September 15, 2008 — Staten Island University Hospital
Staten Island University Hospital (SIUH) has agreed to pay $74,032,565 to settle qui tam actions filed against by two private relators, Dr. Miguel Tirado, a former SIUH Director of Chemical Dependency Services, and Elizabeth M. Ryan, the widow of a SIUH cancer patient.
The allegations of the case were that the hospital had fraudulently billed Medicare and TRICARE by knowingly using incorrect billing codes for cancer treatment performed at the hospital. By using incorrect codes, SIUH obtained payment for treatment that was not covered by Medicare or TRICARE.
The allegations also included claims that SIUH had fraudulently billed Medicare and Medicaid for inpatient detoxification treatment.
A government investigation precipitated by the qui tam actions established that SIUH submitted claims for payment for detoxification treatment provided to patients in beds for which SIUH had received no certification of operation from the New York State Office of Alcoholism and Substance Abuse Services (OASIS).
Although SIUH was authorized to provide inpatient detoxification care to patients in 56 beds, it administered treatment in 12 additional beds located in a locked separate wing and concealed the existence of the wing from OASIS.
As a reward for having filed their qui tam claims, Dr. Tirado will receive $5.2 Million, and Ms. Ryan will receive $3.75 Million.
See U.S. Dept of Justice Press Release 9/15/08