SYRACUSE, NEW YORK – Oswego Hospital has agreed to pay $98,694.36 to resolve allegations that it knowingly violated the False Claims Act by: (1) improperly billing Medicare and Medicaid for outpatient mental healthcare services that were rendered by an unsupervised LMSW, and (2) improperly billing Medicaid for outpatient mental healthcare services rendered by another LMSW for which Oswego Hospital could not provide documentation to support those claims.
“The integrity and strength of our federal healthcare system depends on accurate and honest billing for services that are provided by qualified healthcare workers,” said United States Attorney Carla Freedman. “We will continue to use the False Claims Act to hold healthcare providers accountable when their billing practice do not meet this standard.”
This case began in April of 2019, when a whistleblower filed a qui tam complaint investigation under seal in the United States District Court for the Northern District of New York. When a whistleblower, or “relator,” files a qui tam complaint, the False Claims Act requires the United States to investigate the allegations and elect whether to intervene and take over the action or to decline to intervene and allow the relator to go forward with the litigation on behalf of the United States. The relator is generally able to then share in any recovery. The relator in this case will receive $19,738.87 of the settlement proceeds. The case is docketed with the U.S. District Court for the Northern District of New York under number 5:19-cv-0431 (GTS/ATB).
The investigation and settlement were the result of a coordinated effort among the U.S. Attorney’s Office for the Northern District of New York, the New York State Attorney General’s Office, the Department of Health and Human Services Office of the Inspector General and the Defense Criminal Investigative Service on behalf of the Defense Health Agency. The United States was represented by Assistant U.S. Attorney Carl G. Eurenius, and New York State was represented by Special Assistant Attorney General Ralph D. Tortora, III.