Visiting Nurse Services to pay $35M in Medicaid fraud suit | Capital New York

ALBANY—Visiting Nurse Services, the nation’s largest nonprofit home-health care company, will pay $35 million to the federal Medicaid program to settle a civil suit alleging it enrolled more than 1,700 people into Medicaid plans who were ineligible.The lawsuit, filed by the U.S. Attorney’s Office, claimed V.N.S. enrolled 1,740 people in its Medicaid-managed long-term care plans who didn’t qualify. The people were “improperly referred” for enrollment in the plans by social adult day care centers, which contracted with V.N.S. to receive payments for providing health care services to the same beneficiaries, the settlement said.“V.N.S. collected millions of dollars in Medicaid payments by enrolling ineligible persons into its managed care plan who clearly did not meet the criteria for long-term care,” U.S. Attorney Preet Bharara said in a statement. “The company developed a network of social adult day care centers that were ill-equipped to provide the required level of care and instead served merely as a conduit to induce Medicaid beneficiaries to enroll.”The company receives a $3,800 payment for each person enrolled in one of its managed long-term care plans, but to qualify, beneficiaries must require a nursing home level of care and at least 120 days of long term care services.

via Visiting Nurse Services to pay $35M in Medicaid fraud suit | Capital New York.

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