United States v. RiverSpring Living Holding Corp.; ElderServe Health, Inc., d/b/a RiverSpring at Home; RiverSpring Health Holding Corp.; RiverSpring Health Senior Living, Inc., d/b/a Hebrew Home at Riverdale; The Hebrew Home for the Aged at Riverdale; RiverSpring Licensed Home Care Services Agency, Inc., et al., Southern District of New York (May 23, 2024) — Complaint

DAMIAN WILLIAMS 
United States Attorney for the 
Southern District of New York 
By:   SAMUEL DOLINGER 
 JACOB M. BERGMAN 
Assistant United States Attorneys 
86 Chambers Street, 3rd Floor 
New York, New York 10007 
Tel.: (212) 637-2677/2766 
[email protected] 
[email protected] 
 
UNITED STATES DISTRICT COURT 
SOUTHERN DISTRICT OF NEW YORK 
 
UNITED STATES OF AMERICA ex rel. 
JANE DOE and THE STATE OF NEW YORK 
ex rel. JANE DOE, 
Plaintiffs, 
 
-v-   
 
RIVERSPRING HEALTH HOLDING CORP.; 
ELDERSERVE HEALTH, INC., d/b/a 
RiverSpring at Home; RIVERSPRING 
HEALTH SENIOR LIVING, INC., d/b/a 
Hebrew Home at Riverdale; THE HEBREW 
HOME FOR THE AGED AT RIVERDALE; 
RIVERSPRING LICENSED HOME CARE 
SERVICES AGENCY, INC.; and 
RIVERSPRING SERVICES CORP., 
Defendants. 
  
 
 
 
 
 
 
 
 
 
17 Civ. 636 (PKC) 
 
 
COMPLAINT-IN-INTERVENTION 
OF THE UNITED STATES 
 
JURY TRIAL DEMANDED 
UNITED STATES OF AMERICA, 
 
Plaintiff-Intervenor,
   
-v-   
 
RIVERSPRING LIVING HOLDING CORP. 
and ELDERSERVE HEALTH, INC., d/b/a 
RIVERSPRING AT HOME,  
 
Defendants. 
  
 
 
 
 
 
 

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Plaintiff the United States of America (the “United States” or “Government”), by its 
attorney, Damian Williams, the United States Attorney for the Southern District of New York, 
alleges for its Complaint-in-Intervention as follows:  
PRELIMINARY STATEMENT 
1. The United States brings this Complaint-in-Intervention seeking damages and 
penalties against RiverSpring Living Holding Corp. and ElderServe Health, Inc., d/b/a 
RiverSpring at Home (“Defendants” or “RiverSpring”) under the False Claims Act, 31 U.S.C. 
§ 3729 et seq., and the common law for unjust enrichment. As set forth more fully below, from 
January 1, 2012, through December 31, 2017, RiverSpring submitted or caused to be submitted 
false claims to Medicaid for monthly capitation payments for months during which Defendants 
did not provide community-based long-term care services to RiverSpring Managed Long-Term 
Care Plan members as required by the applicable contract between RiverSpring and the New 
York State Department of Health (“DOH”), or did not adequately maintain documentation of the 
provision of services to plan members.  
JURISDICTION AND VENUE 
2. This Court has jurisdiction over the claims brought under the False Claims Act 
pursuant to 31 U.S.C. § 3730(a) and 28 U.S.C. §§ 1331, 1345, and over the Government’s 
common law claim pursuant to 28 U.S.C. § 1345. 
3. This Court may exercise personal jurisdiction over Defendants pursuant to 
31 U.S.C. § 3732(a), which provides for nationwide service of process. Moreover, Defendants 
are New York not-for-profit corporations that transact business in this district. 

