County to ask feds to review ‘severe’ Medicare billing issues at metro-east nursing home

2/13/26 Update: This article has been updated with information about when the case would be referred to the U.S. Attorney’s Office.

Monroe County leaders will ask the U.S. attorney’s office to review “severe billing irregularities” found during an investigation of Medicare payments at the Oak Hill Senior Living and Rehabilitation Center the county previously operated in Waterloo.

A spokesperson from the U.S. attorney’s office declined to comment Friday.

Monroe County transferred operations of the nursing home to Accolade Healthcare on Dec. 1.

Monroe County has proposed paying Medicare $354,606 to settle the billing issue with the federal government, according to county records.

County Board Chairman George Green said Friday the county will forward documents related to the Medicare billing investigation to the U.S. Attorney’s Office after Medicare confirms receipt of the county’s proposal to settle the issue.

Green declined to discuss details of any disciplinary action taken regarding the Medicare billing issue. He also said the audit of the nursing home’s records was not available to be released because it was still was under an attorney/client review.

After receiving a tip about “allegations of Medicare billing irregularities” at the nursing home in February 2023, the county began an investigation.

“An internal review into the whistleblower allegations quickly revealed evidence of significant problems, prompting the County Board to order a seven-year forensic audit of medical billing records,” according to a news release from the Monroe County Board of Commissioners states.

Armanino LLP reviewed records from 2016 to 2022 and was paid about $266,000.

“The forensic audit revealed a pattern of severe billing irregularities, dating back to 2016,” the news release states.

The audit’s findings include:

• “Misappropriation of excess Medicare payments: Auditors noted that the medical biller improperly moved hundreds of thousands of dollars in excess Medicare payments between resident accounts.”
• “Manipulation of billing software: Auditors observed unusual and unexpected billing and payment entries in the billing software to allow for excess payments to be moved between resident accounts.”
• “False reporting: Inaccurate quarterly reports were filed with Medicare, falsely stating that no excess payments had been received by the nursing home.”
• “Missing records: Auditors observed several ‘blank records’ entries in the billing software that had no supporting documentation.”

In light of the audit findings and the discovery of “serious compliance issues,” the county decided last year to find a private operator of the nursing home, the news release states.

The change was made in part because county real estate taxes would have had to be increased if the county kept operating the nursing home at 623 Hamacher St., according to the release.

This story was originally published February 13, 2026 at 12:41 PM.