WASHINGTON—The Department of Justice (DOJ) announced the United States has settled a civil fraud lawsuit against VNS Health, Visiting Nurse Service of New York Home Care and VNS Health Behavioral Health (collectively VNS) for $1 million.
VNS, which operates one of the largest nonprofit home and community-based health care organizations in the U.S., 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 that it either failed to provide or failed to document to persons with serious mental illness at the ACT Program VNS operated in Far Rockaway, Queens (VNS Far Rockaway ACT Program).
Specifically, the settlement resolves claims that from Jan. 1, 2014, through Dec. 31, 2018, VNS submitted or caused to be submitted false claims to Medicaid for monthly payments for 103 patients at the VNS Far Rockaway ACT Program who did not receive the full array of services that VNS was required to provide under the ACT Program or for whom VNS did not adequately or timely document provision of such services in accordance with applicable regulations or the ACT guidelines.
Under the settlement approved June 25, 2024, by U.S. District Judge Paul A. Engelmayer, VNS will pay the U.S. $381,766.59 and has admitted and accepted responsibility for the conduct alleged in the U.S. complaint. VNS has also agreed to pay the State of New York $572,649.89 to resolve state law claims for a total combined recovery of $954,416.48.
“The patients with serious mental illness who were receiving services from VNS’s Far Rockaway location deserved better," U.S. Attorney Damian Williams said. "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 the necessary services that the federal and state governments are paying for.”
“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," said HHS-OIG Special Agent in Charge Naomi Gruchacz. "Individuals and entities that participate in the federal health care system are required to obey the laws meant to preserve the integrity of program funds and the provision of appropriate, quality services to patients.”
As alleged in the Complaint filed in Manhattan federal court:
VNS, as an ACT Program provider, receives monthly payments from Medicaid for each patient enrolled in its ACT Program. In order to receive these payments, VNS must comply with certain regulations and guidelines promulgated by OMH, as well as their own contractual agreements with OMH.
However, in violation of these regulations, guidelines, and contractual agreements, VNS repeatedly failed to provide or document essential services to 103 patients at the VNS Far Rockaway ACT Program. Specifically, VNS repeatedly failed to complete intake forms and/or conduct initial assessments, failed to complete immediate needs assessments, failed to complete service plans, failed to provide and/or record monthly psychiatric visits, and failed to record progress notes.
As part of the settlement, VNS admitted and accepted responsibility for certain conduct alleged by the U.S. in its complaint, including the following:
- Intake Forms and Initial Assessments: Intake forms and initial assessments record necessary background information about the patient, inform subsequent treatment, and set a baseline for improvement while the patient is in the program. In multiple instances and contrary to the ACT guidelines, VNS failed to complete intake forms and/or initial assessments for patients enrolled in the VNS Far Rockaway ACT Program, failed to complete intake forms and/or initial assessments in a timely manner, or failed to provide the necessary supervisory review and approval of intake forms and/or initial assessments.
- Immediate Needs Assessments: Immediate needs assessments are used to determine patient needs as to safety/dangerousness, food, clothing, shelter, and medical needs. In multiple instances and contrary to the ACT guidelines, VNS failed to complete immediate needs assessments for patients enrolled in the VNS Far Rockaway ACT Program, failed to complete immediate needs assessments in a timely manner, or failed to provide the necessary supervisory review and approval of immediate needs assessments.
- Comprehensive Assessments: Comprehensive assessments provide a necessary baseline to provide services and are updated to reflect the patient’s changing needs over time. In multiple instances and contrary to the ACT guidelines, VNS failed to complete comprehensive assessments for patients enrolled in the VNS Far Rockaway ACT Program, failed to complete comprehensive assessments in a timely manner, or failed to provide the necessary supervisory review and approval of comprehensive assessments.
- Service Plan: Service plans set forth specific objectives and planned services necessary to facilitate the achievement of the patient’s recovery goals. In multiple instances and contrary to the ACT guidelines, VNS failed to complete service plans for patients enrolled in the VNS Far Rockaway ACT Program, failed to complete service plans in a timely manner, or failed to provide the necessary supervisory review and approval of service plans.
- Psychiatric Visits: In multiple instances and contrary to the ACT guidelines, VNS failed to document psychiatric visits for patients enrolled in the VNS Far Rockaway ACT Program.
- Progress Notes: Progress notes document service contacts and attempted contacts, progress or lack of progress toward goals, and significant events. In multiple instances and contrary to the ACT guidelines, VNS failed to record progress notes for patients enrolled in the VNS Far Rockaway ACT Program until several days or even weeks after the contact with the patient. In addition, VNS sought and received payment at the full monthly level even though, based on the progress notes, they were entitled only to partial payment based on the number of documented contacts with the patient.
In connection with the filing of the lawsuit and settlement, the government joined a private whistleblower lawsuit that had been filed under seal pursuant to the False Claims Act.
