

             “I urge them to use all available resources and efforts to reach an agreement that preserves jobs and  services,” he said. “Layoffs hurt everybody. Health care contributions can provide significant savings, which can greatly reduce the number of layoffs we are facing.”

            County Legislator and Republican Minority Leader Jim Maisano of New Rochelle, speaking on behalf of his caucus, said: “It is the best interests of everyone in Westchester County that our unions settle contracts with health care contributions before a budget is submitted next month.” 

            In preparing his proposed budget for 2013, Astorino said that he was following the same approach that was adopted on a bipartisan basis with the Board of Legislators for the current budget:  No increase in the county property tax levy and no use of the unrestricted reserve fund.

            “Taxes are off the table,” he said. “We are already the highest taxed county in the country. Raiding the reserve fund is a non-starter because that would jeopardize our triple A credit ratings. If we are downgraded , our borrowing costs go up and running county government becomes more expensive. Our focus is on preserving the most essential services and bringing down costs to pay for them.”

            In addition to layoffs, Astorino said there were other options available to partially address the $86 million shortfall, but none of them are ideal. These include:

·        Departmental cuts –  Every department is looking at ways to reduce spending, but this inevitably means some service cuts.

·         Borrowing – The county can borrow to pay for pensions and tax certioraris (court-ordered property tax refunds), but the money has to be paid back with interest.

·        Discretionary spending – Also under review is the money the county spends to fund outside non-profit cultural and social agencies, such as libraries, museums and after-school programs.

            “The job is to determine – in an objective way – what are the most essential services and what are the smartest and least painful ways to pay for them,” Astorino said.  

            Driving the costs for next year are a variety of programs with automatic increases that will take place Jan. 1. These include:

·        The county’s share of Medicaid –  the federal and state mandated program to provide health care for the poor – will go up $8 million (to $224 million).

·        Employee pension costs would go up $12 million (to $91 million). This is a state mandate.

·        Employee health care would go up $5 million.

            These increases will not be offset by new or rising revenues. The county’s portion of the sales tax is projected to generate about 3 percent more next year  – but not a sufficient amount to offset the mandated costs in spending. State and federal aid is expected to be down slightly.

            Money raised from the county property tax will remain the same at $548 million, based on Astorino’s continued pledge that he will not raise the county property tax levy.

STATUS OF 2012 BUDGET

            In his review, Astorino also discussed the county’s current budget of $1.697 billion. With three months to go, Astorino said the county has a $15 million shortfall, which is less than 1 percent of the total budget.

            To close the gap by the end of the year, Astorino said he will limit any new hires, defer some spending and liquidate some departmental accounts that have surpluses at the end of the year.

            “There is work to do,” he said, “but I am confident that we can end the year with a balanced budget and that means a balanced budget without drawing down reserves.”

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WPCNR WHITE PLAINS LAW JOURNAL.October 17, 2012 UPDATED October 18, 2012:

The New York State Appellate Court, 2nd Circuit in Brooklyn overturned the 2010 conviction of former White Plains Mayor Adam Bradley on charges of attempted assault,harassment and criminal contempt involving his wife.

In an interview with WPCNR Wednesday afternoon after the court reversed his conviction by a 3 to 1 decision, Adam Bradley told WPCNR he was “very happy, but there was still a lot more to come.”

Bradley told WPCNR the appellate court has ordered a new trial for him at a date to be set. Bradley hoped a different judge other than Judge Susan Capeci would be assigned to the case. Judge Capeci found Bradley guilty in the first trial which was a bench trial.

This time, if a new trial is called, Bradley told WPCNR it would be a jury trial and “a lot more documents would be presented, that I was not allowed to present last time. I was innocent then and I’m innocent now.”

Bradley said he is no longer on probation. He is free to travel outside of Westchester County and is free to practice law anywhere in the state.

Lucian Chalfen, D.A. spokesperson, issued this statement to WPCNR Thursday morning: “We are reviewing the court’s decision and will be making a determination on how we will proceed.”

Bradley noted that the District Attorney could choose not to retry him.

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WPCNR ON THE AISLE. Theatrical Review by John F. Bailey. October 13, 2012:

The beginning moment: the exotic Fiddler,the magical, agile, light-on-his-feet,engaging-on-the-bow Andrew Mayer,(right) with the likable, laughable, lovable, Bill Nolte (left) bring Zero Mostel and Fiddler to life.  

As Nolte sung Tradition beginning Broadway’s 9-Tony award-winning musical , Fiddler on the Roof, at Westchester Broadway Theatre Opening Night, the classic cast the spell it always has from first note to last whether you are seeing it for the first time or many times.

