January 14, 2011 – Medicaid fraud attorneys at Levy Konigsberg LLP announce that the US Government has partially intervened in a qui tam lawsuit brought by the law firm against the City of New York, alleging false claims related to 24-hour Home Care Services.
Medicaid Fraud Attorneys at LK Announce Qui Tam Lawsuit Filed by the Law Firm against NYC Intervened by US Government
Medicaid fraud attorneys at Levy Konigsberg LLP announce that the US Government has partially intervened in a qui tam lawsuit brought by the law firm against the City of New York, alleging false claims related to 24-hour Home Care Services.
NEW YORK, New York, January 14, 2011 – Preet Bharara, the United States Attorney for the Southern District of New York, on behalf of the United States, has partially intervened in a qui tam lawsuit against the City of New York, filed by the Medicaid Fraud Attorneys at Levy Konigsberg LLP, a New York City based qui tam law firm. The lawsuit alleges that the City has improperly overcharged the Medicaid program for the provision of 24-hour Personal Care Services.
Medicaid funded, the Personal Care Services Program was designed to provide housekeeping, meal preparation, bathing, toileting, and grooming services to Medicaid beneficiaries who meet certain eligibility requirements. According to New York State Health Department's website, for a Medicaid-eligible person to receive such services, "his or her doctor must send a completed Physician's Order to the local social services district, which then arranges a social and nursing assessment of the individual. A nurse assessor uses the results of the assessments, together with the physician's order, to recommend an appropriate amount, frequency and duration of services." Additionally, under the applicable state law1, an applicant may not receive 24-hour home care services, without a local medical director's determination that such care is appropriate.
The complaint2 filed by the U.S. Attorney's Office on January 11, 2011, alleges that from the year 2000 to 2010, the City has consistently renewed 24-hour home care services for applicants without the required local medical director's assessment and other reauthorization procedures, and, in some cases, City administrators overruled the findings of local medical directors that Personal Care Services were inappropriate for the patient.
In one case, a medical director determined that a 65-year old woman should receive services for a limited number of hours daily, and did not require 24-hour service. That determination was based on a doctor's examination, which specifically noted that the patient had little trouble ambulating, was alert, was not on medication, and had good judgment. Despite that, an NYC administrator has overruled the doctor's determination and authorized the more expensive and unnecessary 24-hour services for the patient.
In another case, a local medical director determined that a 75-year old patient was ineligible for the 24-hour care program because she required a higher level of service, such as psychiatric facility care, which is not part of the Personal Care Services program. The medical director has noted in his report that the patient "tries to jump out of window several times a day and punches daughter so is dangerous to self and others and is inappropriate for home attendant service." The doctor therefore determined that the patient should be placed in an "appropriate facility." Despite the dangers posed by the patient to herself and others, the City has decided to overrule this determination as well and, instead, continued 24-hour care for this patient. As a result, the patient was not placed in a facility, but remained in the Personal Care Services Program for an extensive period of time.
Since 2000, approximately 17,500 of New York's Medicaid beneficiaries have received 24-hour personal care services costing the taxpayers from $75,000 to $150,000 per person annually or from one billion to more than two billion dollars collectively for the period from 2000 through 2010. The City allegedly improperly authorized services for a substantial percentage of this amount, resulting in damages to the United States of at least tens of millions of dollars.
New York City Human Resources Administration has already announced that it will dispute the lawsuit's allegations.
The whistleblower lawsuit was brought under the Federal False Claims Act by Levy Konigsberg LLP on behalf of Dr. Gabriel Feldman, a New York City doctor, who was contracted by the city to make recommendations as to patient treatments and was concerned about the alleged wasteful spending of the hundreds of millions of dollars of the taxpayers' hard-earned money.
On October 2, 2009, LK Medicaid fraud attorneys filed Dr. Feldman's qui tam complaint under seal. The complaint was unsealed on January 5, 2011. On January 11, 2011, the U.S. Government filed its complaint-in-intervention based on the allegations in Dr. Feldman's October 2009 complaint. If the Government is successful, Dr. Feldman, as the whistleblower, may receive 15% to 25% of the money recovered from the City.
Feldman's qui tam lawyer Alan Konigsberg said that it is not the money or "personal vendetta" that his client is motivated by. "He's a good doctor who cares about his patients and the appropriate expenditure of government funds," said Konigsberg in an interview to Daily News.
The story has already made national news and spread across the internet like a wildfire, appearing both on major news outlets as well as on popular blogs3.
False Claims Act attorneys at Levy Konigsberg LLP represent numerous whistleblowers nationwide in qui tam lawsuits, including those related to Medicaid fraud.
To contact the firm's qui tam lawyers, please call 212-605-6200 or 1-800-988-8005, 24 hours a day, 7 days a week.
IMPORTANT: If you have any first hand knowledge, information, or evidence related to federal, state, or city government fraud, you should speak with an experienced qui tam lawyer who can help you understand your legal rights and help you obtain the compensation you deserve. Contact the whistleblower attorneys at Levy Konigsberg LLP for a free and confidential consultation by calling our 24/7 hotline at 212-605-6200 or toll free at 1.888.FRAUD.USA (1.888.372.8387), or by submitting an email inquiry (see form above).
UPDATE: November 1, 2011 – The lawsuit settled for $70 Million, including a $14.7 Million reward for the whistleblower. UPDATE: September 1, 2011 – Federal judge affirms all allegations of the lawsuit.
1 See attached a copy of the New York law governing the Personal Care Services Program;
2 See attached a scanned copy of the complaint;
3 See below a list of publications:
New York Times – 01/11/2011;
New York Daily News – 01/13/2011.