Queens Hospital Forks Over $2.5M In Settlement To Federal Government

QUEENS, NY — A Queens hospital will have to cough up over $2.5 million in a settlement because a former employee billed the federal government for medically unnecessary services for over four years, announced a Brooklyn court on Wednesday.

The New York-Presbyterian/Queens Hospital physician billed the federal government’s health care program for the replacement of implantable cardioverter defibrillator pulse generator batteries. An ICD is akin to a pacemaker and is placed under the skin of a patient and is designed to make sure the individual’s heart beats at a regular rhythm, federal prosecutors noted.

“This more than $2.5 million settlement rectifies that New York-Presbyterian/Queens was paid by the federal government for unnecessary procedures,” U.S. Attorney Breon Peace said in a prepared statement. “This Office is committed to combating fraud and abuse of our federal health care programs, especially when such conduct potentially puts patients at risk.”

ICD batteries eventually die out and need to be replaced, but physicians are only supposed to replace them once they reach their elective replacement interval, which is determined by equipped computerized monitors, because the process requires a surgical procedure to put in the new batteries, according to prosecutors.

The former employee repeatedly replaced well functioning batteries earlier than needed, which subjected patients to risky procedures that weren’t warranted and then billed to the government’s health care program for them, prosecutors added.

The physician made 114 orders for replacement for the ICD procedures that ranged in cost from $500 to over $50,000 from January 2009 to June 2014. Most of the procedures cost between $8,000 to $9,000, a spokeswoman for Peace's Office told Patch.

The Flushing hospital learned about the physician’s actions via an internal investigation and voluntarily disclosed his misconduct to the U.S. Department of Health and Human Services as the crime violated the False Claims Act, according to the Brooklyn court.

The FCA says that any individual who knowingly submits false claims to the government is liable for double the government’s damages plus a penalty of $2,000 for each false claim. As the U.S. is facing inflation, the government can ask for triple the amount in damages, according to the U.S. Department of Justice.

As of Sept. 30, the federal government obtained over $5.6 billion in damages from civil fraud cases, the DOJ added.