Health Care Agency Agrees to Repay Millions to Medicaid for Enrolling Ineligible Patients in Program

VNSNY Choice, a division of the Visiting Nurse Service of New York, agreed in October 2013 in principle to pay back Medicaid $33.6 million for enrolling patients into its program who were ineligible. VNSNY Choice is New York’s largest managed long-term care agency. According to New York State Attorney General Eric T. Schneiderman, the settlement was reached after his Medicaid fraud control unit conducted an audit and investigation of the company. VNSNY Choice admitted to enrolling ineligible members into its long-term care program. However, as part of the settlement, the state will allow the company to resume enrolling patients into its centers.

VNSNY Choice receives approximately $3,800 per month from Medicaid for each person it enrolls in its long-term plan. The money is used to pay for a network of providers, including social day care, home health aides, and care in nursing homes. The plans and centers work in conjunction with each other. The centers enroll patients to be signed up by the plans, and the plans pay the centers.

VNSNY Choice came under scrutiny after articles and photographs in The New York Times documented healthy older adults playing table tennis at a center in Lower Manhattan. In another instance, the Times reported people bicycling away with free food from a center in Bensonhurst, Brooklyn. The Times even reported that some centers were offering cash gifts and casino trips to healthy seniors as an incentive for them to enroll in their centers. Such centers are supposed to be for frail elderly people and the disabled. There are currently 54 social adult day care centers and seven managed long-term care plans that are being reviewed.

gavel.jpgThe program also came under investigation after one of VNSNY Choice’s centers was involved in a political corruption case. According to reports, the owners of the center were accused of bribing a state assemblyman in order to get rid of the competition.

A spokesman for VNS stated that the settlement “resulted from differing good-faith interpretations of the state’s evolving eligibility criteria.”

VNSNY did not admit to improper marketing practices as a result of the settlement. However, the company will repay Medicaid for hundreds of ineligible patients who were enrolled in its long-term care plan.

Website Resource: Long-Term Care Agency to Repay Millions to Medicaid for Enrolling Ineligible Patients

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