Last week, a New York federal district court approved an approximately $34.4 million settlement (plus interest) between the VNS Choice, VNS Choice Community Care and Visiting Nurse Service of New York (collectively, “VNS”) and the State of New York. The settlement partially resolves a qui tam action filed on June 20, 2013, alleging violations of the federal False Claims Act (FCA) and the New York False Claims Act (United States and New York ex rel. Heisler v. VNSNY Choice, S.D.N.Y., No. 13-cv-4261). A copy of the settlement is available here.

The State of New York, through the Attorney General’s Medical Fraud Control Unit, partially intervened in the action on October 21, 2014, the same day the parties filed a stipulation and order of settlement for the court’s approval. The State’s intervention and the approved settlement relate to allegations that between January 1, 2011 through September 1, 2013, VNS submitted, or caused to be submitted, false claims for payment to the Medicaid program. Through the settlement, VNS admitted that:

  1. 1,740 members of its managed long-term care plan who were referred by social adult day care centers or who received services from social adult day care centers, were not eligible to be members of the plan, and
  2. during 2012 and 2013, various social adult day care centers in VNS’s provider network did not provide services to members of VNS’s managed long-term care plan that qualified as “personal care services” under VNS’s contract with the New York State Department of Health.

The State continues to investigate the remaining allegations in the qui tam action, which remain under seal.