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NewYork-Presbyterian Hospital to pay over $800,000 for improper billing of unnecessary images

por John R. Fischer, Senior Reporter | February 01, 2024
Rad Oncology
NewYork-Presbyterian Hospital Methodist location (Photo courtesy of NYPH)
NewYork-Presbyterian (NYP) has agreed to pay over $800,000 as a settlement for improper billing to Medicare, Medicaid, and TRICARE by two defunct radiology practices associated with it for unnecessary images they used in image-guided radiotherapy sessions for cancer patients.

Radiation Therapist Associates, P.C. (RTA) and Leading Edge Radiation Oncology Services, PLLC (LEROS) provided outpatient radiation oncology services in Brooklyn. RTA operated within NYP’s Methodist Hospital under a contract with the health system’s predecessor, Brooklyn Methodist Hospital, which merged in 2016. LEROS, a freestanding radiotherapy center run by an overlapping group of physicians, had a joint venture with Brooklyn Methodist called M-LEROS.

Between 2012 and 2018, RTA and LEROS performed IGRT procedures with images that were either not reviewed at all or in a timely manner, making them non-reasonable and necessary. They then billed the healthcare programs for them, according to the lawsuit, which was filed in the Eastern District of New York as a civil action under the qui tam or whistleblower provisions of the False Claims Act. An investigation also revealed that RTA billed more than was appropriate for initial consultation sessions.
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“The defendants provided substandard care to cancer patients by not properly or [in a] timely [way] reviewing medical imaging, and then [billing] taxpayer-funded healthcare programs for these shoddy services,” said U.S. attorney Breon Peace in a statement.

Speaking with HCB News, NYP stressed that it was not the defendant in the case as the events "occurred prior" to it becoming the "active parent of, and later merging with, Brooklyn Methodist Hospital. We are pleased to put this issue behind us."

RTA was in operation from 2008 to 2016 and filed for dissolution in December 2018 with the New York Department of State Division of Corporations. LEROS ceased operations in 2020 and filed for dissolution in 2022.

Of the $801,000 that NYPH will pay, $694,999.71 will go to the federal government and $106,000.29 to the State of New York as funds for Medicare, Medicaid, and TRICARE programs. The settlement resolves allegations only, and is not an admission of guilt or liability on NYPH’s part.

Under the False Claims Act, private parties can sue on behalf of the U.S. government and reap a portion of the rewards should the government choose to take over the case.

The settlement was approved in January 2024 by U.S. District Judge William F. Kuntz, II.

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