New York Presbyterian Hospital Pays Over $800,000 to Settle Claims that Physician Practices Improperly Billed Government Health Care Programs

 

Government Alleged that Radiation Oncology Practices Failed to Properly Review Images Taken for Guided Radiation Therapy

Breon Peace, United States Attorney for the Eastern District of New York, announced today that New York Presbyterian Hospital (NYPH) has agreed to pay $801,000 to resolve claims that two radiology practices improperly billed Medicare, Medicaid and TRICARE for images used in image guided radiation therapy treatments (IGRT) provided to cancer patients.  The settlement agreement, which resolved claims under the Federal False Claims Act, was approved on January 19, 2024 by United States District Judge William F. Kuntz, II.

“The defendants provided substandard care to cancer patients by not properly or timely reviewing medical imaging and then billed taxpayer funded healthcare programs for these shoddy services,” stated United States Attorney Breon Peace. “My Office is committed to holding healthcare providers accountable for such conduct.”

Mr. Peace thanked the U.S. Department of Health and Human Services, Office of Inspector General, Federal Bureau of Investigation, Office of Personnel Management, Defense Healthcare Agency, and the New York State Office of Attorney General’s Medicaid Fraud Control Unit for their work on this case.

Radiation Therapist Associates, P.C. (RTA) and Leading Edge Radiation Oncology Services, PLLC (LEROS), which are no longer operating, provided outpatient radiation oncology services to several Brooklyn communities.  RTA was a physician practice located within Methodist Hospital and operated under a contract with a predecessor of NYPH.  LEROS was operated by an overlapping group of physicians and was a joint venture between NYPH’s predecessor and LEROS. 

IGRT is a type of cancer treatment that uses imaging technologies such as PET, MRI, and CT to deliver radiation more accurately and safely to cancer cells.  It uses periodically taken images to guide the precise delivery of radiation. 

The United States claimed that between 2012 and 2018, RTA and LEROS billed for images utilized in IGRT when such images were either not reviewed, or were not timely reviewed, and therefore were not reasonable and necessary.  Further, the investigation found that initial consultation sessions at RTA were in some instances billed at a higher coding level than appropriate. 

Under the terms of the agreement with the United States and the State of New York, NYPH will pay a total of $801,000, with $694,999.71 going to the United States and $106,000.29 to the State of New York.  These funds will go to the Medicare, Medicaid, and TRICARE programs.

The settlement includes the resolution of a civil action brought under the qui tam or whistleblower provisions of the False Claims Act.  Under the qui tam provisions of the False Claims Act, a private party can file an action on behalf of the United States and receive a portion of the settlement if the government takes over the case and reaches a monetary agreement with the defendant.  The claims resolved by the settlement are allegations only and there has been no admission of or determination of liability.