VNS Choice, a Managed Long-Term Care Plan for Medicaid beneficiaries, has been found guilty of Medicaid fraud in a settlement approved by United States District Judge Ronnie Abrams. The company’s improper collection of Medicaid payments for 365 Medicaid beneficiaries whom VNS Choice failed to timely disenroll from the plan has led to a $4.4 million settlement.
The settlement, approved on [current date], requires VNS Choice to pay a total sum of $4,392,150, with $1,756,860 going to the United States and the remaining amount to the State of New York. In the settlement, VNS Choice admits that it failed to timely disenroll 365 Choice MLTCP members and, as a result, received Medicaid payments to which it was not entitled.
Acting Manhattan U.S. Attorney Joon H. Kim stated, ‘VNS Choice failed to timely disenroll individuals from its managed care plan and continued to collect Medicaid payments for their care, even when it provided no medical services to them. This Office is committed to holding accountable those who receive government health care program dollars to which they are not entitled.’
VNS Choice administers a Managed Long-Term Care Plan for Medicaid beneficiaries pursuant to a contract with the New York State Department of Health. The company receives payments for each member enrolled in the Plan (called ‘capitation payments’) in exchange for arranging and providing certain community-based long-term care services, such as care management, skilled nursing services, physical therapy, speech therapy, occupational therapy, and preventive services.
The MLTC Contract sets forth various circumstances under which members must be disenrolled. For example, VNS Choice is required to disenroll Choice MLTCP members when it knows that a member no longer resides in the service area, a member has been absent from the service area for a specified number of consecutive days, a member is hospitalized for 45 consecutive days or longer, a member is no longer eligible to receive Medicaid benefits, or a member is deemed to be no longer eligible for managed long-term care. VNS Choice also must initiate disenrollment upon a member’s voluntary request.
The United States’ Complaint filed in Manhattan federal court alleges that VNS Choice failed to timely disenroll 365 Choice MLTCP members as required by the MLTC Contract and regulatory requirements during the period January 1, 2011, through March 31, 2015. In many instances, VNS Choice continued to collect capitation payments for several months after the date the member should have been disenrolled, during which time VNS Choice provided no health care services to the member.
VNS Choice, a managed care plan, will pay $4.4 million for Medicaid fraud. The company failed to timely disenroll Medicaid beneficiaries, continuing to collect payments even after providing no medical services. The settlement requires VNS Choice to pay $4,392,150, with $1,756,860 going to the United States and the remaining amount to the State of New York.
Key Facts
- State: New York
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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