A health care provider in the lower Hudson Valley has agreed to pay $14.7 million to the federal government and $895,427 to New York State for submitting inflated and otherwise ineligible claims for payment, the U.S. Justice Department announced this week.
Health Quest Systems Inc. and a subsidiary hospital, Putnam Hospital Center, accepted responsibility for submitting improper claims to the government from April 2009 to June 2015.
The company submitted claims without sufficient documentation for the level or service billed during that time, the DOJ said.
For nine months in 2014, Health Quest also submitted allegedly false claims for inpatient and outpatient services referred to Putnam Hospital Center by two orthopedic physicians. The physicians had a direct financial relationship with the hospital for providing administrative services and received compensation from the hospital, the DOJ said. Prosecutors alleged that the compensation received by the physicians was more than the fair market value for the services, which is against federal law.
Health Quest also submitted claims for home health services without sufficient medical records, including documentation of a face-to-face encounter with a physician from April 2011 to August 2014, prosecutors said.
“Today’s settlement holds Heath Quest responsible for false billings to federally funded health care programs, as well as claims tainted by a hospital’s payments to two physicians for administrative services where it appears that one purpose of those payments was to improperly induce referrals,” said U.S. Attorney Grant Jaquith for the Northern District of New York. “Hospitals and providers must be vigilant to make sure that claims accurately reflect medical services provided and are supported by sufficient documentation. We will continue to investigate whistleblower complaints vigorously to protect public funds.”
Health Quest President and CEO Robert Friedberg said in a statement that while the allegations covered an array of issues, there were no claims by prosecutors of patient mistreatment.
“Our doctors, nurses and employees work every day to provide the highest quality of care to the tens of thousands of patients we treat each year,” Friedberg said. “Our intent is always to comply with government regulations. We appreciate the opportunity to work with and finally resolve the matter with all relevant parties, including the U.S. Department of Justice.”
The settlement resolves three lawsuits brought by former employees of Health Quest under the qui tam, or whistleblower, provisions of the False Claims Act.