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4. Venue is appropriate in this district pursuant to 31 U.S.C. § 3732(a) and 28 U.S.C. 
§ 1391(b) and (c) because a substantial part of the events or omissions giving rise to the claims 
occurred in this district, and Defendants maintain offices in this district. 
PARTIES 
5. Plaintiff is the United States of America and is suing on its own behalf and on 
behalf of the United States Department of Health and Human Services, and its component 
agency, the Centers for Medicare and Medicaid Services. 
6. Defendant RiverSpring Living Holding Corp. is a New York not-for-profit 
corporation with a principal place of business in Bronx, New York. RiverSpring Living Holding 
Corp. is organized to provide administrative support to The Hebrew Home for the Aged at 
Riverdale and affiliated tax-exempt organizations pursuing related charitable missions. 
7. Defendant ElderServe Health, Inc., d/b/a RiverSpring at Home, is a New York 
not-for-profit corporation that administers a Managed Long Term Care Plan (the “RiverSpring 
MLTCP”) for Medicaid beneficiaries under which it arranges for health and long-term care 
services on a capitated basis pursuant to a Managed Long Term Care Partial Capitation Model 
Contract, as has been amended and restated from time to time (the “MLTC Contract”), with the 
DOH. 
8. Relator Galina Sidanov (“Relator”) is a healthcare compliance professional who 
conducted certain compliance audits of the RiverSpring MLTCP as a contractor.  In January 
2017, Relator filed an action pursuant to the False Claims Act alleging, among other things, that 
Defendants violated the False Claims Act by failing to disenroll patients from the RiverSpring 
MLTCP when they ceased to qualify for managed long-term care services, and failing to provide 

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certain required services to a number of patients enrolled in the RiverSpring MLTCP, but 
continuing to collect capitation payments for those patients. 
RELEVANT BACKGROUND 
I. The False Claims Act 
9. The False Claims Act establishes treble damages liability to the United States for 
an individual who, or entity that, “knowingly presents, or causes to be presented, a false or 
fraudulent claim for payment or approval,” 31 U.S.C. § 3729(a)(1)(A); or “knowingly makes, 
uses, or causes to be made or used, a false record or statement material to a false or fraudulent 
claim,” 31 U.S.C. § 3729(a)(1)(B).  
10. “Knowingly” is defined to include actual knowledge, reckless disregard and 
deliberate ignorance. 31 U.S.C. § 3729(b)(1). No proof of specific intent to defraud is required. 
Id.  
11. In addition to treble damages, the False Claims Act also provides for assessment 
of a civil penalty for each violation or each false claim.  
II. Medicaid and the Medicaid Managed Long-Term Care Program  
12. Pursuant to the provisions of Title XIX of the Social Security Act, 42 U.S.C. 
§ 1396 et seq., the Medicaid program was established in 1965 as a joint federal and state 
program created to provide financial assistance to individuals with low incomes to enable them 
to receive medical care. Under Medicaid, each state establishes its own eligibility standards, 
benefit packages, payment rates, and program administration in accordance with certain federal 
statutory and regulatory requirements. The state directly pays the health care plans or providers 
for services rendered to Medicaid recipients, with the state obtaining the federal share of the 
Medicaid payment from accounts that draw on the United States Treasury. See 42 C.F.R. § 430.0 
et seq. 

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13. In New York, Medicaid is administered at the state level by DOH. See N.Y. Pub. 
Health Law § 201(1)(v). 
14. New York Medicaid regulations require plans and providers to “submit claims for 
payment only for services actually furnished and which were medically necessary or otherwise 
authorized under the Social Services Law when furnished and which were provided to eligible 
persons.” 18 N.Y.C.R.R. § 504.3(e). 
15. Medicaid recipients in New York enroll in managed care plans administered by 
Managed Care Organizations that provide medical care and other services. Pursuant to Title 
XIX, Section 1932 of the Social Security Act, New York established a Medicaid managed long-
term care program. Managed Care Organizations operate Managed Long-Term Care Plans 
(“MLTCPs”), like the RiverSpring MLTCP, and receive monthly capitation payments from 
Medicaid for each member enrolled in the MLTCP in exchange for arranging and providing 
community-based long-term care services, such as care management, skilled nursing services, 
physical therapy, speech therapy, occupational therapy, and preventive services. During the 
Relevant Period, the average monthly capitation payment for relevant RiverSpring MLTCP 
members was between $4,000 and $4,500. 
16. The requirements for an MLTCP are set forth in the MLTC Contract. RiverSpring 
entered into MLTC Contracts with DOH. 
17. Among other requirements, to be eligible for managed long-term care, a Medicaid 
beneficiary must be assessed as needing at least one of the community-based long-term care 
services listed in Article IV, section B, subsection 6 of the MLTC Contract (“Qualifying 
Services”) in effect at the time, for more than 120 days from the effective date of enrollment.  

