Strong Memorial Hospital Pays $492,000 To Settle Medicaid And Medicare Probes

Attorney General Spitzer today announced that the University of Rochester’s Strong Memorial Hospital has repaid taxpayers $492,507 as a result of state and federal probes into improper billing.

Both the Attorney General’s Medicaid Fraud Control Unit (MFCU) and the Health and Human Services’ Office of Inspector General (OIG) audited the billing records of the hospital’s Digestive Disease Unit for the period September 2001 through December 2003. Based on those audits, MFCU and OIG contended that Strong wrongly billed for endoscopic procedures. Strong claimed that services had been provided by Dr. Uma Sundaram, the former head of the digestive disease unit, when those procedures had in fact been provided by physician fellows, without proper supervision by Dr. Sundaram. This violated both Medicaid and Medicare teaching physician guidelines. The audits further revealed that procedures had been performed in instances where the information in the patients’ medical records did not demonstrate that the procedure was medically necessary.

In agreements with MFCU and with the United States Attorney’s office, Strong agreed to resolve the audit allegations by repaying $292,507 to Medicaid and $200,000 to Medicare. As a further part of the agreement, Strong has agreed to maintain a vigorous compliance program to ensure that its operations conform to the requirements of federal and state laws and regulations governing the Medicaid and Medicare programs.

Spitzer thanked the Department of Health’s Office of Professional Medical Conduct, Health and Human Services Office of Inspector General, and the United States Attorney for the Western District of New York for their assistance and cooperation. Spitzer further noted that Strong cooperated with the investigation and has replaced Dr. Sundaram as head of the unit.

The investigation resulting in the settlement was conducted by Special Assistant Attorney General Jerry Solomon, Director of the MFCU’s Rochester Regional Office, Principal Auditor Investigator Thomas Clarke and Senior Special Investigator William Falk of the MFCU, Assistant United States Attorney Robert Trusiak and Investigator Cindy Pangallo of the OIG.

Strong Memorial Hospital is located at 601 Elmwood Avenue, Rochester, New York.