Bill Nolte as Tevye in the Zero Mostel role, gives an  opening explanation of Tradition starting  you off and never lets you stop living and enjoying, suffering, and experiencing life for all its moments. (Photos Courtesy, Westchester Broadway Theatre by John Vechiolla)

Set in a little Russian village in 1905 (that could be 2005) portraying the conflict of one generation to the next and the sufferings of all oppressed people,  “Fiddler” so connects with its audience, it made Zero Mostel a star. “Fiddler” musically preserves the struggle of life from a Jewish perspective. The “Fiddler” songs in just the first act still touch every parent’s heart.

To Life!

The Inn scene where Nolte as Teyve and the men of the village sing To Life (L’Chaim) to celebrate Teyve’s  assenting to give his daughter Tzeitel’s hand in marriage to the much-older butcher (Eric Johnson) though Tzeitel has her cap set for the tailor in the village, who does not have the courage to ask Teyve for her hand. Mr. Johnson and Nolte make give joyous meaning to the toast L’chaim. This is easily the happiest number in a show that has all that life has in store, drudgery, joy, hope, achievement, heartbreak, courage, it is all here in Fiddler.

Bill Nolte plays Tevye as Zero Mostel played him, a swaggering,bigger-than-life, everyman character whose masterly performance nobly recalls Mr. Mostel’s master-timing of jokes, deadpans, eyebrow rolls and asides and evokes the sense of bewilderment and pain, ability to muddle and endure the inevitable pain of life.

Guests at the wedding of Tevye’s daughter reflect in Sunrise, Sunset on how daughters (and sons) leave to start lives on their own. There’s Nolte’s whimsical tour de force delivering If I were a Rich Man,  

To set the scene for you: it is 1905 Russia  where Jews are afflicted by a labor movement, strikes and resentment gripping all of Russia that lead to pogroms against Jewish towns and enclaves by the Czar and Nationalist groups. Jewish groups had suffered from the Czar’s May Laws restricting Jews from immigrating to Russia, when Jewish labor groups were blamed for the assassination of Czar Alexander II in 1882.

In May 1882, the Czar introduced temporary regulations called May Laws lasting 30 years until 1917. Policies of discrimination, limits on the number of Jews allowed to obtain education and professions caused widespread poverty and mass emigration. In 1886, Jews were expelled from Kiev. Communities of Jews were removed by Czarist forces and nationalist groups alike. “Fiddler” plays out in this atmosphere of  persecution and ethnic cleansing of that time.

Tzeitel (Rachel Prather, left) starts a trend, with Teyve’s other two daughters, Hodel (Sarah Rolleston)(center) and Chava (Donna Glaus)(right each falling in love with a radical young man and a young man not of the Jewish faith. Here the three sisters sing Matchmaker, Matchmaker in Act One.All three deliver their integral cameo romances with believable pathos and longing — all the emotions love is. 

Tevye convinces his wife,  Golde (played with comic seriousness by Emily Zacharias,left, above) that Grandma Tzeitel came to him in a dream predicting that Tzeitel should marry the tailor.The dream sequence wonderfully lit by Andrew Gmoser, is a farce of husbandly storytelling.  Does Golde buy it? What do you think? Nolte and Zacharias also sing a touching duet in Act II, Do You Love Me? I enjoyed this amusing yet poignant portrayal of mystery of marriage.

The musical presents a history lesson of the faith and traditions of the Jewish people, as Teyve works through his daughter Tzeitel (wanting to marry Motel a poor tailor, and not the butcher that matchmaker Yente (Terry Palasz) has selected for her.  Tzeitel played with earnest, believable longing  by Rachel Prather (left), prevails on him to give his permission. She sings a marvelous, touching ode to young love conquering all with Motel, her tailor, Miracle of Miracles.

 Boza and Prather make a winning couple– Boza as Motel is the picture of the infatuated desperate young man, and Prather the lovestruck, determined spirit of youth fighting tradition. They make a great couple.

Act One concludes with the joyous wedding scene featuring the bottle dance…only to end in chaos, as czarist authorities disrupt the ceremony boding troubles to come – that unfold in the second act.

The second act ends with the uplifting spirit of people everywhere who endure and survive. An outstanding song is song by  Sarah Rolleston’s Hodel. She breaks your heart as she sings of her new life with the young man she has chosen to follow taking her Far From the Home I Love.

A viewer who saw the second night performance told this critic, she felt it was the best production she had ever seen at Westchester Broadway Theatre.

Fiddler plays until November 25, then returns to WBT, January 5. For more information on tickets call (914) 592-2222, or go to www.broadwaytheatre.com.

To Fiddler!