DOJ says health system "willfully" delayed repaying $844,000 in Medicaid overpayments. Mt. Sinai says its "good faith" effort to identify the overpayment in 2011 was "time consuming and complicated."
Federal and state prosecutors in New York City this week announced a $2.95 million fraud settlement with Mount Sinai Health System stemming from $844,000 in Medicaid overpayments identified by a whistleblower in 2011.
The hospitals named in the settlement include:
- Mount Sinai Beth Israel
- Mount Sinai St. Luke's
- Mount Sinai Roosevelt
- Continuum Health Partners, Inc. (the hospitals' former partnership group)
The Mount Sinai Health System was formed in September 2013, when Continuum Health Partners combined the Hospitals' operations with those of Mount Sinai Medical Center.
"When Continuum learned that it had received over $800,000 in potential overpayments from Medicaid in 2011, it had an obligation under the law to return those funds within 60 days," Preet Bharara, U.S. Attorney for the Southern District of New York, said in a media statement.
"Instead, Continuum delayed repayment for more than two years and only fully repaid the Medicaid program in 2013. With this settlement, Continuum has made admissions and is paying $2.95 million for its fraud on Medicaid."
Mt. Sinai Health System denied claims that it was attempting to deceive auditors and said it was "fully committed to compliance and the maintenance of a vigorous compliance program."
"The circumstances relating to this settlement occurred before Continuum joined Mount Sinai and stem from a third party insurer's computer error," the health system said in a media release.
"When Continuum became aware of the computer glitch, it worked diligently with the insurance company to correct the error and directed its own staff to identify and refund any overpayments. The process for identifying the refunds was complicated and time consuming, but Continuum continued with the process in good faith until all the refunds were finally identified and repaid, well before it became aware of this lawsuit."
According to the New York State Comptroller's office, in February 2011, an internal investigation by Continuum identified approximately 900 claims totaling over $1 million that may have been wrongly submitted to and paid by Medicaid.
The list, created by the whistleblower who filed this qui tam lawsuit, contained all of the claims that were affected by the software glitch. Rather than using the list to repay the claims, Continuum terminated the whistleblower, failed to bring the list to the attention of the Government, and took nearly two years to complete its repayments.
The settlement was approved this week by U.S. District Judge Edgardo Ramos.