St. Joseph’s Comprehensive Psychiatric Emergency Program’s
Mobile Crisis Outreach Team Failed To Meet Mental Health Staffing Requirements
Schneiderman: We Will Continue Working To Ensure That Psychiatric Patients
Are Cared For By Qualified Personnel
Attorney General Eric T. Schneiderman and United States Attorney Richard
S. Hartunian recently announced that St. Joseph’s Hospital Health
Center (St. Joseph’s) will pay $3.2 million to resolve allegations
that it violated the federal and New York False Claims Act by presenting
false claims for payment to the state Medicaid program for mental health
services rendered by unqualified staff.
Medicaid is a jointly funded federal-state program that provides health
care to needy individuals. St. Joseph’s operates a Comprehensive
Psychiatric Emergency Program (CPEP) that provides evaluation and treatment
to individuals suffering from an acute mental health crisis. The CPEP’s
“mobile crisis outreach” unit provides initial evaluation
and assessment and crisis intervention services to individuals in Onondaga
and Madison counties who are unable or unwilling to use hospital-based
crisis intervention services in the emergency room. The mobile crisis
unit also provides interim crisis services for patients discharged from
the emergency room who require follow up care from a mental health professional.
“Mental health staffing requirements are intended to protect the
public and avoid the waste of public funds by ensuring that services are
delivered by qualified personnel in a meaningful way,” said
Attorney General Schneiderman. “We will continue to work with our federal partners to fight to
recover misappropriated money on behalf of New York’s taxpayers.”
New York State has issued regulations governing the staffing of CPEPs.
The regulations provide that at least two CPEP staff members, one of whom
must be a member of the professional staff, shall be present whenever
crisis intervention services are rendered outside of an emergency room.
Professional staff includes credentialed alcohol counselors, physicians,
psychiatrists, psychologists, registered professional nurses, rehabilitation
counselors and social workers. The regulations condition payment of claims
for CPEP services on compliance with these staffing requirements, making
clear that use of qualified staff is a prerequisite to government payment
of Medicaid claims for these services.
“Today’s settlements reflect my office’s commitment to
protecting central New York’s most vulnerable citizens, including
those in crisis,” said
U.S. Attorney Hartunian. “We will continue to use the False Claims Act to protect health
care beneficiaries and the federal fisc by ensuring that taxpayers do
not pay for services rendered by unlicensed or unqualified individuals.”
These settlements resolve allegations that St. Joseph’s knowingly
presented false claims for payment to Medicaid for mobile-crisis outreach
services rendered from January 1, 2007 through February 29, 2016 by personnel
who failed to satisfy the basic CPEP staffing requirements. By submitting
claims for payment to Medicaid without disclosing that its CPEP staff
failed to meet the regulatory staffing requirements, and by accepting
payment for these claims, the governments allege that St. Joseph’s
misrepresented its compliance with mental health staffing requirements
that are central to the provision of counseling services and, by doing
so, violated the False Claims Act. As part of today’s settlements,
St. Joseph’s admits that it was improper to have conducted mobile
crisis outreach visits without a member of its CPEP professional staff
present and then bill Medicaid for such services.
“Individuals that receive mental health services deserve to be treated
by properly qualified providers, something St. Joseph’s failed to
ensure,” said
Scott J. Lampert, Special Agent in Charge of the U.S. Department of Health
and Human Services, Office of Inspector General’s New York Region (“HHS-OIG”). “HHS-OIG is committed to protecting the
taxpayers and the federally funded health care programs intended for the
nation’s most vulnerable citizens.”
This investigation was triggered by a whistleblower lawsuit filed under
the qui tam provisions of the federal and New York False Claims Acts,
which allow private persons, known as “relators,” to file
civil actions on behalf of the government and share in any recovery. The
relator in this case will receive $560,000 of the settlement proceeds
after full payment by St. Joseph’s. The case is docketed with the
U.S. District Court for the Northern District of New York under number
5:14-cv-850.
The investigation and settlement were the result of a coordinated effort
among the U.S. Attorney’s Office for the Northern District of New
York, the New York State Attorney General’s Office, and HHS-OIG.
The United States was represented by Assistant U.S. Attorney Adam J. Katz.
The state case was handled by Special Assistant Attorney General Jill D.
Brenner and Principal Auditor Investigator Michael Beers. The Medicaid
Fraud Control Unit is led by Director Amy Held and Assistant Deputy Attorney
General Paul J. Mahoney. The Division of Criminal Justice is led by Executive
Deputy Attorney General Kelly Donovan.