Home Health Agency must face whistleblower suit citing massive Medicare and Medicaid fraud

 

 

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The Visiting Nurse Service of New York,, which says it is the largest U.S. nonprofit home health care agency, will face  a whistleblower lawsuit accusing it of defrauding Medicare and Medicaid and failing to provide patients with care prescribed by doctors. U.S. District Judge Alison Nathan in Manhattan said the plaintiff whistleblower Edward Lacey properly  alleged that the nonprofit filed false payment claims based on several alleged fraudulent schemes, violating the federal and state False Claims Acts.

Lacey had been a Visiting Nurse Service vice president of operations improvement and integration and worked there for 16 years before leaving in January 2015.The company said it served 142,057 patients last year in New York City, Nassau, Suffolk and Westchester counties.

He says his former employer of fraudulently  billed and received hundreds of millions of dollars from Medicare and Medicaid through false and improper billings, including services that doctors ordered but which it never provided for tens of thousands of “elderly, disabled and impoverished” patients. Lacey detailed many instances of alleged improper care, including for 14 patients with such conditions as Alzheimer’s disease, coronary disease, diabetes and a kidney transplant who received only small fractions or none of the care they were prescribed.

Lacey “successfully alleged that VNSNY’s misrepresentations that it both intended to follow and did ultimately follow patients’ plans of care were material to CMS’s decision to pay its claims,” Nathan wrote, referring to the federal government’s Center for Medicare and Medicaid Services. False Claims Act cases let whistleblowers sue on a government’s behalf and share in proceeds and receive up to 30% of what the government recovers in the case.   

Jeffrey Newman represents whistleblowers nation wide and represented the two whistleblowers in the case of United States ex. rel. Janet Halpin and Shawn Fahey v. RehabCare Inc. and Kindred HealthCare Inc. which settled for $125 million in 2016.