Mount Sinai Health System Agrees to $2.95 Million Fraud Settlement Owing to Medicaid

Attorney General Eric T. Schneiderman and United States Attorney Preet Bharara announced a $2.95 million fraud settlement with three hospitals in the Mount Sinai Health System resulting from Medicaid overpayments.

A whistleblower alleged that Mount Sinai Beth Israel, Mount Sinai St. Luke’s, and Mount Sinai Roosevelt knowingly retained over $844,000 in Medicaid overpayments beyond the 60-day repayment window, a violation of False Claims Acts (on both the state and federal levels). The hospitals’ former partnership group, Continuum Health Partners, Inc., experienced a software error in 2009, which sent hundreds of erroneous claims to Medicaid by 2011. These overpayments were not fully reimbursed to Medicaid for nearly two years. A $2.95 million fraud settlement was determined in a qui tam lawsuit, United States and the State of New York, ex rel. Robert P. Kane v. Healthfirst, Inc., et al.

The settlement could signal the beginning of a wave of similar lawsuits, with hospitals worried due to the FCA’s extensive statute of limitations of 10 years, to which an additional 6 years may be added due to a Centers for Medicare and Medicaid Services rule finalized in February of this year.

For further clarification regarding the above, please contact Adrienne Dresevic, Esq., at adresevic@thehlp.com, or Carey Kalmowitz, Esq., at ckalmowitz@thehlp.com, or alternatively, please reach them at our offices by calling (248) 996-8510 or (212) 734-0128.