Attorney General Recovers $1.7 Million From 77 Hospitals Across The State For Medicaid Overbillings

Attorney General Spitzer today announced that 77 hospitals across the state have agreed to repay more than $1.7 million for overbilling taxpayers. An investigation by the Attorney General's Medicaid Fraud Control Unit (MFCU) revealed that the hospitals improperly billed the Medicaid system for treating patients who had been transferred to them from hospices between 1994 and June of this year. Terminally ill Medicaid patients who enter hospices can, at times, require hospital inpatient care as well. Spitzer explained that such general inpatient care is covered by the payment rate hospices receive from the State Medicaid program. As a result, when a hospice patient is admitted to a hospital, the correct procedure is for the hospice to continue to bill Medicaid and pay the hospital itself for the patient's care. There should never be any patients who are the subjects of simultaneous claims by hospitals and hospices. "Apparently, this was just another case of hospitals establishing protocols to ensure that they were never underpaid, while at the same time failing to take necessary steps to prevent overpayments," said Spitzer. "The recovery of these sorely needed tax dollars from scores of hospitals across the state will help ensure that the needs of Medicaid patients are properly met."

Deputy Attorney General Jos' Maldonado, Director of Spitzer's MFCU, noted that the duplicate billing issue was discovered last September during an investigation of a hospice by the MFCU's Long Island Regional Office. Using the unit's data warehouse computer system, which contains years of adjudicated Medicaid claims, the review was expanded both in geographic scope and by time frame. "We then matched billings for the same patient on the same day and added the total amounts paid to the hospitals," he said. "What would have taken weeks to audit in the past was accomplished in a matter of minutes."

Spitzer added, "Once the problem was brought to the attention of the hospitals, they readily agreed to reimburse the State. They also asked for guidance to put safeguards in place to ensure that the problem would never occur again."

The statewide audit-investigation resulting in the repayment was principally conducted by Special Assistant Attorney General Michael P. Sofarelli, Deputy Director of MFCU's Special Projects Unit, and members of his staff, including Principal Special Auditor Granville Senior, and Associate Special Auditors Ali H. Sencer and Deowattie Khelawan. Additional assistance was provided by Chief Auditor Ronald Tysowski, Supervising Associate Auditor Christopher Simeti, and Associate Special Auditor Joann Satchwill, of MFCU's Long Island Regional Office.

All cases are handled under the direct supervision of Deputy Attorney General Jos? Maldonado.

