The government announced it settled a civil fraud lawsuit against Community Options, Inc., (“COI”) and Community Options New York, Inc., (“CONY,” and together with COI, the “Defendants” or “Community Options”) for fraudulently billing Medicaid for services without necessary and accurate documentation and failing to report and return overpayments to Medicaid. Defendants agreed to pay the United States $2,148,540.37 plus $2,868,085.74 to the State of New York, for a settlement totaling $5,016,626.11.

CONY, a New York-based not-for-profit corporation, operates a network of residential and non-residential facilities and programs for adults with developmental or intellectual disabilities in the State of New York. The network offers Day Habilitation services and beneficial programs to boost individuals’ independence and life skills.

COI, located in New Jersey, oversees CONY and lends administrative support to process CONY’s claim submissions for reimbursement to the New York Medicaid Program.

Among other violations from 2017-2024, Community Options did not meet the New York State Office for People With Developmental Disabilities (OPWDD) requirements. They did not maintain adequate policies concerning the provision and documentation of Day Habilitation services consistent with the requirements and failed to adequately train their employees in compliance.

Defendants entered into a Corporate Integrity Agreement with HHS-OIG, requiring that they maintain a compliance program to follow federal healthcare program requirements. They will use an independent organization to review claims they submit to Medicaid to ensure they meet all requirements.

Acting U.S. Attorney Matthew Podolsky said: “Community Options has now admitted and accepted responsibility for its conduct. This Office will continue to ensure that our most vulnerable New Yorkers receive the services they deserve, and that our federal healthcare programs are protected against fraud and abuse.”

91pornwhistleblower partner Alysia Solow said: “Everyone who participates in federal healthcare programs must comply with all laws to ensure taxpayer dollars are used appropriately. This case underscores the importance of enforcing laws to maintain the integrity of government healthcare programs.”

In connection with this lawsuit and settlement, the government joined a private whistleblower lawsuit filed under seal pursuant to the False Claims Act.

Under the qui tam (or whistleblower provision) of the False Claims Act, private parties can file lawsuits on behalf of the government and receive up to 30% of the monetary recovery.

Medicaid Fraud

Fraud is pervasive in the healthcare and pharmaceutical fields, and with government programs�����Գ����ܻ徱�Բ���Medicare�����Ի���Medicaid. Examples can include upcoding, taking kickback payments for service or patient referrals, billing for medically unnecessary services, making false statements about covered services, and more.

Our Firm Helps Medicaid Fraud Whistleblowers

91pornhas extensive experience representing Medicaid whistleblowers. Please contact us if you believe you have a case. We will connect you with an experienced member of the 91pornwhistleblower team for a free and confidential consult.

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Read Network that Offers Programs for Adults with Disabilities Agrees to Pay $5M to Settle False Claims Act Case at constantinecannon.com

United States Attorney for the District of Connecticut, Vanessa Roberts Avery, and Connecticut Attorney General, William Tong that Home Care VNA LLC and its current and former owners, Shakira Lubega and Constant Ogutt, have $361,520 to resolve allegations that they submitted claims for home health care services that violated Medicaid regulations for plans of care.

Home Care VNA is a home health agency located in Hartford, Connecticut. Lubega is the current owner of Home Care VNA. Ogutt is a former and part owner. Lubega and Ogutt are married.

The Regulations of Connecticut State Agencies require that each patient has a plan of care as a condition of payment for home health care services. The plan of care must be signed by a licensed practitioner within 21 days after the care begins. A new or modified plan of care is reviewed, revised, and signed every 60 days.

According to the United States and the State of Connecticut, Home Care VNA, Lubega, and Ogutt submitted or caused the submission of claims for reimbursement to Connecticut Medicaid for home health care services for patients with unsigned plans of care, or patients without any plans of care.

Home Care VNA, Lubega, and Ogutt have agreed to pay $361,520 to resolve the False Claims Act allegations from August 1, 2018, through March 26, 2020. They are not strangers to such allegations. In 2022, they paid $630,000 to resolve similar plan of care Medicaid fraud in Massachusetts.

The Office of Inspector General for the Department of Health and Human Services investigated this case. It will be prosecuted by Assistant U.S. Attorney Richard M. Molot and by Assistant Attorney General Joshua Jackson of the Connecticut Office of the Attorney General.

