Dive Brief:
- One of New York City's largest not-for-profit healthcare organizations is asking a federal court to throw out a case involving delays in sending overpayments back to Medicaid.
- Mount Sinai Health System was slapped by a little-known provision of the ACA that demands that providers return all Medicare and Medicaid overpayments within 60 days of when the overpayments were identified. Facilities that don't do so face liability under the False Claims Act, with penalties of up to $11,000 for each "fraudulently denied" claim multiplied by three.
- This case, which is one of the the first of its kind, asserts that Continuum Health, which has since merged with Mount Sinai, submitted $1 million in improper Medicaid claims to the state health plan in 2009 and 2010 due to coding mistakes. Continuum's hospital revenue cycle director reported the problem to the chain, which repaid the overpayments, but not within the ACA's required 60-day span.
Dive Insight:
There's no question that Continuum has caught up with repaying its overpayments. But the final refunds weren't made until March 2013, more than two years after Continuum was informed about the overpayments by Medicaid. Moreover, it doesn't help that the payments for 300 of the claims were made only after the government issued a civil investigative demand. The Department of Justice is seeking the maximum penalty of $11,000 for delayed improper claims plus treble damages, which would cost Mount Sinai roughly $30 million.
Mount Sinai, for its part, is arguing that the case should be thrown out for two key reasons, according to its legal filing. First, it says, there's no evidence that the former Continuum hospitals "knowingly concealed or knowingly and improperly avoided" repayments, which is a requirement of False Claims Act suits. The health system also argues that violations would require retroactive application of the newer law, which it claims is improper.