During the investigation of New York-Presbyterian/Brooklyn, it was discovered that physicians at a chemotherapy infusion center affiliated with the hospital were actually being paid based on the number of referrals they made.
The United States Attorney for the Eastern District of New York, Breon Peace, has announced a recent settlement agreement with New York-Presbyterian/Brooklyn Methodist Hospital. This agreement entails the hospital paying $17.3 million to settle allegations of providing unlawful kickbacks to physicians at the chemotherapy infusion center. The payments were tied to the number of referrals made by physicians, which was deemed inappropriate.
Additionally, claims of inadequate supervision of chemotherapy services by physicians at the infusion center were also addressed in the settlement. The resolution covers violations of both federal and New York State False Claims Acts. Out of the total settlement, $16.410 million will go to the federal government, while $890,000 will be paid to New York State. It is worth noting that the hospital voluntarily disclosed these issues to the United States.
“This settlement addresses a compensation scheme that incentivized physicians to make referrals for services based on how much they would be paid and were essentially kickbacks,” stated United States Attorney Peace. “New York-Presbyterian/Brooklyn Methodist Hospital voluntarily self-disclosed the conduct to the United States, which allowed it to mitigate the penalties associated with the conduct.”
In order to prioritize the well-being of patients, Medicare and Medicaid have implemented strict regulations to prevent physicians from receiving any form of compensation in exchange for referring patients to specific services. However, during the investigation of New York-Presbyterian/Brooklyn, it was discovered that physicians at a chemotherapy infusion center affiliated with the hospital were actually being paid based on the number of referrals they made.
Furthermore, Medicare and Medicaid rules also emphasize the importance of involvement from those who bill for medical services. For example, a hospital cannot bill for a physician's services if that physician did not actively participate in the patient's care. These rules acknowledge that non-physicians, such as nurses, play a crucial role in providing care to patients, which is often necessary and beneficial. However, in certain cases, this care must be supervised by a physician who is readily available to assist if needed.
Unfortunately, at the infusion center in question, Medicare and Medicaid were billed for services provided by non-physicians even when physicians were not present to adequately oversee the care being provided.
Following a string of embarrassing security breaches, the hospital found itself in hot water when thousands of patients' personal information was disclosed. After a thorough investigation by Health & Human Services (HHS), June 28, 2021, the hospital agreed to pay OCR $3,300,000 to settle potential violations of HIPAA rules. They also put in place a corrective action plan to show they were addressing the issues.
It was discovered that the hospital had improperly shared Electronic protected health information (ePHI) of 6,800 patients with Google and other search engines due to a server misconfiguration. The hospital had neglected to conduct a proper risk analysis, failed to monitor IT equipment and data systems, and did not have adequate security measures in place. Additionally, they had not implemented the necessary policies for authorizing access to patient databases, nor did they follow their own information access management protocols.
“New Yorkers searching for a doctor or medical help should be able to do so without their private information being compromised,” said Attorney General James. “Hospitals and medical facilities must uphold a high standard for protecting their patients' personal information and health data. NewYork-Presbyterian failed to handle its patients’ health information with care, and as a result, tech companies gained access to people’s data. Today’s agreement will ensure that NewYork-Presbyterian is not negligent in protecting its patients’ information."
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