There is a concerning pattern of fraud in �ٳ����home health care sector relating to patient-specific plans of care. 91pornlitigated a False Claims Act whistleblower lawsuit addressing this issue against VNS Health (formerly, Visiting Nurse Service of New York/VNSNY), the largest not-for-profit home health care agency in the country, serving roughly 150,000 patients a year in New York, most of whom are elderly and/or disabled. The case alleged that VNSNY systematically failed to provide patients all the critical visits and services their doctors prescribed in the plans of care. After several years of litigation, VNSNY agreed to pay $57 million to settle the case.

If you would like to learn more about health care fraud, �ٳ����False Claims Act,���ǰ���what it means to be a whistleblower, please don’t hesitate to contact us. We will connect you with an experienced member of our whistleblower team.

Read Hoodwink in Hartford: Home Health Care Company and Its Owners Settle Medicaid False Claims Act Allegations at constantinecannon.com

On November 20, 2024, New York Attorney General Letitia James that former pharmacy owner Aftab Hussain was sentenced to two to six years in prison for swindling over $11.5 million in a Medicaid fraud scheme that targeted low-income HIV patients who required life-saving medications.

Hussain and his co-conspirators paid illegal kickbacks to patients to entice them as repeat customers at over 20 Hussain-controlled pharmacies in New York City and Westchester County.

Patients’ prescriptions were then filled with unsafe medications illegally purchased from the black market or other pharmacy patients. Hussain and his associates billed Medicaid over $11.5 million for these illegally obtained drugs. From 2015 to 2019, Hussain and his co-conspirators paid, or directed others to pay, illegal kickbacks to Medicaid recipients diagnosed with HIV to return to their pharmacies to feed the scheme. Each kickback ranged from $25-$100.

At the time each medication was filled and delivered, Hussain and his associates would offer to buy back the HIV medication from the Medicaid recipients in exchange for cash, offering $100 to $200 per bottle. The wholesale prices for these medications generally cost between $2,000 and $3,000 per bottle. As a result of this scheme, many HIV patients went without their medication and were at risk of developing life-threatening complications.

“This predatory scheme stole millions of dollars while denying lifesaving treatment to New Yorkers in need,” said Attorney General James. “Aftab Hussain exploited and endangered vulnerable New Yorkers with HIV, using them to steal taxpayer funds that provide health care to low-income patients, and now he will pay for his fraud. This case should serve as a warning to any crooked pharmacy operator. My office will continue to bring these cases to shut down illegal businesses that put New Yorkers at risk with fraud and dangerous medications.”

Hussain and his associates also bought large amounts of HIV medications from the black market, drugs often obtained through other illegal kickbacks, and then the pharmacies distributed these prescriptions to unsuspecting recipients. They submitted claims for reimbursement to the Medicaid program as if they were disbursing medications that were obtained legally and safely.

State law prohibits all medical providers, including pharmacies, from paying, or offering to pay, kickbacks in return for referring Medicaid-covered medical services. State law mandates that pharmacies source their prescription medications from licensed wholesale distributors to ensure the integrity and safety of the drug supply.

Hussain is the last defendant sentenced in a long investigation that arrested and convicted five defendants. Hussain’s co-conspirators, including Josmary Cardenas (aka Yasmine Aftab Hussain), Victor Streety, Blanca Vanessa Alvarado, and Felix Lopez, all previously pleaded guilty to related crimes and have been sentenced.

Four corporations operating as pharmacies owned or controlled by Hussain or his co-conspirators were also charged: Harlem Super Pharmacy Inc., Health Smart Pharmacy Inc., Broadway RX Enterprises Inc., and E-Green Pharmacy Inc. d/b/a WinHealth Pharmacy. RX Enterprises Inc. and E-Green Pharmacy Inc. both pleaded guilty and were sentenced on October 16, 2024. The corporations must dissolve as part of the sentences.

Hussain was sentenced by Judge Brendan Lantry in New York County Supreme Court on his previously entered guilty plea to the charges of Grand Larceny in the First Degree, Grand Larceny in the Third Degree, Health Care Fraud in the First Degree, Health Care Fraud in the Second Degree, Scheme to Defraud in the First Degree, and Conspiracy in the Fourth Degree. He was also required to satisfy a settlement agreement in which he paid $7 million in restitution to the state.

If you have information relating to healthcare fraud, we want to hear from you. You could be the next whistleblower to bring justice to the healthcare system. If you would like to learn more about what it means to be a whistleblower or any of the other whistleblower rewards programs, please do not hesitate to contact us. We will connect you with an experienced member of the 91pornwhistleblower team for a free and confidential consult.

Read Predatory Pharmacies Targeted Low-Income HIV Patients: Former Owner of New York Pharmacies Sentenced for Ongoing $11 Million Medicaid Fraud Scheme at constantinecannon.com