A federal judge has ordered that Visiting Nurse Service of New York, one of the largest nonprofit home health care agencies in the U.S., must face the majority of whistleblower claims brought forth in a healthcare fraud lawsuit against the company.
The healthcare fraud lawsuit was filed by a former employee of the company, who worked as the vice president of operations improvement and integrations for 16 years before leaving in January 2015. The whistleblower employee accused the nonprofit of receiving hundreds of millions of dollars through false and improper billings to Medicare and Medicaid.
Whistleblowers are those individuals who become aware of information that could illustrate fraud or illegal activity and take action to report it to the appropriate authorities without fear of reprisal. They are instrumental in helping the government curb abuse of its programs and to recover money lost to fraudulent schemes.
Individuals with information about healthcare fraud, including Medicare fraud, Medicaid fraud and health insurance fraud, can use the evidence they have about the misconduct to file a whistleblower lawsuit (also known as a qui tam lawsuit) against the offending company.
If the government decides there is enough evidence they may choose to step in and help the whistleblower prosecute the case. Whistleblowers will be rewarded between 15 percent and 25 percent of whatever money the government recovers if they step in and the qui tam lawsuit is successful.
Details Behind the Healthcare Fraud Lawsuit
More than 142,000 patients were served at the Visiting Nurse Service throughout Westchester, Suffolk, and Nassau counties in New York.
The plaintiff in the healthcare fraud lawsuit alleges that doctors for the nonprofit ordered services that were never provided for tens of thousands of impoverished elderly and disabled patients. He further alleged many instances in which patients received improper care for things such as Alzheimer’s, heart disease, diabetes and a kidney transplant, including 14 patients who either did not receive any of the care they were prescribed or only received a small fraction of what they were supposed to get.
U.S. District Judge Alison Nathan ruled September 26 that the whistleblower plaintiff had plausibly alleged that Visiting Nurse Service of New York filed false claims for Medicare and Medicaid payment through several alleged fraudulent schemes, including the ordering of services that were never performed.
Defining Healthcare Fraud
Healthcare fraud is a broad term that applies to misuse and abuse of Medicaid, Medicare, and the Children’s Health Insurance Program. Abuse of these programs decreases the availability of access for those who need it and costs taxpayers money.
The federal government has recently launched investigations to crack down on healthcare fraud, but more often than not it’s a whistleblower who shares information that leads to a successful outcome in a healthcare fraud lawsuit. The law protects whistleblowers who report fraud from being retaliated against in an effort to encourage those with information to come forward.
It’s estimated that fraud against these government programs totals more than $100 billion every single year. In addition to the protections afforded to whistleblowers, someone convicted of healthcare fraud may face both civil and criminal penalties.
The False Claims Act allows whistleblowers to sue on the government’s behalf and share in the proceeds as in this health care fraud lawsuit. Both the New York Attorney General’s Office and the U.S. Department of Justice decline to help the plaintiff in this case.
The Healthcare Fraud Lawsuit is U.S. and State of New York ex rel Lacey v. Visiting Nurse Service of New York, U.S. District Court, Southern District of New York, No. 14-05739.
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