DOJ Catch of the Week - St. Joseph's Hospital Health Center
By the C|C Whistleblower Lawyer Team
This week’s Department of Justice “Catch of the Week” goes to St. Joseph’s Hospital Health Center. On Monday, the Central New York hospital agreed to pay $3.2 million to resolve allegations it violated the federal False Claims Act and New York False Claims Act by billing the state Medicaid program for mental health services provided by unqualified staff. See DOJ Press Release.
St. Joseph’s operates a Comprehensive Psychiatric Emergency Program (CPEP) that treats individuals suffering from acute mental health episodes. Some of this treatment is provided through St. Joseph’s “mobile crisis outreach” unit to patients unable or unwilling to use the hospital’s emergency room services or those needing follow-up care after an emergency room visit. Under New York law, CPEPs operating outside an emergency room must be staffed with at least two employees, one of whom is a professional or credentialed health care worker such as a physician, psychiatrist, psychologist, registered nurse, social worker or alcohol or rehabilitation counselor. According to the government, St. Joseph’s for the past decade billed Medicaid for mobile-crisis outreach services that failed to comply with these basic CPEP staffing requirements. As part of the settlement, St. Joseph’s admitted to its violations of these requirements.
In announcing the settlement, the government stressed its commitment to enforcing the laws intended to ensure that mental health care patients are treated only by qualified personnel. New York Attorney General Eric Schneiderman stated that “mental health staffing requirements are intended to protect the public and avoid the waste of public funds by ensuring that services are delivered by qualified personnel in a meaningful way.” United States Attorney Richard S. Hartunian echoed this sentiment, noting his office’s “commitment to protecting Central New York’s most vulnerable citizens, including those in crisis . . . [and] ensuring that taxpayers do not pay for services rendered by unlicensed or unqualified individuals.”
The allegations against St. Joseph’s originated in a whistleblower lawsuit filed by registered nurse Catherine Lembo under the qui tam provisions of the federal and New York False Claims Acts. Ms. Lembo will receive a whistleblower award of $560,000 from the proceeds of the government’s recovery.
Tagged in: Catch of the Week, FCA Federal, FCA State, Hospital Fraud, Improper Medical Personnel,