New York City-based New York-Presbyterian Hudson Valley Hospital will pay $6.8 million to resolve allegations it improperly paid a Westchester, N.Y.-based oncology practice to induce referrals later billed to Medicare and Medicaid, according to a Dec. 22 Justice Department news release.
Here are five things to know:
1. Federal officials allege the hospital entered into three contracts with the practice between 2011 and 2012. The agreements called for the hospital to pay hundreds of thousands of dollars annually for work tied to proposed projects, including planning for a melanoma center, planning for a breast cancer center and developing an intraoperative radiation therapy service line The hospital paid the practice more than $4 million between 2011 and 2019, according to the complaint.
2. Officials allege the practice often did not perform the contracted work, did not perform it as required or did not maintain adequate documentation — including time records — to support the payments.
3. The complaint also alleges the hospital kept paying the practice despite the lack of documentation, while continuing to receive referrals that generated millions of dollars in Medicare and Medicaid reimbursements.
4. The hospital admitted and accepted responsibility for certain conduct alleged by the government, including paying more than $4 million for work that was not performed, not performed as required, or lacked time records.
5. By October 2016, officials said the hospital either knew, or should have known, that the practice was performing only part of the work required under the radiation therapy agreement and was not completing most of the work under the melanoma directorship agreement. Even so, the hospital allegedly continued paying under both agreements for another three years.
New York-Presbyterian Hudson Valley Hospital declined to respond to Becker’s requests for comment.