HOSPITAL LOCATION TOTAL AMOUNT DUE (including interest)
AMSTERDAM HOSPITAL Amsterdam $24,871.55
ARDEN HILL HOSPITAL Goshen $5,478.37
ARNOT OGDEN MEDICAL CENTER Elmira $7,230.56
AUBURN MEMORIAL HOSPITAL Auburn $10,145.00
BAYLEY SETON HOSPITAL New York City $11,648.66
BENEDICTINE HOSPITAL Kingston $29,981.74
BETH ISRAEL KINGS HIGHWAY New York City $9,963.37
BETH ISRAEL MEDICAL CENTER New York City $144,237.61
BROOKHAVEN MEMORIAL HOSPITAL Patchogue $2,346.39
BROOKLYN HOSPITAL New York City $11,054.95
BROOKS MEMORIAL HOSPITAL Dunkirk $7,100.24
BRUNSWICK HOSPITAL CENTER Amityville $9,539.17
BUFFALO GENERAL HOSPITAL Buffalo $4,273.95
CAYUGA MEDICAL CENTER, ITHICA Ithaca $4,497.28
CENTRAL SUFFOLK HOSPITAL Riverhead $2,036.62
CHAMPLAIN VALLEY PHYSICIAN HOSPITAL Plattsburgh $33,640.46
COMMUNITY GENERAL, SULLIVAN Harris $10,919.77
CORNWALL HOSPITAL Cornwall $17,716.62
ELLIS HOSPITAL Schenectady $12,962.09
ELMHURST HOSPITAL New York City $66,223.49
ERIE COUNTY MEDICAL CENTER Buffalo $42,350.51
GENESEE GENERAL HOSPITAL Rochester $9,449.14
GENEVA GENERAL HOSPITAL Geneva $12,029.16
GLENS FALLS HOSPITAL Glens Falls $31,627.47
HARLEM HOSPITAL New York City $30,913.18
HORTON MEDICAL CENTER Middletown $25,694.36
HUDSON VALLEY HOSPITAL Cortland Manor $59,871.51
INTERFAITH MEDICAL CENTER New York City $2,569.01
IRA DAVENPORT HOSPITAL Bath $9,954.39
KINGSTON HOSPITAL Kingston $14,702.29
LAKESIDE MEMORIAL HOSPITAL Brockport $6,837.30
LAWRENCE HOSPITAL Bronxville $5,809.75
MASSENA MEMORIAL HOSPITAL Massena $11,929.81
JOHN T. MATHER MEMORIAL HOSPITAL Port Jefferson $5,809.49
MERCY COMMUNITY HOSPITAL Port Jervis $21,809.26
MERCY HOSPITAL Rockville Centre $9,368.71
MERCY HOSPITAL OF BUFFALO Buffalo $8,010.40
MILLARD FILLMORE HOSPITAL Buffalo $60,629.57
MONTEFIORE MEDICAL CENTER New York City $44,065.33
MOUNT VERNON HOSPITAL Mount Vernon $36,293.29
MYERS COMMUNITY HOSPITAL Sodus $5,791.81
NASSAU COUNTY MEDICAL CENTER East Meadow $24,791.18
NEW ROCHELLE HOSPITAL MEDICAL CENTER New Rochelle $54,775.86
NEW YORK HOSPITAL CENTER, QUEENS New York City $25,897.70
NORTH SHORE/LONG ISLAND JEWISH Glen Cove/Plainview $26,491.99
NYACK HOSPITAL Nyack $21,710.06
ONEIDA HEALTHCARE CENTER Oneida $14,036.62
OUR LADY OF VICTORY Lackawanna $10,245.47
PENINSULA HOSPITAL CENTER Far Rockaway $527.51
PHELPS MEMORIAL HOSPITAL Sleepy Hollow $20,436.38
PUTNAM HOSPITAL CENTER Carmel $8,464.49
ROCHESTER GENERAL HOSPITAL Rochester $24,346.73
ROME MEMORIAL HOSPITAL $4,546.29
ROSEWELL CANCER INSTITUTE Buffalo $25,013.80
SHEEHAN MEMORIAL HOSPITAL Buffalo $20,432.53
SOUTHSIDE HOSPITAL Bay Shore $9,135.55
ST. AGNES HOSPITAL New York City $33,622.09
ST. ANTHONY COMMUNITY HOSPITAL Warwick $14,184.11
ST. CHARLES HOSPITAL AND REHABILITATION Port Jefferson $9,790.06
ST. ELIZABETH MEDICAL CENTER Utica $6,944.03
ST. FRANCIS HOSPITAL Poughkeepsie $8,450.96
ST. JOHN'S RIVERSIDE HOSPITAL Yonkers $12,520.52
ST. JOSEPH HOSPITAL, ELMIRA Elmira $15,727.25
ST. JOSEPH'S HOSPITAL, SYRACUSE Syracuse $3,846.44
ST. JOSEPH'S HOSPITAL, YONKERS Yonkers $10,030.44
ST. LUKE'S HOSPITAL OF NEWBURGH Newburgh $53,778.45
ST. LUKE'S MEMORIAL HOSPITAL Utica $6,039.85
ST. LUKE'S ROOSEVELT HOSPITAL CENTER New York City $194,147.44
ST. PETER'S HOSPITAL, ALBANY Albany $13,812.47
ST. VINCENT MEDICAL CENTER New York City $10,768.27
STATEN ISLAND UNIVERSITY HOSPITAL New York City $4,796.33
UNITED HOSPITAL MEDICAL CENTER Port Chester $3,244.07
UNIVERSITY HOSPITAL, SUNY Syracuse $10,991.89
WESTCHESTER COUNTY MEDICAL CENTER Hawthorne $67,796.47
WHITE PLAINS HOSPITAL CENTER White Plains $41,656.75
WOMANS CHRISTIAN ASSOCIATION Jamestown $4,502.20
YONKERS GENERAL HOSPITAL Yonkers $4,922.37
    TOTAL $1,703,808.25


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