Wednesday, March 27, 2024

Gamma Healthcare and Three of Its Owners Agree to Pay $13.6 Million for Allegedly Billing Medicare for Lab Tests That Were Not Ordered or Medically Necessary

 

Gamma Healthcare Inc. (Gamma), a laboratory located in Poplar Bluff, Missouri, and three of its owners, Jerry W. Murphy, Jerrod W. Murphy and Joel W. Murphy (the Murphys), have agreed to pay the United States $13,619,660.18 to resolve allegations that they violated the False Claims Act (FCA) by submitting or causing the submission of claims to Medicare for lab tests that were not ordered by health care providers and were not medically necessary. Gamma, Jerry W. Murphy and Jerrod W. Murphy also agreed to a 15-year exclusion from participating in federal health care programs.  

The settlement announced today resolves allegations that, from Jan. 1, 2020, to Oct. 31, 2020, Gamma and the Murphys submitted or caused to be submitted claims to Medicare for medically unnecessary polymerase chain reaction (PCR) urinalysis laboratory tests that were not ordered by treating physicians. When a physician ordered a urinalysis (UA) with culture and sensitivity (C&S) or just a C&S, Gamma automatically performed, and submitted claims for payment to Medicare for, a urinary tract infection (UTI) panel of tests by PCR (the UTI PCR Tests). Medicare reimbursements for the UTI PCR Tests were significantly higher than reimbursements for a UA with C&S — on average, Medicare paid approximately $11 for a UA with C&S but paid an additional $573 for a panel of UTI PCR Tests. Gamma’s requisition forms were structured in a way that did not allow physicians to opt out of the UTI PCR Tests. Physicians expressed concerns to Gamma about the UTI PCR Tests as early as March 2020, including concerns that they did not order the tests, that the tests were expensive and that they were not medically necessary.

“Laboratories are permitted to bill federal healthcare programs only for medically necessary tests that are actually ordered by physicians,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “The department will continue to hold accountable those who seek to misuse federal healthcare programs for their own financial gain.”

“We’d like to thank the whistleblower for bringing his concerns forward,” said U.S. Attorney Sayler A. Fleming for the Eastern District of Missouri. “As a result, Gamma and its owners who were responsible for this fraud will not be able to participate in federal health care programs for 15 years, and a large sum of money is being returned to Medicare.”

“Health care providers who cause the submission of Medicare claims for medically unnecessary services pose a significant risk to the program and the patients who rely on it,” said Special Agent in Charge Linda Hanley of the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG works diligently with our law enforcement partners to hold accountable individuals who, to satisfy their own greed, exploit federal health care programs.”

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Bradley Bibb M.D., a physician who owns a number of health care clinics and provided services to patients for whom Gamma performed laboratory tests. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States ex rel. Bibb v. Gamma Healthcare Inc. et al., No. 1:20-cv-00250-SNLJ (E.D. Mo). Bibb will receive $2,315,342.23 of the proceeds from the settlement.

The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section and the U.S. Attorney’s Office for the Eastern District of Missouri, with substantial assistance from HHS-OIG and FBI. Trial Attorney Elizabeth J. Kappakas of the Civil Division’s Fraud Section and Assistant U.S. Attorney Suzanne Moore for the Eastern District of Missouri handled the matter, with the assistance of Financial Analyst Sheryl Paynter of the Civil Division.  

The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to HHS at 800-HHS-TIPS (800-447-8477).

The claims resolved by the settlement are allegations only and there has been no determination of liability.

Representative Jamaal Bowman -Join My Cure Violence Community Conversation

 

Dear Neighbor, 

I want to invite you to my Cure Violence Community Conversation today, Wednesday, March 27th at 6:30pm at the Boys and Girls Club in Mount Vernon at 350 S 6th Ave. We’ll have a youth-focused conversation about ending violence and we hope to brainstorm ideas to combat violence and promote community healing. I hope to see you there.

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For any questions or assistance from my office, you can reach us at the phone numbers below or at Bowman.casework@mail.house.gov. To get updates on future events, sign up for our newsletter by clicking the subscribe button at the top of this message or by visiting our website.  

