The settlement in part resolves suits filed on behalf of the government in the United States District Court for the Eastern District of New York by two individuals. Dr. Miguel Tirado, a former SIUH director of chemical dependency services, who filed suit under the federal False Claims Act and the New York State False Claims Act, alleged that the hospital had fraudulently billed Medicaid and Medicare for inpatient alcohol and substance abuse detoxification treatment. The governments investigation established that, from July 1, 1994 through June 30, 2000, SIUH submitted claims for payment for detoxification treatment provided to patients in beds for which SIUH had received no certificate of operation from the New York State Office of Alcoholism and Substance Abuse Services (OASAS).
Although SIUH was authorized to provide inpatient detoxification care to patients in 56 beds, it administered treatment in 12 additional beds located in a locked, separate wing and concealed the existence of the wing from OASAS. SIUH has agreed to pay the United States $11.8 million and nearly $15 million to the state of New York according to an agreement that has been approved by a U.S. District judge.
Elizabeth M. Ryan, widow of an SIUH cancer patient, asserted in her federal False Claims Act suit that SIUH fraudulently billed Medicare for stereotactic body radiosurgery treatment that was provided on an outpatient basis to cancer patients. The investigation established that from1996 through 2004, SIUH defrauded Medicare and TRICARE by knowingly using incorrect billing codes for cancer treatment performed at the hospital. By using incorrect codes, SIUH obtained reimbursement for treatment that was not covered by Medicare or TRICARE. SIUH will pay the United States $25 million to settle this claim according to an agreement that has been approved by a U.S. District judge.
The governments other two claims were resolved before the filing of suit. The federal government had determined that SIUH deliberately inflated its resident count from the 1996 cost report year through the 2003 cost report year; SIUH paid $37.5 million to resolve this claim. The hospital also paid about $1.5 million to settle allegations regarding SIUHs billings to Medicare and Medicaid for treatment of psychiatric patients in unlicensed beds during the period July 2003 through September 2005. Finally, SIUH has agreed to enter into a Corporate Integrity Agreement with the Office of Inspector General, Department of Health and Human Services under which the hospital will maintain a compliance program to help ensure against a recurrence of fraud.
