The U.S. District Court for the Southern District of New York has stopped False Claims Act allegations against a long-term home health care provider accused of defrauding the government.
A former employee made the claims against Bon Secours New York Health System’s Schervier long-term home health care program, alleging it had submitted false claims to Medicare and the New York Medicaid programs.
The former employee argued that the program submitted claims for unapproved, over-budget services for patients and could have impacted the state government’s payment decision. The former employee also argued that forged signatures on plan of care forms may have affected the state’s decision to pay claims.
The court denied those arguments, saying they didn’t show proof that the government would have paid in excess for the excess billing, nor was there proof the alleged forged documents would have impacted the government’s decision to pay or deny the claims.
“We find that they provide no proof that the Government ever denied claims or likely would deny payments based on over-budget billing,” Judge Gabriel Gorenstein wrote in the opinion.
The court, however, did decide to move forward with one of the claims, which alleges the program double-billed for services it provided to patients who were eligible for both Medicare and Medicaid, Bloomberg Law reported. The court stated the government wouldn’t have paid for Medicaid’s claims if it knew they could be paid by Medicare.
“The defendants have not pointed to any evidence that the government knew after this lawsuit was filed that it was receiving claims for payments under Medicaid that should have been presented first to Medicare,” Gorenstein wrote.
A call by McKnight’s seeking comment from Bon Secours’ representation was not returned by production deadline.