MAYOR ADAMS LAUNCHES MULTI-PRONGED EFFORT TO CONNECT MORE NEW YORKERS TO JOBS AND TRAINING, REDUCE BARRIERS TO OPPORTUNTIES

 

Targeting Areas with High Unemployment, Adams Administration Will Bring Public and Private “Hiring Halls” Directly to Communities, Launch New Jobs and Talent Portal

 

Adams Administration Has Already Reformed Requirements to Make City Jobs More Accessible


New York City Mayor Eric Adams today announced “Jobs NYC,” a new multi-pronged citywide effort to reduce barriers to economic opportunities and deliver workforce development services directly to communities across the five boroughs that are experiencing high unemployment. The collaborative effort will focus on three core pillars: 1) revamping the administration’s “hiring halls” in an effort to bring public and private job opportunities and career services to economically-disadvantaged communities on a monthly basis in each borough, 2) launching a new Jobs.nyc.gov talent portal to connect New Yorkers to job and training opportunities, and 3) continuing to reform the city’s Minimum Qualification Requirements to make certain entry-level jobs within city government are more accessible. In June 2023, Mayor Adams removed the bachelor’s degree requirement for certain city jobs.

 

“While we have a lot to celebrate in recovering all of the private-sector jobs lost during the pandemic — more than a year ahead of schedule — our recovery has not been equitable and it has not yet reached every New Yorker. That’s why we are doing everything we can to make sure New York City remains a city for working-class people,” said Mayor Adams. “Black unemployment is still far too high in New York City and across the nation, but Jobs NYC will bring a whole-of-government effort to meet New Yorkers where they are — helping to build an economy of the future with real pathways to family-sustaining careers. This is how we ensure all New Yorkers, particularly those in Black and Brown communities, have access to the jobs of the 21st century, and this is how we can continue to recruit a workforce that is reflective of the diversity of our city. Jobs NYC will help us build a city where opportunity reaches every borough, block, and neighborhood.”

 

“We have recovered all of the private-sector jobs lost during the COVID-19 pandemic. However, that recovery has not been equitable,” said First Deputy Mayor Sheena Wright. “The unemployment rate for Black New Yorkers is 9.3 percent compared to 3 percent for white New Yorkers. This difference is unacceptable. Through a new jobs portal, hiring halls across the five boroughs, and changes to the Minimum Qualification Requirements for city jobs, we are making additional changes to close that gap. These investments build upon the Adams administration’s work throughout the past two years. We created job hubs in select neighborhoods, launched the largest public-private loan fund for small businesses in the city’s history, and set a $6 billion record in M/WBE awards. Today’s announcement ensures that all New Yorkers have the opportunity to participate in the city’s thriving economy.”

 

“At the start of this administration, we committed, through Executive Order 22, to invest in the city’s talent and workforce development systems,” said Deputy Mayor of Housing, Economic Development, and Workforce Development Maria Torres Springer. “The key to that investment was to develop strategies that centralize, and better coordinate workforce services and programming for the benefit of New Yorkers who need them most. The Jobs NYC portal and Jobs NYC hiring halls — digital and physical points of entry to the city’s workforce system — bring public and private employment opportunities and workforce programming together in a central place, realizing the goal of a better centralized and coordinated talent and workforce development system that meets New Yorkers where they are.”

 

“Jobs NYC provides the full spectrum of resources a New Yorker needs to find a job, from a one-stop shop online portal to career training to job opportunities in both the private and public sectors, and delivers it right to the communities most in need,” said Deputy Mayor for Strategic Initiatives Ana J. Almanzar. “This all hands-on-deck government approach will make it easier for New Yorkers to better participate in our economy and uplift entire communities. I want to thank all the community based-organizations, government agency partners, private-sector collaborators, and my fellow deputy mayors who are ensuring that everyone has a fair chance to prosper in our economic recovery.”

 

“Today’s announcement executes on our values to expand opportunities in every area across the city and to take action to see that every individual and family has the chance to fully participate in the economy,” said Deputy Mayor for Health and Human Services Anne Williams-Isom. “We encourage interested New Yorkers to explore opportunities to work for Team New York City as part of our city government. There are so many fulfilling career pathways to help us build an ever stronger and more equitable city.” 

