Visiting Nurse Service of New York, which claims to be the largest nonprofit home health agency in the U.S., will have to face a False Claims Act lawsuit, a federal judge has ruled. The company is accused of defrauding Medicare and Medicaid and also of failing to provide the care prescribed by patients' doctors.
The lawsuit claims that Visiting Nurse Service filed false claims for payment and engaged in several other fraudulent schemes in violation of the federal and New York False Claims Acts. The suit was brought by a highly placed whistleblower -- the former vice president of operations for the service. He worked for the nonprofit for 16 years before leaving in January 2015.
The former VP accused the service of using false and improper billings to defraud Medicare and Medicaid, and that some of those improper billings were in regards to prescribed services that were never provided. The services were intended for tens of thousands of patients, most of them elderly or disabled and many of them impoverished.
Visiting Nurse Service says that it served 142,057 patients last year. It serves New York City and Westchester, Nassau and Suffolk counties.
The federal judge did dismiss parts of the lawsuit, some based on the statute of limitations having passed. However, he found that the former VP credibly detailed a number of instances in which patients -- some with Alzheimer's disease, diabetes and heart disease -- received only some of the care they were prescribed, or none at all.
As was required for the case to continue, the former VP alleged successfully that the Visiting Nurse Service made misrepresentations that it intended to, and ultimately did, follow the patients' plans of care. If it had not made such misrepresentations, the Center for Medicare and Medicaid Services would not have paid the claims.
The Justice Department and the New York Attorney General's Office both declined to take over the suit, but that does not bar a private lawsuit from moving forward.
Both the New York and federal False Claims Acts allow plaintiffs to sue organizations on the government's behalf when they make false or fraudulent claims that cost the government money. If successful, the plaintiff takes a share of whatever money is recovered.
If you work with government contracts and notice a false or fraudulent claim against the government, contact an attorney experienced in False Claims Act litigation before taking any steps on your own.