New York State Department of Health Terminates Soundview from Medicaid Program
ALBANY, N.Y. (August 10, 2011) -- The New York State Department of Health today terminated the Comprehensive Community Development Corporation, also known as Soundview, from the Medicaid program effective September 12, 2011. After that date, the Corporation will not be eligible for reimbursement for services rendered to Medicaid recipients.
In a letter to the Constance Bruno, Chairman of the Board, the Department cited that the Corporation failed to have a Compliance Plan as required by state statute and regulation. Compliance Plans are designed to ensure that Medicaid dollars are properly accounted for and that systems are in place to ensure that all claims for funding are valid.
The letter also noted that the Corporation's Medicaid service delivery is managed by two individuals who were excluded from participation in the New York State Medicaid program earlier this year by the Office of the Medicaid Inspector General. These individuals are Pedro Espada, Director of Environmental Care; and Pedro Espada, Jr., President and Chief Executive Officer.
The Department's actions were taken following release today by the Office of the Medicaid Inspector General of a notice of proposed agency action recommending that New York State exclude Soundview from the Medicaid program. The OMIG's notice is based on significant failures in the Corporation's business operations and lack of controls to ensure compliance with state and federal billing and operational requirements.
The state DOH will be working to ensure that all Medicaid patients that currently receive care at Soundview clinics will have access to medical care that they need and that all records will be transferred appropriately. The Corporation will continue to be able to care for patients through Medicare or private insurance.
A copy of the letter is below.
August 10, 2011
Miss Constance Bruno, Chairman
Board of Directors
Comprehensive Community Development Corp.
d/b/a/ Soundview Health Care Network
731 White Plains Road
Bronx, New York 10473
NOTICE OF TERMINATION
Provider ID # 00665274
THE NEW YORK STATE DEPARTMENT OF HEALTH (DOH) IS DISCONTINUING YOUR PARTICIPATION IN THE MEDICAID PROGRAM.
The DOH has determined that the best interest of the Medicaid Program would be served by discontinuing your participation as Medicaid Provider. Therefore, we are exercising our option under 18 NYCRR 504.7(a) to discontinue our relationship with you.
Effective September 12, 2011, your participation will cease. You will not be eligible for reimbursement for services rendered to Medicaid recipients as of that date, and you will be prohibited from verifying the eligibility of Medicaid recipients through the Medicaid Eligibility Verification System (MEVS).
If you have questions regarding this action, please contact this office at (518) 474-8161.
Division of Provider Relations and Utilization Management
NEW YORK STATE DEPARTMENT OF HEALTH
DIVISION OF PROVIDER RELATIONS AND UTILIZATION MANAGEMENT
COMPREHENSIVE COMMUNITY DEVELOPMENT CORPORATION D/B/A SOUNDVIEW HEALTH CARE NETWORK
Provider NUMBER # 00665274
SUMMARY OF FACTORS:
- The Division of Provider Relations and Utilization Management determined that you do not have a compliance program that meets statutory and regulatory requirements of the Social Services Law Section 363-d and Title 18 NYCRR Part 521.
- The Division of Provider Relations and Utilization Management determined that your Medicaid service delivery is managed by two individuals who are excluded from participation in the New York State Medicaid program: Pedro G. Espada, Director of Environmental Care; Pedro Espada, Jr., President and Chief Executive Officer.