For individuals in need of long-term care (i.e., a permanent stay in a nursing home), the options are to either self-fund the monthly charge or to apply for Medicaid benefits. As Medicare does not cover long-term care, patients in need of this vital service must be eligible by showing financial hardship and a lack of personal assets. Once eligibility is established, Medicaid will generally cover the costs of long-term care so long as the patient is in need of such skilled nursing services. Similarly, Medicaid may also cover the costs of in-home care in the event the patient is considered homebound and suffering from a severe medical condition wherein a visiting nurse is necessary.
In a recent settlement out of New York, several nursing care companies have agreed to pay $34 million to settle startling allegations of sub-standard care and enrollment of ineligible patients. As we have discussed in the past, the False Claims Act is triggered any time intentional fraud occurs with regard to a patient enrolled in federal healthcare programs, including Medicare, Medicaid, and the military’s TRICARE.
Details of the case against Visiting Nursing Service
Visiting Nurse Service (VNS) is one of the nation’s largest non-profit home healthcare organizations, and operates in the state of New York providing skilled nursing care, physical therapy, stroke care, palliative care, senior support, and grief support services. According to the allegations, over 1,740 of the patients enrolled in services with VNS were ineligible for coverage under applicable Medicaid laws. More specifically, VNS had enrolled these individuals in a skilled nursing managed care plan – which is reimbursable at $3,800 per patient per month – despite the fact the patients were not suffering from medical conditions severe enough to warrant the need for long-term care. In fact, VNS had set up a network of “social adult day care centers” where patients were kept and Medicaid payments were sent.
Under the terms and conditions of long-term care enrollment, patients receiving Medicaid coverage are to be provided a wide range of care services, including personal care and a thorough medical care plan. None of this was occurring for the patients attending the adult day care centers, yet VNS collected $3,800 per month on behalf of each of these patients nonetheless.
Comments from the government
U.S. Attorney Preet Bharara commented on the matter involving VNS, remarking, “VNS 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. 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.”
Likewise, a Health and Human Services special agent commented, “VNS’s conduct compromised the integrity of the Medicaid program. HHS-OIG is committed to holding providers accountable for the quality of care they deliver and the manner in which that care is provided.”
Contact Berger Montague today
If you are aware of healthcare fraud or sub-standard care provided to patients receiving Medicaid, please contact our office right away. You may not only be able to prevent this costly and wasteful misconduct, but could help save patients from dangerous and life-threatening neglect.