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18. Qualifying Services include, but are not limited to, nursing services in the home, 
therapies in the home, home health aide services, personal care services in the home, and adult 
day health care. See 2017 Model MLTC Contract Art. IV(b)(6). 
FACTUAL ALLEGATIONS 
19. In order to receive capitation payments from Medicaid for members of the 
RiverSpring MLTCP, RiverSpring was required to ensure that RiverSpring MLTCP members 
received Qualifying Services during their enrollment or otherwise remained appropriately 
enrolled in the RiverSpring MLTCP consistent with the MLTC Contract and DOH disenrollment 
practices. 
20. During the period from January 1, 2012, through December 31, 2017, Defendants 
improperly collected monthly capitation payments for RiverSpring MLTCP members who did 
not receive Qualifying Services during the relevant months, or for whom RiverSpring did not 
adequately maintain documentation of the provision of such Qualifying Services. 
21. In particular, in many instances during the Relevant Period, Defendants collected 
capitation payments for RiverSpring MLTCP members despite the fact that RiverSpring either 
did not provide, or did not adequately maintain documentation reflecting the provision of, 
Qualifying Services to these members for three or more consecutive months during their 
enrollment in the RiverSpring MLTCP. 
22. For example, RiverSpring obtained monthly capitation payments for Member A, a 
Medicaid beneficiary who was enrolled in the RiverSpring MLTCP between January 2012 and 
August 2014. However, RiverSpring did not provide Qualifying Services to Member A , or did 
not adequately maintain documentation reflecting the provision of Qualifying Services to 
Member A , during periods of more than three consecutive months between February 2012 and 

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June 2012, and between January 2014 and June 2014. RiverSpring wrongfully obtained more 
than $43,000 as a result of its receipt of capitation payments for Member A during these periods. 
23. In certain additional instances during the Relevant Period, Defendants collected 
capitation payments for RiverSpring MLTCP members despite the fact that RiverSpring either 
did not provide, or did not adequately maintain documentation reflecting the provision of, 
Qualifying Services to these members during the entirety of their enrollment in the RiverSpring 
MLTCP. 
24. For example, RiverSpring obtained monthly capitation payments for Member B, a 
Medicaid beneficiary enrolled in the RiverSpring MLTCP, between July 2013 and August 2014. 
However, RiverSpring did not provide Qualifying Services to Member B, or did not adequately 
maintain documentation reflecting the provision of Qualifying Services to Member B, during 
that period. RiverSpring wrongfully obtained more than $53,000 as a result of its receipt of 
capitation payments for Member B during this period. 
FIRST CLAIM 
Violations of the False Claims Act:  
Presenting False Claims for Payment 
31 U.S.C. § 3729(a)(1)(A)  
 
25. The United States incorporates by reference each of the preceding paragraphs as if 
fully set forth in this paragraph. 
26. The United States seeks relief against Defendants under 31 U.S.C. 
§ 3729(a)(1)(A). 
27. As set forth above, Defendants knowingly, or acting with deliberate ignorance or 
reckless disregard for the truth, presented, or caused to be presented, false or fraudulent claims to 
Medicaid for capitation payments for RiverSpring MLTCP members who did not receive 

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Qualifying Services, or as to whom Defendants did not adequately maintain documentation of 
the provision of Qualifying Services, during relevant months between January 1, 2012, and 
December 31, 2017. 
28. The Government made capitation payments to RiverSpring under the Medicaid 
program because of the false or fraudulent claims. 
29. By reason of the false or fraudulent claims, the United States suffered damages 
and therefore is entitled to treble damages under the False Claims Act, to be determined at trial, 
and a civil penalty as required by law for each violation. 
SECOND CLAIM  
Unjust Enrichment 
 
30. The United States incorporates by reference each of the preceding paragraphs as if 
fully set forth in this paragraph. 
31. Through the acts set forth above, Defendants have received managed long-term 
care monthly capitation payments to which they were not entitled and therefore were unjustly 
enriched. The circumstances of these payments are such that, in equity and good conscience, 
Defendants should not retain those payments, the amount of which is to be determined at trial. 
WHEREFORE, the United States respectfully requests that judgment be entered in its 
favor and against Defendants as follows:  
a. On the First Claim (False Claims Act violation), for a sum equal to treble 
damages and civil penalties to the maximum amount allowed by law; 
b. On the Second Claim (Unjust Enrichment), for a sum equal to the damages to be 
determined at trial, along with costs and interest; and 
c. Granting the United States such further relief as the Court may deem proper. 

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Dated:  May 20, 2024 
 New York, New York 
 
DAMIAN WILLIAMS 
United States Attorney for the 
Southern District of New York 
 
By:   /s/ Samuel Dolinger     
SAMUEL DOLINGER 
JACOB M. BERGMAN 
Assistant United States Attorneys 
86 Chambers Street, 3rd Floor 
New York, New York 10007 
Tel.: (212) 637-2677/2766 
[email protected] 
[email protected]