 

“Jobs NYC leverages the strength and scale of New York City’s public workforce system and its many partners to ensure city resources are more easily accessible and reaching the communities that need them the most,” said New York City Mayor’s Office of Talent and Workforce Development Executive Director Abby Jo Sigal. “This integration of technology and community partnership helps streamline client access to important career services and other benefits, so all New Yorkers can more easily find the resources they need to obtain good-paying jobs and share in the city’s economic prosperity.”

 

“Democratizing technology and removing barriers to access critical services and information are key commitments made by the Adams administration, and the Jobs NYC talent portal is yet another example of delivering on these promises,” said New York City Chief Technology Officer Matthew Fraser. “Jobs NYC, and its targeted training and workforce development resources, make it easier for more New Yorkers to be skills-ready and connect to greater economic opportunities across the city.”

 

“There is no greater privilege than working for the city and serving our fellow New Yorkers, and thanks to this effort to reevaluate some of the city’s more restrictive titles through our Minimum Qualification Requirement reviews, it is our hope that more people than ever will be eligible to join our great municipal workforce,” said New York City Department of Citywide Administrative Services (DCAS) Commissioner Dawn M. Pinnock. “With the launch of Jobs NYC, we are not only expanding opportunities for New Yorkers to find meaningful employment, but also ensuring that our city's workforce represents the diversity and talent of our communities. Through innovative advancements like the renewed hiring halls and the online jobs and talent portal, we are breaking down barriers, and fostering equity and access in every corner of our city.”

 

“Jobs NYC is an example of this administration’s commitment to bringing resources directly to communities,” New York City Mayor’s Public Engagement Unit Executive Director Adrienne Lever. “Rather than asking people to navigate multiple government websites to find help, this streamlined approach will make it easier for New Yorkers to apply to jobs. The Public Engagement Unit is thrilled to support this important initiative to bring employment resources and job opportunities to more New Yorkers.”

 

“Jobs NYC is about more than just employment. It is the embodiment of SBS's mission to unlock the economic potential of all New Yorkers,” said New York City Department of Small Business Services (SBS) Commissioner Kevin D. Kim. “SBS is proud to support this initiative by connecting jobseekers directly with employers, ensuring that everyone in New York City has the opportunity to succeed as we build up the ‘City of Yes.’”

 

“Jobs NYC will bring economic opportunities directly to communities throughout the five boroughs. This initiative will build on the extensive investments already made by the Adams administration to reduce barriers between employers and those seeking employment,” said New York City Mayor’s Office Community Affairs Unit (CAU) Commissioner Fred Kreizman. “CAU is eager to support Jobs NYC and connect New Yorkers to jobs, services, trainings, and more.”

 

“We are proud to partner on the development of the Jobs NYC talent portal,” said New York City Mayor’s Office for Economic Opportunity Acting Executive Director Carson Hicks. “Helping New Yorkers to more easily access jobs and training opportunities is a key part of our mission to increase economic opportunity.”

 

“New York City’s economic recovery has been robust, but it has also been uneven with many communities, especially communities of color, still experiencing high rates of unemployment and economic instability. As a result, we continue to see more New Yorkers relying on government benefits to make ends meet,” said New York City Department of Social Services Commissioner Molly Wasow Park. “With Jobs NYC, the Adams administration is taking the necessary steps to reverse this trend and ensure that New York City’s recovery is truly equitable. We look forward to working with our Jobs NYC partners to reduce barriers to employment and connect disadvantaged New Yorkers to quality employment opportunities that will lead to long-term financial security.”

 

“Our city has experienced a great economic rebound, but the benefits of this recovery have not been equally distributed. Through Jobs NYC, this city is helping bridge the gap — bringing employers to the table and placing job opportunities at the fingertips of every New Yorker,” said New York City Chief Equity Officer and Mayor's Office of Equity & Racial Justice Commissioner Sideya Sherman. “The city is taking an important step in reversing this trend by focusing resources, including hiring halls, trainings, and educational programs, towards the communities with the highest unemployment rates. We are pleased to collaborate with our fellow city agencies and community partners to help more New Yorkers start and grow their careers.”

