New York-Presbyterian/Queens Hospital Settles Allegations of Federal Health Care Fraud for Over $2.5 Million

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FILE PHOTO: The U.S. Department of Justice Building is pictured

Breon Peace, United States Attorney for the Eastern District of New York, announced today a settlement agreement with New York-Presbyterian/Queens Hospital. The settlement agreement, which requires a payment of over $2.5 million, addresses allegations that a former physician at New York-Presbyterian/Queens performed services that were not medically necessary and then billed federal health care programs for those services. The services involved the replacement of implantable cardioverter defibrillator (ICD) pulse generator batteries.

“This more than $2.5 million settlement rectifies that New York-Presbyterian/Queens was paid by the federal government for unnecessary procedures,” stated United States Attorney Peace. “This Office is committed to combatting fraud and abuse of our federal health care programs, especially when such conduct potentially puts patients at risk.”

Procedure Overview

An ICD is akin to a pacemaker. It is placed under a patient’s skin and is designed to ensure that the patient’s heart beats on a regular rhythm. ICDs run on batteries. Like all batteries, ICD batteries will eventually fail, which could lead to disastrous consequences, even death. But replacing an ICD battery involves a surgical procedure, which carries risk. Physicians closely monitor the functioning of ICD batteries so that they replace the batteries when they are nearing the end of their lives, but no earlier. That way, physicians can balance the risks associated with a failing ICD battery against the risk of the procedure needed to replace that battery. Put in more technical terms, the standard of care is to replace an ICD battery only when it reaches what is called the elective replacement interval (ERI) as determined by device interrogation conducted by specially equipped computerized monitors.

Settlement

A physician who was formerly affiliated with New York-Presbyterian/Queens repeatedly replaced ICD batteries earlier than was necessary. That is, he repeatedly replaced ICD batteries before they reached the ERI. Such batteries were functioning normally. He therefore subjected his patients to unneeded and risky surgical procedures. New York-Presbyterian/Queens then submitted claims for payments to federal health care programs for these procedures.

As a result of an internal investigation, New York-Presbyterian/Queens learned of the physician’s conduct. It voluntarily self-disclosed that conduct to the United States Department of Health and Human Services, Office of Inspector General. The settlement here, which requires New York-Presbyterian/Queens to pay $2,588,882.50 to the United States, resolves claims that the conduct violated the federal False Claims Act.

The matter was handled by Assistant United States Attorney Michael Blume of the Office’s Civil Division.