WASHINGTON – Brookhaven Memorial Hospital Medical Center, a Long Island, N.Y.-based hospital, has agreed to pay $2.92 million, plus interest, to settle allegations that the hospital defrauded Medicare, the Justice Department announced today.
The government alleged that the hospital fraudulently inflated its charges to Medicare patients to obtain enhanced reimbursement from the federal health care program. In addition to its standard payment system, Medicare provides supplemental reimbursement, called "outlier payments," to hospitals and other health care providers in cases where the cost of care is unusually high. Congress enacted the supplemental outlier payments system to ensure that hospitals possess the incentive to treat inpatients whose care requires unusually high costs. The lawsuit alleged that the hospital inflated its charges to obtain supplemental outlier payments for cases that were not extraordinarily costly and for which outlier payments should not have been paid.
"Conduct like that alleged here drives up the costs of health care for all of us," said Tony West, Assistant Attorney General for the Justice Department’s Civil Division. "The resolution announced today is the most recent in a series of settlements that illustrates the Justice Department's continued commitment to protecting the Medicare Trust Fund from hospitals that knowingly charge more than the law allows."
The suit was originally filed in the U.S. District Court for the District of New Jersey by a whistleblower, Tony Kite, in 2005. The United States intervened in the suit in November 2009. Mr. Kite brought his suit under the whistleblower provisions of the False Claims Act, which permit private citizens with knowledge of fraud against the government to bring a lawsuit on behalf of the United States and to share in any recovery. Under the civil settlement announced today, Mr. Kite will receive roughly $613,000, plus interest, out of the settlement proceeds.
"This office is determined to root out any conduct that threatens to undermine the integrity of the federal health care programs," said Paul J. Fishman, U.S. Attorney for the District of New Jersey.
The settlement is the result of a coordinated effort by the Commercial Litigation Branch of the Justice Department’s Civil Division; the U.S. Attorney’s Office for the District of New Jersey, Affirmative Civil Enforcement Unit; the Department of Health and Human Services, Office of Inspector General, and the Centers for Medicare and Medicaid Services; and the Federal Bureau of Investigation.
This settlement is part of the government’s emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover approximately $2.3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 have topped $3 billion. Since 2006, the United States has recovered over $1.2 billion from hospitals that it alleged engaged in outlier fraud.