NY hospital will pay $89M to settle False Claims Act claims

Staten Island University Hospital has agreed to pay the U.S. Department of Justice and the state of New York nearly $89 million to settle a handful of False Claims Act allegations brought by both the feds and private whistleblowers. The hospital, which admitted no wrongdoing, said in a written statement that it had already put programs into place to address the problems addressed by these allegations when the investigation began.

One whistleblower suit charges that the hospital defrauded Medicare and Tricare by consciously using the wrong billing codes for stereotactic radiosurgery from 1996 to 2004 in care for her now-deceased husband. To settle this charge, the hospital will pay $25 million to the federal government, of which the widow, Elizabeth Ryan, will get $3.75 million.

Another, separate whistleblower complaint alleges that the hospital operated and hid a locked wing of 12 inpatient detox beds without a state CON from 1994 to 2000. The whistleblower, Miguel Tirado, was the hospital's former director of chemical dependency services. Staten Island University Hospital will pay $11.8 million to the DoJ and $14.9 million to the state of New York to settle this complaint. Tirado will get about $5 million.

Meanwhile, the hospital will pay $35.7 million to the feds to resolve their assertion that it inflated the number of residents on its Medicare cost reports from 1996 to 2003 to get bigger graduate medical education reimbursements. It will also pay $1.5 million over charges that it billed Medicare and Medicaid for treatment of psychiatric patients in unlicensed beds from 2003 to 2005.

To learn more about the suit:
- read this Modern Healthcare piece

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