United States Attorney's Office District of Connecticut
Press Release

YALE-NEW HAVEN HOSPITAL ENTERS INTO FEDERAL CIVIL SETTLEMENT AGREEMENT

Nora R. Dannehy, Acting United States Attorney for the District of Connecticut, today announced that YALE-NEW HAVEN HOSPITAL, located at 20 York Street, New Haven, has entered into a civil settlement agreement with the Government in which it will pay $885,953 to resolve allegations that it billed the Medicare program for medically unnecessary inpatient hospital admissions.

Acting U.S. Attorney Dannehy explained that the allegations against YALE-NEW HAVEN HOSPITAL involved charges to Medicare for inpatient hospital admissions for patients who were undergoing Gamma Knife stereotatic radiosurgery procedures.  Gamma Knife is a non- invasive treatment that directs focused radiation to a specific target, while causing little or no damage to surrounding tissue.  It is utilized to treat malignant and benign tumors, vascular abnormalities, trigeminal neuralgia (a nerve condition that causes chronic pain), and other neurological conditions.  Typically, such treatment is performed on an outpatient basis without general anesthesia.

The allegations against YALE-NEW HAVEN HOSPITAL involved cases where, instead of performing the Gamma Knife procedures on an outpatient basis, YALE-NEW HAVEN HOSPITAL admitted the patients for overnight stays and billed Medicare for inpatient admissions that were not medically necessary.  After YALE-NEW HAVEN HOSPITAL received a letter in April 2006 from Qualidigm, the Medicare Quality Improvement Organization, notifying the hospital that there was a lack of medical necessity to support one patient’s inpatient admission for a Gamma Knife surgical procedure, YALE-NEW HAVEN HOSPITAL performed an internal review of its billings and determined that the inpatient overnight stays for Gamma Knife procedures were generally not medically necessary.  Thereafter, in September 2006, YALE-NEW HAVEN HOSPITAL voluntarily notified the Medicare contractor and the U.S. Department of Health and Human Services, Office of Inspector General, of the improper billing and offered to refund Medicare for these inpatient admissions for a four-year time period, from April 2002 to April 2006.  YALE-NEW HAVEN HOSPITAL then sent Medicare a refund in the amount of $2,356,702, for the April 2002 to April 2006 time period.

After further investigation, the Government determined that YALE-NEW HAVEN HOSPITAL also charged Medicare for medically unnecessary inpatient admissions related to Gamma Knife procedures during the time period April 1, 1998 to March 31, 2002.  Pursuant to the civil settlement agreement entered into between YALE-NEW HAVEN HOSPITAL and the Government, YALE-NEW HAVEN HOSPITAL agreed to reimburse Medicare for an additional $885,953, to cover this earlier time period.

In entering into the civil settlement agreement, YALE-NEW HAVEN HOSPITAL did not admit liability.

YALE-NEW HAVEN HOSPITAL fully cooperated with the Government in its investigation of this case.

This case was investigated by the Office of Inspector General for the Department of Health and Human Services and was prosecuted by Assistant United States Attorney Richard M. Molot, along with Auditor Kevin A. Saunders.

People who suspect health care fraud are encouraged to report it by calling the Health Care Fraud Working Group at (203) 785-9270 or 1-800-HHS-TIPS.

CONTACT:

U.S. ATTORNEY'S OFFICE
Tom Carson
(203) 821-3722
thomas.carson@usdoj.gov