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MANHATTAN---At the same time that the U.S. Attorney's office for Southern District of New York filed a complaint in U.S. District Court that Harlem Hospital Center defrauded the government by doubebilling the Medicare program, the hospital has agreed to pay $2.3 million to resolve the civil charges.
The complaint alleges that during the period January 1992 through June 30, 2001, the hospital billed Medicare twice for the same outpatient services rendered to patients at its facilities, and that the government paid twice for the services.
According to the complaint, Harlem Hospital submitted these duplicate claims for payment even though it knew, or acted with deliberate ignorance or reckless disregard of the fact, that it had already been paid for the very same services, and thus its claims for payment were false.
The complaint further alleges that, on July 28, 1997, Empire Medicare Services, the government's fiscal intermediary responsible for processing claims for Medicare payment for outpatient services, notified Harlem Hospital that Empire's review of the hospital's claims showed that it was consistently double-billing Medicare, and Empire directed the hospital to stop. However, the hospital failed to do so for several years.
The complaint details the hospital's alleged continued failure to stop double-billing despite the notification from Empire, including:
--in a letter to Empire dated Jan. 21, 1998, nearly a year after the hospital received Empire's notification, the hospital's Manager of Special Projects in the Department of Patient Accounts conceded that the hospital continued to double-bill, allegedly as a result of peculiarities in the hospital's computer system;
--in an internal memorandum dated April 8, 1998, the hospital's chief financial officer at the time informed the hospital's then-Director of Revenue Management that the hospital continued to double-bill, which the CFO acknowledged had been an "open issue . . . for too long" and was "looked at by [M]edicare as fraudulent activity;" and
--the hospital's Performance Improvement Committee regularly discussed problems related to the doublebilling at its meetings through 2000, but did nothing to resolve them. The hospital continued to double-bill for outpatient services well into 2001.
The hospital agreed to pay the government $2.3 million to settle the charges outlined in the complaint. In agreeing to the settlement, the hospital did not admit any wrongdoing or liability.
U. S. District Judge Robert Sweet approved the settlement in Manhattan federal court. 5-23-06
© 2006 North
Country Gazette
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