Corporate Compliance

Staten Island University Hospital to pay $89 million to settle fraud claims

Compliance Monitor, September 17, 2008

Staten Island University Hospital (SIUH) agreed to pay almost $89 million to settle four separate charges for alleged defrauded Medicare, according to a Department of Justice (DOJ) press release.

 The DOJ alleges SIUH:

  • Fraudulently billed Medicaid and Medicare for inpatient alcohol and substance abuse detoxification treatment
  • Used incorrect billing codes for cancer treatment performed at the hospital to receive reimbursement for services not covered by Medicare
  • Deliberately inflated the resident count from the 1996 cost report year through the 2003 cost report year
  • Billed Medicare and Medicaid for treatment of psychiatric patients in unlicensed beds between July 2003 and September 2005

Whistleblowers filed two of the four counts.

 

Dr. Miguel Tirado, a former SIUH Director of Chemical Dependency Services, alleged SIUH performed alcohol and substance abuse in unauthorized beds. SIUH will pay the $11.8 million to the federal government and $14.9 million to the state of New York, according to an agreement. Tirado will receive $2.3 million from the federal government for filing the suit.

 

Elizabeth M. Ryan, widow of an SIUH cancer patient, alleged the hospital used incorrect codes to bill for outpatient cancer treatments. SIUH will pay the $25 million to settle this claim, and Ryan will receive $3.75 million of it.

 

The government filed the other two claims. According to the agreement, SIUH will pay the government $35.7 million for inflating cost report numbers and $1.5 million for allegedly performing psychiatric treatments in unlicensed beds.

 

To read the full DOJ press release click here.

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