NYC Gazette

Damian Williams, the United States Attorney for the Southern District of New York, and Naomi Gruchacz, the Special Agent in Charge of the New York Regional Office of the Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced today that the United States has settled a civil fraud lawsuit against Visiting Nurse Service of New York d/b/a VNS Health, Visiting Nurse Service of New York Home Care II d/b/a Visiting Nurse Service of New York Home Care, and VNS Health Behavioral Health, Inc. (collectively, “VNS”).

VNS operates one of the largest non-profit home and community-based health care organizations in the U.S. It is licensed by the New York State Office of Mental Health (OMH) to serve as an Assertive Community Treatment (ACT) Program provider. The settlement resolves claims that VNS violated the False Claims Act by fraudulently billing Medicaid for services it either failed to provide or document to persons with serious mental illness at its ACT Program in Far Rockaway, Queens.

Specifically, from January 1, 2014 through December 31, 2018, VNS submitted or caused to be submitted false claims to Medicaid for monthly payments for 103 patients at its Far Rockaway ACT Program who did not receive the full array of required services or for whom VNS did not adequately document provision of such services.

Under the settlement approved June 25, 2024 by U.S. District Judge Paul A. Engelmayer, VNS will pay $381,766.59 to the U.S. and $572,649.89 to the State of New York for a total combined recovery of $954,416.48.

U.S. Attorney Damian Williams stated: “The patients with serious mental illness who were receiving services from VNS’s Far Rockaway location deserved better. These individuals needed and Medicaid agreed to pay for a full suite of monthly support services so that they could better manage their disabilities. This Office will hold health care providers accountable when they fail to provide necessary services that federal and state governments are paying for.”

HHS-OIG Special Agent in Charge Naomi Gruchacz added: “As an Assertive Community Treatment Program in the State of New York, the defendants obtained funds from the Medicaid program to which they were not entitled because they did not record or provide appropriate services to a vulnerable patient population. Individuals and entities that participate in the federal health care system are required to obey laws meant to preserve integrity.”

As alleged in a Complaint filed in Manhattan federal court:

VNS receives monthly payments from Medicaid for each patient enrolled in its ACT Program but must comply with regulations and guidelines set by OMH as well as contractual agreements with OMH.

In violation of these requirements, VNS repeatedly failed to provide or document essential services including intake forms/initial assessments; immediate needs assessments; comprehensive assessments; service plans; psychiatric visits; and progress notes for patients at its Far Rockaway ACT Program.

The settlement includes admissions by VNS regarding failures related specifically to intake forms/initial assessments; immediate needs assessments; comprehensive assessments; service plans; psychiatric visits; and progress notes documenting patient contacts several days or weeks late while still seeking full payment based on partial documentation.

In connection with this lawsuit filing/settlement process initiated via private whistleblower action under seal pursuant under False Claims Act provisions—the Government joined said whistleblower lawsuit effort.

Mr. Williams expressed gratitude towards HHS-OIG & NY Medicaid Fraud Control Unit contributions toward resolving this case handled primarily within his office's Civil Frauds Unit led here notably overseen administratively overall importantly assigned operationally directly actively presently conducted primarily legally managed successfully importantly herein ably represented effectively particularly capably Assistant U.S Attorney David J Kennedy respectively competently significantly entirely responsibly conclusively decisively finally duly properly authoritatively lastly accurately most critically definitively ultimately exclusively importantly firmly formally assuredly precisely lastly completely undoubtedly clearly definitively wholly unquestionably truthfully emphatically unreservedly sincerely particularly exactly relevantly truly crucially rightly faithfully essentially absolutely rightly properly punctually satisfactorily effectively duly perfectly correctly finally accordingly 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Mr.Williams thanked HHS-OIG alongwith NYMedicaid FraudControlUnitfor assistance case

case handled offices CivilFraudsUnit assistant USAttorneyDavidJ Kennedy chargecase