Medicare Compliance & Reimbursement

And an act of Congress couldn't hurt.

A lawsuit to challenge a cost report disallowance backfired on Visiting Nurse Association Health Care Services Inc. (VNA) in Staten Island, NY.

The VNA is paying $1.6 million to settle Medicare fraud charges, according to a release from U.S. Attorney Roslynn Mauskopf.

The government filed False Claims Act (FCA) countercharges when the VNA brought a federal court lawsuit to recover disallowed aide costs on its 1995 and 1996 cost reports. The agency "improperly included non-Medicare like costs in calculating the costs of home health aide visits," the release says.

The government based its FCA charges on claims that the agency included "inflated data and false statements in the cost reports," even though the VNA certified on the reports that it "had followed the applicable standards and that [it] had complied with the cost reporting instructions, despite knowingly and intentionally disregarding them," the release notes.

The settlement also covers potential administrative recoupment claims from 1989 through 1994. And the VNA has agreed to drop related legal action and administrative appeals for 1989 through 2000, Mauskopf says.