New York’s Staten Island University Hospital will have to pay $88.9 million to federal and state authorities in the largest health-care fraud settlement ever registered in the United States.
A lawsuit filed in federal court in Brooklyn accused the hospital of fraudulently billing Medicare, Medicaid, and TRICARE, the insurance offered to military personnel, between 1994 and 2005.
The settlements stem from two False Claims Act suits filed by whistleblowers, as well as two investigations by the US Attorney’s Office and the state Attorney General’s Office. The fraud schemes date between 1994 and 2005, according to officials. Part of the settlements covers work done by Dr. Gilbert Lederman’s radiation oncology department.
"This was a hospital that sought to exploit the Medicare program and obtain millions of dollars in payments that it was not entitled to," said Richard Reich, lawyer for federal whistleblower Elizabeth Ryan, who brought the first case against Lederman and the hospital. Investigators in this case determined that the hospital used incorrect billing codes in cancer treatment from 1996 through 2004 to Medicare and TRICARE. The hospital agreed to return $25 million to the federal government. Ms. Ryan, the widow of a hospital’s patient, will receive $3.75 million.
The hospital will also have to pay another $26.6 million to cover Medicare and Medicaid reimbursements it received for treating thousands of patients for substance abuse using unregulated and unlicensed methods between 1994 and 2004.
A statement released by the hospital said: “We want to assure our patients and the communities we serve that SIUH will continue to deliver the same high-quality care that has enabled us to win coveted national awards.”
By Anna Boyd