RiverSpring at Home paid $10.1 million to resolve False Claims Act allegations that it received Medicaid capitation payments for long-term care services it failed to provide or adequately document for plan members.

RiverSpring at Home (New York) — Managed Long-Term Care Plan Capitation Fraud (2024)

Outcome: RiverSpring Living Holding Corp. and ElderServe Health, Inc. d/b/a RiverSpring at Home paid $10.1 million to resolve allegations they improperly received Medicaid capitation payments for home and community-based long-term care services that were not delivered or not adequately documented.

RiverSpring at Home operated as a Managed Long-Term Care Plan (MLTCP) in New York, enrolled in the state's Medicaid program. MLTCPs receive fixed monthly capitation payments per enrollee from Medicaid to provide an array of health and long-term care services. RiverSpring allegedly "failed to provide required services, or failed to adequately document the provision of services, to members" — yet continued collecting capitation payments as though full services had been rendered.

The failure to deliver or document services while billing capitation rates constitutes a False Claims Act violation. The $10.1 million settlement was announced May 23, 2024 by the U.S. Attorney's Office. Managed long-term care plans are required to document all services provided to members as a condition of Medicaid participation.

Primary Source: OIG Enforcement Record