Whistle-Blower Suit Accuses Visiting Nurse Service of Fraud

The current complaint alleges three main areas of fraud, all involving the agency’s core operations as a provider of home health care services to about 150,000 patients a year in New York City; Nassau, Suffolk and Westchester Counties; and several upstate counties.

It charges that for financial gain, the agency “intentionally ignored” the plans of care prescribed by physicians, providing only a fraction of the nursing and rehabilitation visits that had been ordered under Medicare, which pays a set rate for an “episode of care.” The practice seriously endangered the welfare of patients, the lawsuit charges, and resulted in needless rehospitalizations.

Among the examples cited from the agency’s own 2014 records is a patient with lupus who had undergone a lower-limb amputation and used a wheelchair. The patient’s doctor had ordered 27 rehabilitation visits and 38 nursing visits to be made over a 60-day period. The agency provided none of the rehabilitation visits and only five nursing visits during the two-month period, but it collected a full $3,537 in government reimbursement, the lawsuit says.

Similar cases cited in the complaint involve patients coping with the aftereffects of a mastectomy, a kidney transplant, a hip fracture and a knee replacement, some with complications from diabetes, high blood pressure or heart disease, others with bedsores and Alzheimer’s disease. All are said to have received a fifth or less of the care prescribed, without the agency notifying them, their doctor or the government of the reduction in services.

Read more: http://www.nytimes.com/2016/09/24/nyregion/whistle-blower-suit-accuses-visiting-nurse-service-of-fraud.html