A federal judge in New York refused to toss a whistleblower lawsuit accusing the Visiting Nurse Service of New York of defrauding Medicare and Medicaid by providing substandard service. The company reports that it provides home healthcare to over 140,000 New Yorkers each year. If the allegations of the complaint are true, the company could be forced to pay hundreds of millions of dollars in penalties and lose its license to treat patients.
Ex Visiting Nurse Service VP Files Whistleblower Suit
The hero of this story is Edward Lacey, former Vice President of Operations Improvement. For 16 years Lacey worked his way up through the ranks at the Visiting Nurse Service. His career culminated in two different vice president positions.
In his position as head of Operations Improvement, Lacey was in charge of “development and implementation of strategies to ensure operational best practices and the delivery of standardized and cost effective services throughout the company.”
In his position, Lacey observed widespread fraud. He claims three specific types of fraud schemes by the Visiting Nurse Service of New York.
First, he says the company “engaged in a systematic failure to provide its patients the home care visits and services specifically ordered by their referring physician…” Under Medicare rules, the patient’s doctor specifies the type of home care services needed by the patient and the frequency of treatment. Instead of carrying for their patients as they were paid to do, Lacey says the company “intentionally ignored these plans and provided tens of thousands of its patients only a fraction of the critical care their doctors have ordered while still billing the government.”
In a second scheme, he claims that company nurses and therapists falsified their time records. He says that a review of the billing records show that it was physically impossible for some nurses to see as many patients as they have claimed. One nurse allegedly would have seen a patient every two minutes, 20 seconds in order for her billing to be accurate!
(We often see cases where doctors and health workers claim they worked more hours than there are in a day. For example, a nurse that says she saw 26 patients in a day when each visit was required to be an hour!)
In the final scheme, Edward claims that the Visiting Nurse Service bills for services never provided, bills for services not covered by Medicare or bills for services that don’t meet the government’s quality of care standards.
Medicare Fraud Costs Taxpayers and Endangers Patients
Medicare and Medicaid are funded with tax dollars. When a company rips off Medicare, everyone suffers. Worse, the real victims are the patients. In this case, most of the Visiting Nurse Service’s patients are home bound and elderly. Folks that we consider to be especially vulnerable.
The allegation against the company are especially troubling because it bills itself as the oldest and largest home healthcare company in the nation. Founded in 1893, It is a nonprofit that claims it has a “commitment to home care quality, service and compassion like no other.”
Although it may be the largest home care company, that may also be its problem. The lawsuit says the company takes every patient referred even if doesn’t have the resources to provide the necessary care. Medicare and Medicaid get billed for the service even though those services often aren’t delivered.
Lacey says he complained to the CEO, Mary Ann Christopher, that patients were not receiving quality care. He suggested that the Service cut back on the number of patients accepted. Rather than heed his warnings, Christopher allegedly “screamed for an hour” and upper management dropped F-bombs while demanding that every new patient referral be accepted.
Medicare rules require providers to give written notices to patients if they don’t have the resources to provide proper care. That allows the patient to make other arrangements. It appears, however, that Christopher was more interested in the money than patient health or complying with Medicare rules.
Lacey was able to provide many examples of poor patient care. For example, in one case
Patient [Name Redacted], the patient had a kidney transplant and was diagnosed with having difficulty walking and poor endurance. The patient’s physician ordered in the Plan of Care 22 rehabilitation visits and 35 nursing visits to occur over the April 15, 2014 to June 3, 2014 60-day episode of care period. However, VNSNY provided 0 rehabilitation visits and 6 nursing visits during this period, amounting to only 11 percent of the prescribed visits. Nevertheless, VNSNY billed for [the care as if delivered].
In many cases, the patients received NO CARE!
After the lawsuit was filed, Visiting Nurse Service of New York asked the court to dismiss the case. The company says the violations are not “material.” The company called Lacey “a disgruntled former employee with no responsibility for and little knowledge of the clinical realities of our business who has spun a tale out of whole cloth. The court didn’t agree. On September 26th, U.S. District Court Judge Alison Nathan denied the company’s motion. That means Lacey’s whistleblower lawsuit can proceed.
Medicare Fraud, Whistleblower Awards and Home Health Care
Home healthcare has one of the highest incident rates of Medicare fraud. That is especially worrisome because the patients are typically quite vulnerable and dependent on their care givers.
If you have inside information about one of these schemes, you could receive an award of between 15% and 30% of whatever the government collects from the wrongdoers. We have prosecuted cases in which whistleblowers have received tens of millions of dollars.
Visiting Nurses / Home Healthcare Whistleblowers Needed
We are actively seeking visiting nurses and home healthcare workers with inside information about Medicare fraud and false billing schemes. Federal and state laws not only offer generous whistleblower awards, the law also protects whistleblowers from retaliation. Of course, the primary reason to blow the whistle is to protect patients! Contact us today for a confidential evaluation of your case.