Westchester Medical Center will have to pay $7 million to the federal government over Medicaid fraud that went on for almost nine years.
The lawsuit and settlement, filed by the United States Attorney for the Southern District of New York, claimed that from August 2001 through June 2010, Westchester Medical Center submitted false reimbursement claims to Medicaid, billing the program for millions of dollars of outpatient services at its Valhalla-based Behavioral Health Center without core documentation. Westchester Medical Center management knew for years that the outpatient mental health clinics were missing documentation.
“Medicaid is a vital resource for people who suffer from physical and mental illnesses and related conditions. We have absolutely no tolerance for those who fail to comply with the program,” U.S. Attorney Preet Bhara said in a prepared statement. “We will continue to work with our federal and state partners to protect the Medicaid program against waste, fraud and abuse.”
Westchester Medical Center also did not return funds it received from the Medicaid program despite knowing it was substantially overpaid as a result of having billed for services for which it lacked proper documentation. As a result of this billing fraud, Westchester Medical Center was paid millions of dollars by the Medicaid program it was not entitled to.
“Today”™s settlement involves not the quality, medical necessity or substance of the services provided by the Behavioral Health Center (BHC), but only technical deficiencies in the clinical documentation that the New York Medicaid program requires to bill outpatient clinic claims,” said David Billig, director of media relations for Westchester Medical Center.
“BHC exhaustively audited and improved the documentation practices of its clinicians more than two years ago, when these issues first came to light, followed by a voluntary self-disclosure to the state. We are proud of Westchester Medical Center’s long history of furnishing high-quality, critically needed care to those in need of psychiatric treatment,” said Billig.
Aside from the $7 million settlement, Westchester Medical Center will have to pay back all of the funds it unlawfully received.
The case was handled by the Civil Frauds Unit, which was started by Bhara in March 2010 to combat financial fraud.