 

“Jobs NYC builds on the New York City Department of Youth and Community Development’s existing workforce development efforts, and we are thrilled to help secure hiring hall sites and volunteers in support of Mayor Adams’ forward-thinking vision to enhance the lives of working-class New Yorkers,” said New York City Department of Youth and Community Development (DYCD) Commissioner Keith Howard. “DYCD is excited to work alongside our administration colleagues and provider partners to connect communities to training and paid opportunities, particularly in neighborhoods that need jobs the most.”

 

Chaired by First Deputy Mayor Wright, with Deputy Mayors Torres-Springer, Almanzar, and Williams-Isom as co-chairs, Jobs NYC brings a whole-of-government approach to building a more equitable city through workforce development. Working across nearly two dozen city agencies, in addition to partnering with community organizations and private partners, the Adams administration will revamp the already popular hiring halls. Not only will these hiring hall take place in each borough on a monthly basis in areas of the city experiencing employment disparities, but — in addition to connecting New Yorkers with job opportunities in the municipal workforce — these events will now provide jobseekers with the unique opportunity to engage with multiple organizations, including employers interviewing for roles and community-based organizations connecting talent to training and other opportunities.  

 

To deliver job and training opportunities citywide, the Adams administration also launched the Jobs NYC online talent portal, a free resource managed by the Mayor’s Office of Talent and Workforce Development and accessible through the MyCity portal that connects job seekers to career opportunities, free employment services, and occupational-skills trainings for opportunities in both the public and private sectors.

 

In June 2023, DCAS began reducing barriers to employment within city government by reforming the city’s Minimum Qualification Requirements for entry level civil service titles. To date, DCAS has completed review on 17 entry-level titles with the potential to impact 20,000 jobs and expand eligibility for civil service positions that were previously restrictive and posed difficult for many applicants to meet minimum qualifications. Previous requirements mandated a college degree or credits, but with this updated review, the city is now more inclusive and equitable, focusing on relevant work experience and practical skills rather than formal education.

 

Today’s announcement builds on a series of policy reforms made by Mayor Adams to retain top talent in the city workforce, provide high-quality services to New Yorkers, and create equitable pipelines to enter the city’s workforce, which has historically been a vehicle for economic mobility for millions of New Yorkers. Last month, Mayor Adams made city government more family-friendly for thousands of employees by expanding both paid parental and family leave for non-union city workers. Impacting over 10,000 municipal employees and making the city more competitive with municipalities and employers across the country, the Adams administration doubled paid parental leave for non-union employees, from six to 12 weeks, and began providing up to 12 weeks of paid family leave for those caring for seriously ill family members.

 

In the last 13 months, Mayor Adams has successfully negotiated contracts with unions representing 95 percent of the city’s workforce and 100 percent of the city’s uniformed workforce — the quickest any mayoral administration has reached that milestone in modern city history. These agreements with District Council 37Communications Workers of America Local 1180, the Marine Engineers’ Beneficial AssociationUniformed Sanitation Workers’ Union Local 831, the United Federation of Teachers (UFT), the Police Benevolent Association, the Uniformed Officers Coalition , the Council of School Supervisors and AdministratorsTeamsters Local 237, and dozens of other unions have all included wage increases, including retroactive wage increases for employees that had not received a raise in years. Additionally, many of these contracts included dedicated funding to address retention and recruitment challenges and other important benefits, such as the child care fund established in the agreement with DC 37.

 

Additionally, in an effort to retain talent in the human services sector, just two weeks ago, Mayor Adams announced a $741 million investment for an estimated 80,000 human services workers employed by non-profit organizations with a city contract as part of a new cost-of-living adjustment.


Renderings Revealed For 170 West 225th Street In Marble Hill, Manhattan

 

Rendering of 170 West 225th Street, courtesy of Timber Equities

Renderings have been released for 170 West 225th Street, a seven-story residential building in Marble Hill, Manhattan. Designed by Marin Architects and developed by Timber Equities, the 115,000-square-foot structure will yield 115 rental units, with 30 percent reserved for affordable housing. The property is located near the intersection of Adrian Avenue and West 225th Street, adjacent to Spuyten Duyvil Creek. 

