Largest non profit visiting nurse org sued for defrauding Medicare and Medicaid of hundreds of millions

 

A 16 year veteran manager of The Visiting Nurse Service of New York has filed a whistleblower suit against the non-profit agency for defrauding Medicare and Medicaid of hundreds of millions of dollars over the years through fraudulent invoices and other practices. The lawsuit, reported by the New York Times charges that for financial gain, the company “intentionally ignored” the plans of care prescribed by physicians and provided only  a small portion of the nursing and rehabilitation visits that had been ordered under Medicare, which pays a set rate for an “episode of care.”

These actions, says the lawsuit, jeopardized the physical welfare of the patients.

It said one patient with lupus  who had undergone a lower-limb amputation and used a wheelchair had been  ordered 27 rehabilitation visits and 38 nursing visits to be made over a 60-day period. The agency provided no rehabilitation visits and only five nursing visits during the two-month period However  it collected a full $3,537 in government reimbursement, the lawsuit says.

A second type of fraud alleged  is the falsification of time and service records by hundreds of agency nurses and therapists.

The third type of fraud described involves billing for home health aides . The lawsuit charges that the Visiting Nurse Service has routinely billed the government for home aide services that were not provided or properly supervised, and that it routinely double-bills when patients are eligible for both Medicare and Medicaid.

For more detailed information read: http://www.nytimes.com/2016/09/24/nyregion/whistle-blower-suit-accuses-visiting-nurse-service-of-fraud.html

Jeffrey Newman represents whistleblowers but not in this case