Oswego Hospital And Physician Combine To Pay Over $1.5 Million To Resolve Billing Improprieties Self-Disclosed By The Hospital

SYRACUSE, NEW YORK – Oswego Hospital (“Oswego”), a 164-bed acute care community hospital located in Oswego, New York will pay $1,456,457.33 to resolve False Claims Act liability stemming from healthcare billing improprieties that the hospital selfdisclosed to the federal government, announced United States Attorney Richard S. Hartunian. Dr. Vilas Patil, a physician formerly working as an independent contractor with Oswego, has paid $204,365.97 to resolve False Claims Act liability in connection with a related investigation. Under the settlements, the United States will receive $1,026,790.89, and the State of New York, which also participated in the investigation, will receive $429,666.44.

During the course of an internal review, Oswego identified a number of billing improprieties in its Behavioral Health Services Department. Specifically, Oswego identified claims that were paid by federal and state payors where the supporting medical record documentation: (1) was not created or could not be located; (2) contained incorrect service dates; (3) were simply verbatim treatment notes from prior appointments with patients; and/or (4) failed to include time-related information required for certain time-based billing codes. Oswego promptly took corrective steps to remedy the problems and brought its findings to the government’s attention. Due in large part to Oswego’s decision to self-disclose these issues and its cooperation throughout the government’s investigation, Oswego was required to pay far less than the treble damages and penalties that the United States is authorized to seek under the False Claims Act. Furthermore, the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) decided that Oswego would not have to enter into a corporate integrity agreement or adopt other compliance measures.

United States Attorney Hartunian said: “Our office is committed to ensuring that federal health care programs and their beneficiaries receive the services for which the government pays. The settlements in this investigation demonstrate how voluntary self-disclosures benefit both the integrity of the health care programs and the providers who discover and report improper billing in their organizations. Oswego should be commended for the manner in which it handled the disclosure and investigation.”

“Medicaid serves many New Yorkers’ essential health care needs and I will continue to work with partners in government to protect this important program,” said Attorney General Eric Schneiderman. “This settlement illustrates the importance of hospitals being mindful of billing requirements for government-sponsored healthcare. Through its cooperation with the investigation and return of Medicaid funds, Oswego Hospital demonstrated its accountability and commitment to abide by government healthcare rules and regulations and uphold the highest standards of integrity.”

The United States encourages all health care providers to self-disclose any known violations that have resulted in the submission of improper claims to federal health care programs. The investigation and settlements were the result of coordinated effort among the United States Attorney’s Office for the Northern District of New York, on behalf of HHS-OIG, the Defense Criminal Investigative Service, and the New York State Attorney General (Medicaid Fraud Control Unit). Locally, the United States was represented by Assistant United States Attorney Michael D. Gadarian.