NEWARK, N.J. – Saint Michael’s Medical Center Inc., located in Newark, New Jersey, has agreed to pay $450,000 to resolve allegations that it falsely billed Medicare and Medicaid for medically unnecessary cardiac procedures, U.S. Attorney Paul J. Fishman announced today.
Under Medicare and Medicaid rules, health care providers have a duty to provide services only when they are medically necessary. In addition, government health care programs only authorize payment for reasonable and necessary medical services. Today’s settlement resolves allegations that, during the period from Jan. 1, 2009, through Jan. 1, 2015, Saint Michael’s allegedly submitted claims for percutaneous coronary interventions, catheterizations, and stents performed in its cardiac catheterization lab that were not medically necessary.
The allegations were raised in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Timothy Gallagher in Newark, and the U.S. Department of Health and Human Services, Office of the Inspector General, under the direction of Special Agent in Charge Scott J. Lampert, with the investigation leading to the settlement.
The government is represented by Assistant U.S. Attorneys Lucy Muzzy and Bernard J. Cooney of the Health Care and Government Fraud Unit and Assistant U.S. Attorney Eamonn J. O’Hagan of the office’s Financial Litigation Unit.
U.S. Attorney Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $1.29 billion in health care fraud and government fraud settlements, judgments, fines, restitution and forfeiture under the False Claims Act, the Food, Drug and Cosmetic Act and other statutes.
The claims settled by this agreement are allegations only, and there has been no determination of liability.
Defense counsel: Bruce Levy Esq., Newark.
Relator’s counsel: David J. Caputo Esq., Philadelphia