Rendering of 170 West 225th Street, courtesy of Timber Equities

Renderings show the building clad in a mix of tan and black paneling surrounding a grid of floor-to-ceiling windows. Two stacks of balconies are positioned around the center of the northern elevation, and a long setback at the sixth story will be topped with a terrace. A garage entrance is depicted at the northeastern corner of the building.

Rendering of 170 West 225th Street, courtesy of Timber Equities

Residents will have access to a variety of amenities curated by Durukan Design, including a resident lounge, coworking spaces, a fitness center, and a rooftop lounge with outdoor dining.

Rendering of 170 West 225th Street, courtesy of Timber Equities

170 West 225th Street is located a short walk from the 1 train at the Marble Hill-225th Street station by the northern end of the Broadway Bridge.
Financing for the development was provided by BHI USA and construction of the foundations is underway. The project team expects the building to top out by the middle of 2024 and welcome residents by summer 2025.

Bronx Borough President Vanessa L. Gibson - Community Resources & Updates

 

Dear Neighbor,


Thank you for joining us for another week in review.


Last week, we celebrated an announcement that the city has been awarded $77 million in competitive grants from the federal Bipartisan Infrastructure Law to expand the number of electric school buses and trucks on city streets.


With the expansion of our electric school buses and electric vehicle charging, we are making an investment in not just our EV infrastructure but in decreasing harmful environmental pollutants that, for years, have contributed to poor health outcomes for our most vulnerable residents in the Bronx.


As the city is working to grow our green economy with assistance from our federal partners, we will continue to work with our colleagues in government to ensure the Bronx is not left behind and that our communities also reap the benefits of this initiative.


Thank you to Mayor Adams and the federal government for their commitment to investing in our EV infrastructure.


Lastly, we are accepting donations for new/gently used prom dresses and suits for our high school seniors! You can drop off your donations at Bronx Borough Hall from 9 AM - 5 PM in room 206.


If you have any questions or concerns, please do not hesitate to contact our office at 718-590-3500 or email us at webmail@bronxbp.nyc.gov.

 

In partnership,

Bronx Borough President Vanessa L. Gibson



IN THE COMMUNITY

We would not be the borough we are today without the incredible women who work tirelessly every day to care for our communities. Congratulations to the women of distinction who we had the honor of recognizing during our Annual Women’s History Month Celebration at (woman of color owned) Grand Slam Banquet Hall. As the first woman Bronx Borough President, I am grateful for the women in my life who helped guide me to be in this position and I will continue to empower young girls and women to stand in their power and purpose.


It was an honor to attend this year’s Green City Force graduation and speak to this year’s cohort about the importance of environmental justice in historically underserved neighborhoods. One of the first steps to undoing years of environmental neglect and degradation in our society is recruiting committed and passionate members of our communities and equipping them with the tools to create a greener and more sustainable world.


The opening of the new Lifestyle Medicine program at Lincoln Hospital represents an important opportunity to invest in healthy food options with medically trained professionals offering comprehensive programs for patients and families. Access to healthy food choices is a necessity coupled with programs on sleep, stress management, physical activity, substance use and healthy relationships. Thank You Mayor Adams, Dr. Katz, CEO Roker, Health & Hospitals, the Lincoln Hospital team, our CAB Members and the medical team for this important partnership that will build healthy families and create healthy lifestyles.


UPCOMING EVENTS






RESOURCES




United States Seeks Forfeiture of Former Mongolian Prime Minister's Luxury New York City Apartments Purchased with Proceeds of Corruption Scheme

 

Former Mongolian Prime Minister Sukhbaatar Batbold Diverted Proceeds from Lucrative Mining Contracts and Laundered the Money Using New York Real Estate

The United States unsealed a civil complaint seeking to forfeit two luxury apartments located in New York City at 21 East 61st Street and 230 West 56th Street, purchased for $14 million.  According to court documents, the apartments were purchased, in whole or in part, with the proceeds of unlawfully awarded Mongolian mining contracts, at the direction and for the benefit of then-Mongolian Prime Minister Sukhbaatar Batbold and his family.

