12-06-05 -- Saint Barnabas Corporation -- Settlement -- News Release

St. Barnabas Health Care System Agrees to Pay $3.8 Million for Medicare Overbilling

NEWARK – The Saint Barnabas Corporation, doing business as Saint Barnabas Health Care System (SBHCS), has agreed to pay the United States more than $3.8 million to settle claims that it overcharged Medicare, U.S. Attorney Christopher J.Christie announced.

The settlement agreement entered into between the parties provides that SBHCS, based in Livingston, will pay the government a total of $3,877,694 to settle claims that from Jan. 1, 1992 through Dec. 31, 1999, SBHCS wrongfully submitted claims for services to Medicare patients that reflected a higher level of service than was actually performed.

Specifically, the United States contended that SBHCS had submitted claims containing pneumonia treatment codes that reflected a higher level of care – and therefore a higher level of reimbursement – than was actually provided. The parties agreed to settle the pneumonia claims for $1,040,000.

Additionally, the parties settled claims involving the billing of outpatient services as inpatient services. The United States contended that SBHCS had submitted claims for inpatient services where the patients were not admitted and were discharged on the same calendar day. The parties agreed to settle the inpatient claims for $2,837,694, according to Assistant U.S. Attorney John Silbermann.

“Higher, unsubstantiated and unearned charges to government health-care programs mean higher costs for everyone,” Christie said. “As such, we will continue to aggressively seek reimbursement from health care providers for claims to which they were not entitled in the first place.”

The settlement comes under the federal False Claims Act that permits the government to seek up to triple damages plus penalties for false or fraudulent claims to the government.

While agreeing to the settlement, SBHCS has denied the government’s allegations, according to Silbermann. SBHCS cooperated during the government’s investigation.

Christie credited Special Agents from the Office of Inspector General, U.S. Department of Health and Human Services, under the direction of Special Agent in Charge Gary Heuer, with developing the case.

The government is represented by Assistant U.S. Attorney Silbermann of the Affirmative Civil Enforcement Unit of the U.S. Attorney’s Civil Division in Newark, and Richard Linzer, Senior Counsel, Office of Counsel to the Inspector General, U.S. Department of Health and Human Services.

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Defense Counsel: Robert Salcido, Esq., Washington, D.C., for SBHCS