Oswego Hospital agrees to pay more than $98K fine for improper Medicare, Medicaid billing

OSWEGO, N.Y. — Oswego Hospital has agreed to pay more than $98,000 to resolve allegations that it “knowingly violated” the False Claims Act by improperly billing Medicare and Medicaid for outpatient mental-health care services that were rendered by an unsupervised licensed master social worker (LMSW).

The violation also involved improperly billing Medicaid for outpatient mental-health care services rendered by another LMSW for which Oswego Hospital could not provide documentation to support those claims.

That’s according to a Wednesday news release from the U.S. Attorney’s Office Northern District of New York.

“The integrity and strength of our federal health-care system depends on accurate and honest billing for services that are provided by qualified healthcare workers,” U.S. Attorney Carla Freedman said. “We will continue to use the False Claims Act to hold health-care providers accountable when their billing practices do not meet this standard.”

In a statement forwarded to CNYBJ Thursday afternoon, Oswego Health said it “takes compliance very seriously and we openly communicated and fully cooperated with federal and state officials during the investigation. Behavioral Health leadership has implemented a process to ensure ongoing supervision of the social workers is documented on an ongoing basis. In addition, due to the complex regulatory requirements we are faced with, Oswego Hospital annually conducts audits and reviews our services to ensure we maintain compliant practices.”

This case began in April 2019 when a whistleblower filed a qui tam complaint investigation under seal in the U.S. District Court for the Northern District of New York. When a whistleblower, or “relator,” files a qui tam complaint, the False Claims Act requires the U.S. to investigate the allegations and elect whether to intervene and take over the action or to decline to intervene and allow the relator to go forward with the litigation on behalf of the U.S.

The relator is generally able to then share in any recovery. The relator in this case will receive $19,738.87 of the settlement proceeds.

The investigation and settlement were the result of a coordinated effort among the U.S. Attorney’s Office for the Northern District of New York, the New York State Attorney General’s Office, the U.S. Department of Health and Human Services Office of the Inspector General and the Defense Criminal Investigative Service on behalf of the Defense Health Agency.

The U.S. was represented by Assistant U.S. Attorney Carl Eurenius, and New York State was represented by Special Assistant Attorney General Ralph Tortora, III.