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Post date: June 27 2014

A.G. Schneiderman Announces Lawsuit Against Continuum Health Partners, Beth Israel Medical Center And St. Luke’s-Roosevelt

Lawsuit Alleges False Claims Act Violations Against Continuum Health Partners, Beth Israel Medical Center And St. Luke’s Roosevelt

Schneiderman: Those Who Fail To Return Funding That Isn’t Rightfully Theirs Will Be Held Accountable

NEW YORK – Attorney General Eric T. Schneiderman today announced that his office has filed a lawsuit alleging that Continuum Health Partners, Inc., Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center, headquartered in New York, failed to return money to the New York State Medicaid Program that they knew they had no right to have received.

“This lawsuit sends the message that those who violate the New York State False Claims Act and fail to return funding that isn’t rightfully theirs will be held accountable,” Attorney General Eric T. Schneiderman said. “My office will continue working diligently on all fronts to protect the integrity of the Medicaid Program.” 

The complaint in intervention alleges that between 2009 and 2010 Beth Israel and St. Luke’s-Roosevelt, submitted improper claims to Medicaid for services rendered to Healthfirst enrollees as a result of a computer error. In 2010, the New York State Comptroller’s office informed Continuum (which at the time of the conduct operated Beth Israel and St. Luke’s-Roosevelt) that it had identified a handful of improper claims stemming from the computer problem. After learning of this from the Comptroller’s Office, Continuum conducted an internal investigation.

The complaint also alleges that in February of 2011, Continuum identified over 900 potentially improper claims to Medicaid, totaling approximately $1,000,000. It also alleges that nonetheless, Continuum failed to take steps to repay all of the affected claims within 60 days after these claims had been identified, and that Continuum proceeded to repay only small batches of affected claims, some of which were brought to its attention by the Comptroller, over the next two-plus years. Final repayments were not made until March 2013, and repayments were made for more than 300 of the claims only after the United States, through the United States Attorneys’ Office for the Southern District of New York, issued a Civil Investigative Demand to Continuum concerning these payments in June 2012.  

The complaint against Continuum, Beth Israel and St. Luke’s-Roosevelt was filed under the New York False Claims Act and other statutes in U.S. District Court for the Southern District of New York.

The Attorney General’s Medicaid Fraud Control Unit and the United States Attorneys’ Office for the Southern District of New York coordinated on the investigation. The New York investigation was conducted by Special Auditor-Investigator Elliot Hirshon and Special Auditor Investigator Deowattie Persaud.

The matter is being handled by Special Assistant Attorney General Jacob M. Bergman of the Attorney General’s Medicaid Fraud Control Unit, led by Acting Director Amy Held, and Executive Deputy Attorney General of the Division of Criminal Justice Kelly Donovan. 

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