Mount Sinai hospitals to pay $2.9M to settle false claims case

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Three hospitals that are part of New York City-based Mount Sinai Health System have agreed to pay a total of $2.95 million for delaying repayment of more than $800,000 in Medicaid overpayments, according to the Department of Justice.

In June 2014, the federal government intervened in a whistle-blower lawsuit alleging Continuum Health Partners in New York City — now part of Mount Sinai — had failed to return Medicaid overpayments to the government within the 60-day period required by the Affordable Care Act.

Under the 60-day repayment rule, any entity that receives an overpayment from the state or federal government must report and return the overpayment within 60 days.

The government alleged that between 2009 and 2010 Mount Sinai Beth Israel, Mount Sinai St. Luke's and Mount Sinai Roosevelt erroneously submitted claims to Medicaid for payment due to a software error.

The New York State comptroller notified Continuum of the software glitch in 2010. In February 2011, Robert Kane — the employee who filed the whistle-blower suit — provided a list of the claims affected by the software error to Continuum. It took the system nearly two years to complete its repayments for the 444 erroneously billed Medicaid claims in violation of the 60-day repayment rule.

In a ruling last August that preserved the whistle-blower's case against the hospitals, U.S. District Judge Edgardo Ramos said an overpayment is identified when a healthcare provider is put on notice of a possible overpayment. "After Kane put defendants on notice of a set of claims likely to contain numerous overpayments, defendants had an established duty to report and return wrongly collected money," Judge Ramos wrote in his decision.

More articles on healthcare industry lawsuits:

Former CEO of West Virginia hospital sued for defamation
Federal judge orders Walker County to pay Erlanger $8.7M in hospital loan dispute
Calif. hospital to pay 3 former employees $1.7M in harassment suit

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