The Visiting Nurse Service of New York (VNSNY) announced over the summer it would agree to pay $57 million to settle a whistleblower claim filed by a former executive in 2014.
The agreement brought to an end a years-long legal battle and put a spotlight on some home health industry practices that may be dangerous and/or fraudulent.
The suit was originally filed under state and federal statutes of the False Claims Act by Edward Lacey, who had a 16-year tenure as an executive at VNSNY. In his complaint, he claims the organization did not provide patients with all of the services ordered as part of their care plans. He also alleges the organization billed Medicare and Medicaid for services not rendered under an “accept all referrals” policy.
The $57 million payout is the largest non-kickback FCA settlement in history for a home health company, and the second-largest home health fraud settlement of all time. It is also the first case officials are aware of that directly focuses on failure to follow a physician’s care plan.
Billing for services not rendered is one of the more common types of healthcare fraud, and often is only discovered due to the reports of whistleblowers with insider knowledge. Various forms of healthcare fraud add up to billions of dollars in losses every single year, a burden put on the American taxpayer.
If you work in the healthcare industry and have any inside knowledge of fraud or other forms of wrongdoing, it is important you take immediate, appropriate action to bring the scheme to a halt and file a proper report. For more information about how to proceed, contact an experienced lawyer at Kardell Law Group.