Last week, the Visiting Nurse Service of New York (“VNS”), a not-for-profit organization providing in-home care to New York residents, agreed to pay nearly $35 million to settle claims that it defrauded Medicaid by improperly billing ineligible patients for services at its adult day care facilities. Specifically, VNS admitted to receiving $3,800 payments for 1,740 members in its long-term care plan who were referred by social adult care centers, or used the services at those facilities, but did not qualify for the program. Investigators also claimed that the services provided were substandard. Ultimately, these members were un-enrolled in August 2013. VNS also admitted that in 2012 and 2013, various centers in its network did not provide services that qualified as personal care services under the terms of its Medicaid contract.
As part of its settlement terms, VNS is required to credential only social adult care centers that are equipped to provide care consistent with regulatory requirements and ensure that these centers will provide the care required under its long-term care plan.