A whistle-blower is suing Visiting Nurse Service of New York, alleging the giant home healthcare agency fraudulently charges the government for services it doesn't perform. It's the second Medicaid fraud suit against the agency in as many years.
A former executive at Visiting Nurse Service filed a lawsuit against the not-for-profit organization under claims it consistently bills Medicare and Medicaid for treatment but doesn't provide the services. The suit alleges the charges have led to millions of dollars in illegal revenue for Visiting Nurse Service.
The complaint was filed in 2014 by Edward Lacey, who was formerly vice president of operations improvement and integration at Visiting Nurse Service. He was with the organization for 16 years before he left in January 2015.
The suit was originally sealed when filed, but it was recently opened to the public after state and federal agencies conducted an investigation, the New York Times reported. The state and federal government declined to join the case but can do so later.
Lacey and his attorneys at the law firm Constantine Cannon have declined to comment on the case.
In a prepared statement, Visiting Nurse Service spokesman Richard Rothstein said, the agency “is proud of the quality and integrity of its nursing and home health services. We will defend this case vigorously and we are confident that we will prevail.” He added that Lacey is a “disgruntled former employee with little knowledge and no responsibility for the clinical realities of our business.”
The lawsuit claims that since at least 2004, Visiting Nurse Service consistently ignores the care plans from referred physicians for patients and instead provides only some of the care paid for by the CMS. A large number of nurses and therapists falsify time spent with patients to see more patients in a day so the agency can increase reimbursement, according to the complaint.
Lacey alleges Visiting Nurse Service is severely understaffed and has a mandatory policy to accept all referrals. Former CEO Mary Ann Christopher strictly imposed the policy, Lacey alleges, citing meetings with executives while he was employed there.
A report from April 2014 included in the complaint found the agency had approximately 5,000 patients referred for rehabilitation services, but the Visiting Nurse Service didn't provide prescribed physical, occupational and speech therapy services for 2,574 of those patients.
“The ultimate victims here are the tens of thousands of elderly, disabled and impoverished New York residents who because of (Visiting Nurse Service's) misconduct have not been getting the critical home health care services they require,” the lawsuit states. The majority of the agency's patients are Medicare and Medicaid beneficiaries.
The lawsuit also details several instances when patients with chronic conditions were not given prescribed rehabilitation services prescribed. In one example, a patient with diabetes, hypertension and obesity was ordered by a physician to have 38 rehabilitation visits and 14 nurse visits in a 60-day period. The agency provided only three rehabilitation visits and two nurse visits during the time period.
This isn't Visiting Nurse Service's first Medicaid fraud suit. The agency paid $35 million in November 2014 after the U.S. attorney's office found it enrolled 1,740 unqualified people in Medicaid care plans.
Visiting Nurse Service provides services to 150,000 patients per year in New York's five boroughs and several counties upstate. It employs about 20,000 and revenue exceeds $2 billion, according to the lawsuit.