Three hospitals that are part of New York’s Mount Sinai Health System have agreed to pay a $2.95 million settlement to state and federal authorities, closing the book on a whistleblower lawsuit filed under provisions of the False Claims Act.
The hospitals involved are Mount Sinai Beth Israel, Mount Sinai St. Luke’s, and Mount Sinai Roosevelt, now known as Mount Sinai West. At the time of the billing problems, the facilities were part of Continuum Health Partners. The group merged with Mount Sinai Medical Center in the fall of 2013.
The lawsuit alleged that the healthcare providers held onto over $844,000 in Medicaid overpayments, retaining the money well after the 60 day window afforded for returning such funds after discovery of a mistake.
Though the hospitals did eventually repay the overage, in March 2013, that came more than two years after one of their employees first called attention to the full scope of the error.
According to a Reuters news story, government officials credit Robert Kane, technical director for operations for Continuum, as the individual who first identified the magnitude of the overbilling. In total, Continuum filed 444 erroneous Medicare claims over the course of 2009 and 2010.
Continuum utilized billing software from the company Healthfirst. Evidently, a discrepancy occurred in the conversion of billing codes from Continuum’s previous system, leading to the false remittances. Once the issue was discovered, Continuum directed Kane, among others, to scour the electronic billing records to find offending claims.
Kane compiled a spreadsheet with hundreds of faulty claims, attached it to an email, and sent it to multiple managers within Continuum. That email was sent in February 2011. Kane was fired four days later. He filed the whistleblower lawsuit shortly thereafter.
The state of New York will be paid $1.77 million as a condition of the settlement, and $1.18 million will go the federal government. The remainder of the total payout will be allotted to Kane as the named plaintiff in the suit.
Filed Under: Industry regulations