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.