Consumer Fraud

Mount Sinai Hospitals Settle Whistleblower Lawsuit Alleging They Held Onto Medicare, Medicaid Overpayments

Pills Stethascope on Money 435x289 Mount Sinai Hospitals Settle Whistleblower Lawsuit Alleging They Held Onto Medicare, Medicaid OverpaymentsThree Mount Sinai Health System hospitals have agreed to pay the U.S. government nearly $3 million to settle a False Claims Act lawsuit brought by a whistleblower who accused them of keeping Medicare and Medicaid overpayments beyond the 60-day repayment window.

According to Modern Healthcare, the New York City hospitals named in the complaint – Mount Sinai Beth Israel, Mount Sinai St. Luke’s, and Mount Sinai Roosevelt – were a part of Continuum Health Partners when the alleged overpayments were made in 2009 and 2010.

The 444 overpayments at the crux of the case total $844,000. Mount Sinai Health System would have been on the hook for three times that amount under the rules of the False Claims Act, plus nearly $5 million more in penalties, had the case gone to trial. The hospital settled for $2.95 million.

Continuum was alerted to the overpayments by a New York state audit in September 2010 and by a whistleblower email in the following February, but it did not return all of the overpayments until March 2013, federal and state prosecutors argued.

The 60-day limit on the return of overpayments to Medicare and Medicaid became a rule under the 2009 Fraud Enforcement Recovery Act and a 2010 provision in the Affordable Care Act. The Mount Sinai case was the first False Claims Act case alleging violations of the rule to be settled.

Modern Healthcare notes that hospitals have strongly opposed the new rule, which mandates that hospital repay the overages within 60 days of identifying them. After the 60-day window, the retained overpayments are subject to the False Claims Act and additional penalties for noncompliance.

On the day of the settlement, Mount Sinai attributed its retention of overpayments to a third-party computer glitch and said that Continuum had worked to fix the error when it became aware of the problem.

Source: Modern Healthcare