After more than a hundred years of providing nonprofit home health care, Visiting Nurse Service of New York is facing accusations of defrauding Medicare and Medicaid.

The whistleblower lawsuit alleges Visiting Nurse Service of New York systematically submitted hundreds of millions of dollars’ worth of false and overbilled claims to the Medicare and Medicaid systems.

At the same time, the allegations say, the agency withheld some of the health care that doctors had ordered for their patients.

This whistleblower lawsuit is the latest addition to an era of audits, investigations and other negative attention for the vaunted home health service.

The complaint was originally filed under seal in 2014 and was just recently unsealed.

After investigating the whistleblower’s allegations, prosecutors have decided not to intervene in the whistleblower lawsuit, but they may choose to intervene later.

Whistleblower Says Visiting Nurse Service of New York Overbilled, Underprovided

Founded in 1893 by Lilian Wald, Visiting Nurse Service of New York originally provided home nursing services to poor New York immigrants.

It has since grown to become one of the largest home health care agencies in the U.S. It now provides services to around 150,000 patients each year in New York City and its nearby counties, as well as several other counties in upstate New York.

The whistleblower at the helm of this action is plaintiff Edward L., the agency’s vice president of operations improvement and integration. Edward left the agency in January 2016 after working there for 16 years.

According to the whistleblower lawsuit, Visiting Nurse Service of New York “intentionally ignored” physicians’ prescribed plans of care.

The agency allegedly provided only some of the prescribed home health and rehabilitation service prescribed while claiming the usual set rate for a single episode of care, as set by Medicare.

In one case, supposedly documented in the agency’s own records, a physician ordered 27 rehabilitation visits and 38 nursing visits for a wheelchair-bound patient who had undergone a lower limb amputation.

The agency allegedly provided only five nursing visits and none of the rehab visits, but it allegedly claimed government reimbursement for the full line of care.

Other, similar episodes of alleged Medicare and Medicaid fraud are described in the whistleblower lawsuit, involving patients with a broad spectrum of different ailments.

The agency allegedly provided these patients with only a fraction of the care prescribed.

Internal reports allegedly show that in a given period, nearly half the patients referred for rehabilitation went without services.

Edward also alleges that hundreds of agency nurses and therapists falsified their time records. These records allegedly show claims for “impossibly high” numbers of visits, visits not long enough to provide effective care, and lack of patient verification that certain visits actually took place.

One nurse reportedly claimed 20 visits in a single day at nine different addresses, alleging that not a single one of those patients was able to sign documentation of the visit.

Another nurse claimed around 4,000 visits in a single year, vastly more than the usual 1,300.

If his whistleblower lawsuit against Visiting Nurse Service of New York is successful, Edward stands to collect up to 30 percent of the amount of money recovered.