Pursuant to the Amended Settlement Agreement filed on June 25. 2020 in federal case number 1:14-cv-05739-AJN, the Visiting Nurse Service of New York (“VNSNY”) has agreed to pay the total sum of $57,000,000 to resolve the following allegations that cover the period from January 1, 2004 through June 25, 2020:
VNSNY accepted patients when it did not have the capacity or ability, or without regard to whether it had the capacity or ability (i) to start nursing or therapy care on the date specified by the patients’ referring or treating physician, or within the period of time required by law, regulation, or otherwise; (ii) to provide the number of visits and services for nursing and therapy ordered in patients’ Plans of Care, or (iii) to provide nursing and therapy visits and services in accordance with patients’ Plans of Care. Relator further claims that VNSNY did not disclose its incapacity or inability timely to start care or to follow the number and type of visits and services ordered in patients’ Plans of Care to the referring or treating physicians, to hospitals and referral sources, to patients, or to the government;
VNSNY submitted Requests for Anticipated Payment to the government seeking payment without disclosing to the government that VNSNY (i) did not intend to or did not have the capacity or ability to provide the number of visits and services ordered in patients’ Plans of Care; or (ii) did not intend to or did not have the capacity or ability to provide the visits and services in accordance with the Plans of Care;
VNSNY did not provide the number of nursing or therapy visits and services prescribed in its patients’ Plans of Care; did not provide nursing or therapy visits and services in accordance with patients’ Plans of Care; or did not disclose its failures to follow the Plan of Care to the government;
VNSNY did not follow the Plan of Care or otherwise deviated from or made changes to its patients’ Plans of Care, VNSNY did not notify or obtain approval from the patients’ treating or referring physicians; did not comply with regulations relating to modifications to patients’ Plans of Care; or did not document physician notification or approval of Plan of Care modification or noncompliance;
VNSNY and its nursing or therapy clinicians created, retained, or submitted to the government inaccurate records relating to the number of visits delivered by nursing and therapy clinicians, the length of visits delivered to patients (i.e., patient service time) delivered by nursing and therapy clinicians, or the type or quantity of services delivered to patients during visits;
VNSNY created inaccurate patient service records for home health aide personal care and custodial care visits. Relator contends that VNSNY used inaccurate codes for services provided by home health aides to obtain payment for noncovered services. Relator further claims that VNSNY improperly billed Medicaid for home health services to dually-eligible patients;
VNSNY failed to comply with home health aide supervision requirements by failing to have nurses or therapists accompany home health aides to their field visits as required by Medicare and Medicaid.
As a result of the above alleged conduct, the Relator alleges that VNSNY knowingly submitted or caused the submission of false or fraudulent claims to Medicare and New York State Medicaid in violation of the False Claims Act and New York False Claims Act.
Under 31 U.S.C. § 3730(d) and N.Y. Fin. Law § 190(6), the Relator is entitled to receive between 25 and 30 percent of the proceeds of the Relator’s Action, and to Relator’s reasonable expenses, attorneys’ fees, and costs in bringing and litigating the Relator’s Action.
The Amended Settlement Agreement states that VNSNY does not admit to the allegations stated above or liability for same.
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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