Medicare penalizes New Windsor ER staffing firms for imaginary doctors

Four emergency room staffing companies based in New Windsor, Orange County have agreed to pay $475,000 to the federal government to settle a whistleblower lawsuit over fraudulent billing practices.

Advanced Health Partners Inc. and its affiliates confessed to submitting false claims to Medicare for services by doctors who did not perform the services and in many instances were no longer working for the staffing companies, in a stipulation filed on July 27 in U.S. District Court in White Plains by U.S. Attorney Damian Williams.

Williams, acting on behalf of the Centers for Medicare and Medicaid Services, also filed a complaint-in-intervention, joining a 2014 False Claims Act lawsuit filed by two employees of the companies.

Medexcel Emergency Physician Services of Yonkers and Tri-State Emergency Physicians staffed emergency rooms in the region. Medexcel USA provided management services to the staffing groups and advised Advanced on which doctors to name in Medicare claims.

Advanced, formerly known as Medicom Management Services Inc., submitted the claims to Medicare.

The companies are based in a business park in New Windsor and share some common ownership, according to the complaint. Drs. Anthony R. Ruvo and Edward Orlando are listed on the Advanced website as co-owners, and Ruvo signed the settlement on behalf of the companies.

From 2007 to 2017, according to the government, the companies submitted thousands of claims to Medicare that used identifications of more than a dozen physicians “who did not perform or supervise the services in question and, in fact, no longer worked at the practice groups or the hospital emergency departments at which the services were rendered.”

A physician referred to as Dr. A, for instance, worked for Tri-State as medical director of an emergency department from August 2009 to September 2011, yet Advanced submitted more than 1,800 claims for services performed by the doctor in 2012 and 2013.

Had Medicare known that the doctor had not provided or supervised the services, the complaint states, it would not have paid the claims.

The government charged the companies with violating the federal False Claims Act for making false statements and presenting false claims.

The settlement requires the companies to cooperate with investigations of individuals and any other entities not already named, and to not make any public statement that contradicts the conduct to which they admitted.

The 2014 whistleblower lawsuit was filed by Christina Myruski, who was once the director of operations for Medicom, and Glynis Cowart, who was once the chief information officer of MedExcel USA. The lawsuit was filed under seal, and nearly two dozen documents submitted in the case remain under seal.

Myruski and Cowart also signed onto the settlement, agreeing that the terms are fair. The settlement does not say how much they will receive for initiating the False Claims Act lawsuit; generally, whistleblowers are awarded 15% to 30% of the damages.

The U.S. Department of Health and Human Services Office of Inspector General assisted in the investigation. Assistant U.S. Attorneys Peter M. Aronoff and Jacob M. Bergman are handling the case. Nassau County attorneys John G. Martin and Steven R. Antico represented the companies. Manhattan attorney John Howley represented the whistleblowers.

U.S. District Judge Nelson R. Román approved the settlement.