Breon Peace, United States Attorney for the Eastern District of New York, Nicole M. Argentieri, Principal Deputy Assistant Attorney General, head of the Justice Department’s Criminal Division, and James Smith, Assistant Director-in-Charge, Federal Bureau of Investigation, New York Field Office (FBI), announced the forfeiture action.

“As alleged, former Mongolian Prime Minister Batbold used the profits from his illicit corruption scheme to purchase high-end real estate in violation of United States federal law. This forfeiture action sends a message that corrupt officials will not use our real estate market to conceal proceeds of crimes,” stated United States Attorney Peace.  “My Office will not tolerate public corruption that undermines faith in government, wherever committed.”

“As alleged in the complaint, Sukhbataar Batbold — the former prime minister of Mongolia — abused his position as prime minster to profit from the sale of his country’s natural resources. He and his family used the proceeds of their corrupt scheme to buy $14 million in high-end real estate in the United States,” stated Principal Deputy Assistant Attorney General Nicole M. Argentieri, head of the Justice Department’s Criminal Division. “With this action, those properties are subject to forfeiture. Kleptocrats should take note: the Criminal Division is unwavering in its resolve to recover proceeds of official corruption and take the profit out of crime.”

“Former Mongolian Prime Minister Sukhbaatar Batbold allegedly crafted a corruption scheme, funneling millions of dollars from mining contracts through illegitimate shell companies to finance his family’s lavish lifestyle including the purchase of two luxury apartments in Manhattan. Batbold’s alleged behavior – personally profiting off of public corruption comes at the expense of the law-abiding citizens he governed. Today’s action emphasizes the FBI’s commitment to dismantling public corruption and punishing those who utilize the U.S. banking system to illegally divert resources, wherever it may occur,” stated FBI Assistant Director-in-Charge Smith.

The civil forfeiture complaint alleges that while Batbold was Prime Minister of Mongolia, Catrison, an entity he owned through trusted intermediaries, was awarded a $68 million mining contract.  Prior to being awarded that contract, Catrison had no operational history, no mining expertise, and no financial or logistical infrastructure to execute commodity sales, and its sole director was a former linguistics teacher.  Millions of dollars from the mining contracts were then siphoned into foreign bank accounts, transferred through a series of shell companies, and, among other things, directed towards the purchase of the New York City apartments for the benefit of Batbold’s family, including his eldest son who used the apartments.

The civil forfeiture complaint further explains how Batbold and his family used state-owned mining contracts to funnel funds through shell companies for their personal use, consistent with the scheme used to purchase the apartments sought by the government for forfeiture.  Although it had no operational history or experience in commodities, one of the shell companies was awarded a mining contract worth $30 million, and proceeds were wired to an account in the United States held by Batbold’s eldest son that was earmarked for personal use, such as car payments, travel and an interior designer.

The government’s case is being handled by the Business and Securities Fraud Section of the United States Attorney’s Office for the Eastern District of New York, in coordination with the Office’s Bank Integrity Task Force, which is charged with investigating and prosecuting corporate and individual actors who launder criminal proceeds using the U.S. banking system and enforcing anti-money laundering controls under the Bank Secrecy Act, and the Kleptocracy Asset Recovery Initiative of the Criminal Division’s Money Laundering and Asset Recovery Section (MLARS).  Assistant United States Attorneys Tara McGrath and Brian Morris and Trial Attorney Adam J. Schwartz are handling the case with assistance from Paralegal Specialist Jacob Menz.  The Justice Department’s Office of International Affairs provided assistance.

A civil forfeiture complaint is merely an allegation that money or property was involved in or represents the proceeds of crime.  These allegations are not proven until a court enters judgment in favor of the United States.

The Defendants In Rem:

ANY AND ALL SHARES OF 21 EAST 61 STREET APARTMENT CORP. HELD IN THE NAME OF LOVITAS, INC., TOGETHER WITH THE APPURTENANT PROPRIETARY LEASE FOR COOPERATIVE UNIT 12E WITHIN THE REAL PROPERTY AND PREMISES LOCATED AT 21 EAST 61ST STREET, NEW YORK, NEW YORK 10065

CONDOMINIUM UNIT 58D, LOCATED AT 230 WEST 56TH STREET, NEW YORK, NEW YORK 10019