Monday, 8 October 2018

Staten Island University Hospital Settles, Again

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From the New York Times comes the latest installment of the sorry story of Staten Island (NY) University Hospital:



Staten Island University Hospital has agreed to return $88.9 million that prosecutors say it fraudulently obtained from government properly being policy programs, one in each of the finest settlements of such a claim ever paid by a single hospital.



The settlement, which prosecutors announced Monday, represents the third time in a decade that the hospital, that is the borough’s largest, has paid tens of hundreds of money to clean up civil charges that it knowingly overbilled the government for treatment costs. Prosecutors had accused the hospital of conducting a collection of schemes from 1994 to 2005 that spanned many facets of its operations, including substance abuse detoxification, inpatient psychiatric care, cancer treatment and the amount of residents it had in training.



Two of the charges protected in the expense stemmed from separate whistle-blower lawsuits filed by a former doctor at the hospital and the widow of a cancer patient. Dr. Miguel Tirado, a former director of chemical dependency companies at the hospital, accused the hospital of fraudulently billing the state Medicaid and the federal Medicare ways for inpatient alcohol and substance abuse detoxification treatment. Investigators discovered that from July 1994 by way of June 2000, the hospital submitted claims for 12 more beds than it was licensed to use, and hid those beds from state inspectors. To settle those charges, the hospital agreed to return $11.8 million to the federal government and $14.8 million to New York State.



The other whistle-blower suit, filed by Elizabeth M. Ryan of Florida, accused the hospital of using the codes of a cancer treatment protected by Medicare to achieve payments for treatment to her husband that was not covered. Investigators discovered that the hospital used fallacious billing codes in cancer treatment from 1996 by way of 2004 to Medicare and Tricare, the United States military’s properly being policy program. The hospital agreed to return $25 million to the federal government.



The expense also resolved five hundred other claims that had been not yet the topic of lawsuits. Federal prosecutors mentioned that from 1996 to 2003, the hospital had deliberately inflated its count of residents in training, which resulted in the hospital receiving reimbursements for which it wasn’t entitled. The hospital agreed to return $35.7 million.



Finally, the expense resolved what prosecutors mentioned had been wrongful billings to Medicare and Medicaid for treatment of psychiatric patients in unlicensed beds from July 2003 by way of September 2005. The hospital agreed to repay the federal government almost $1.5 million to settle that claim.

In 1999, the hospital entered a expense with Eliot Spitzer, then the legal professional general, to repay $45 million to Medicaid and to provide $39 million in unfastened appear after indigent patients. Mr. Spitzer had charged that from 1994 by way of 1998, the hospital provided treatment to developmentally disabled adults in rooms at crew homes, but billed the companies as outpatient hospital treatments, which Medicaid reimburses at a price 10 instances higher.



In 2005, Mr. Spitzer’s office negotiated a second expense with the hospital that required it to return $76.5 million to Medicaid. Mr. Spitzer, who accused the hospital of overbilling by way of part-time community clinics, mentioned at the time that the hospital’s own authorized experts had warned its executives to stop, nevertheless it the illegal billing continued nonetheless.



We had posted twice before at the 2005 expense (here and here). It turned out that the former executive vice president of the hospital had been hailed as a leader with "gravitas" after he moved to his next job, which he therefore quick quit after his connection with the troubles at Staten Island got right right here to light.



This story again reminds us how usually the self-proclaimed leaders with "gravitas" of properly being care agencies are weighed down with other baggage. This is quite pertinent during the week while the high priests of finance, essentially maybe the major exalted of the exalted leaders of business, had been shown to have foolishly and arrogantly over-reached. The push to destroy the medical guild and positioned managers without properly being care experience into the leadership of properly being care agencies unfortunately got right right here at a time while such managers had been growing up in a culture of greed, arrogance, and self-interest. So while high-paid chiefs of investment banks are brought low, it is time to rethink whom we have positioned in expense of properly being care.



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