New Jersey Hospital to Pay $3 Million to Resolve Allegations of Medicare Fraud

The United States has entered into a settlement with a New Jersey hospital and filed a motion to intervene in a lawsuit against a New York hospital involving allegations that the hospitals defrauded Medicare, the Justice Department recently announced.

The United States settled for $3.02 million, plus interest, with Trinitas Regional Medical Center in Elizabeth, N.J. The United States is also seeking to intervene in a lawsuit brought against Brookhaven Memorial Hospital in East Patchogue, N.Y.

Both of the hospitals are defendants in a suit brought by a whistleblower, Tony Kite, in 2005. The lawsuit involved allegations that the hospitals fraudulently inflated their charges to Medicare patients to obtain enhanced reimbursement from Medicare.

In addition to its standard payment system, Medicare provides supplemental reimbursement, called "outlier payments," to hospitals and other health care providers in cases where the cost of care is unusually high. Congress enacted the supplemental outlier payments system to ensure that hospitals possess the incentive to treat inpatients whose care requires unusually high costs. The lawsuit alleged that the hospitals inflated their charges to obtain supplemental outlier payments for cases that were not extraordinarily costly and for which outlier payments should not have been paid.

"As today's actions demonstrate, the Department of Justice is committed to pursuing those who defraud Medicare and drive up the cost of health care," said Assistant Attorney General Tony West, head of the Justice Department's Civil Division. West noted that the settlement and intervention announced were the result of the collaborative efforts of the Civil Division of the Department of Justice, the U.S. Attorney's Office for the District of New Jersey, the Office of Inspector General of the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, and the Federal Bureau of Investigation.

"This office is determined to protect the integrity of the Medicare system for the citizens of New Jersey and of the United States," said U.S. Attorney Paul J. Fishman.

Kite brought his suit under the qui tam or whistleblower provisions of the False Claims Act, which permit private citizens with knowledge of fraud against the government to bring a lawsuit on behalf of the United States and to share in any recovery. Under the civil settlements announced, Kite will receive roughly $679,000, plus interest, out of the total recovery against Trinitas Regional Medial Center.

Download Center

HTML - No Current Item Deck
  • Safety Management Software - Free Demo

    IndustrySafe Safety Software’s comprehensive suite of modules help organizations to record and manage incidents, inspections, hazards, behavior based safety observations, and much more. Improve safety with an easy to use tool for tracking, notifying and reporting on key safety data.

  • Create Flexible Safety Dashboards

    IndustrySafe’s Dashboard Module allows organizations allows you to easily create and view safety KPIs to help you make informed business decisions. Our best of breed default indicators can also save you valuable time and effort in monitoring safety metrics.

  • Schedule and Record Observations

    IndustrySafe's Observations module allows managers, supervisors, and employees to conduct observations on employees involved in safety critical behavior. IndustrySafe’s pre-built BBS checklists may be used as is, or can be customized to better suit the needs of your organization.

  • Why Is Near Miss Reporting Important?

    A near miss is an accident that's waiting to happen. Learn how to investigate these close calls and prevent more serious incidents from occurring in the future.

  • Get the Ultimate Guide to Safety Training

    When it comes to safety training, no matter the industry, there are always questions regarding requirements and certifications. We’ve put together a guide on key safety training topics, requirements for certifications, and answers to common FAQs.

  • Industry Safe
comments powered by Disqus

OH&S Digital Edition

  • OHS Magazine Digital Edition - May 2019

    May 2019

    Featuring:

    • RESPIRATORY PROTECTION
      Why Pick a PAPR? 
    • FIRE SAFETY TRAINING
      Fire Safety: Plan, Prevent, Train, Recover
    • PROTECTIVE APPAREL
      The Truth About Heat Stress and FRC
    • AIHCE EXP 2019 PREVIEW
      Underestimated No More
    View This Issue