Halperin & Bikel wants to speak with current and former employees of New York City Health and Hospitals Corporation, known to the public as NYC Health + Hospitals. Our firm is currently investigating a number of potential Medicaid and Medicare fraud violations.
We are also interested in learning about fraud against MetroPlus Health, the Medicaid managed care organization operated by NYC Health + Hospitals.
Under the federal False Claims Act (“FCA”) and the New York State False Claims Act, people with information about Medicare, Medicaid, and TRICARE fraud at a medical facility are entitled to a cash reward for reporting misconduct.
Awards are given to whistleblowers who file successful qui tam lawsuits, and their awards are calculated based on a percentage of the government’s recovery in the lawsuit.
Federal and state False Claims Acts hold healthcare providers accountable for knowingly submitting false claims to insurers. These providers may be held liable for damages and penalties amounting to millions of dollars. The FCA also allows citizens with insider information to sue entities involved in fraud on behalf of the U.S. and/or state government.
Whistleblowers have filed FCA lawsuits against NYC Health + Hospitals in the past.
Combined with the company’s history of wrongful death, negligence, and labor and employment lawsuits, there is reason to believe the hospital system may be committing fraud currently.
Whistleblowers may receive up to 30 percent of the total financial recovery from a positive verdict or settlement. Past health care fraud whistleblowers have earned millions of dollars for coming forward.
About NYC Health and Hospitals Corporation
Headquartered in Lower Manhattan, the New York City Health and Hospitals Corporation is the country’s largest municipal health care system. The company operates public hospitals and clinics across New York City’s five boroughs and serves 1.4 million patients a year.
Since its founding in 1969, the company underwent a rebranding campaign in 2015 and is now known as NYC Health + Hospitals.
NYC Health + Hospitals’ system includes 11 acute-care hospitals in the Bronx, Queens, Brooklyn, Staten Island, and Manhattan, including the infamous Bellevue Hospital, the oldest public hospital in the U.S.
Other large hospitals in the system include:
- Elmhurst Hospital in Queens
- Woodhull Medical Center in Brooklyn’s Bedford-Stuyvesant neighborhood
- Metropolitan Hospital Center in East Harlem, and
- Jacobi Medical Center in the Morris Park neighborhood of the Bronx.
The company also has five long-term care facilities and a network of Federally Qualified Health Center clinics known as Gotham Health.
Frightening History & Rapacious Profits of NYC Health and Hospitals Corp.
The New York City Health and Hospitals Corp. was founded by the New York State Legislature as a public benefit corporation. According to NYC Health + Hospitals’ website, it is “committed to preserving the fundamental promise of our mission to care for all, without exception, and regardless of income, immigration or insurance status.”
Even though it ostensibly serves a public purpose, that has not stopped the company from generating massive profits: NYC Health and Hospitals had nearly $10 billion in revenue in 2017, the last year this information was publicly available.
Under the leadership of President and CEO Dr. Mitchell Katz, a large portion of that revenue has been set aside to pay legal settlements. Between 2014 and 2019, NYC Health and Hospitals paid out $34 million to 56 families who sued the company for the wrongful death of their loved ones, according to an investigation by the New York Post. One of the largest payouts was a $3.2 million settlement with the family of Georgia Thompson, a woman who died at Brooklyn’s Kings County Hospital when her tuberculosis was ignored and mistreated. Kings County has the highest number of wrongful death claims in the NYC Health + Hospitals system by far. 91 claims were filed between 2014 and 2018, compared to 54 claims against Bellevue, which is a much larger facility.
If you consider all medical malpractice, not just wrongful death, the dollar amount grows even larger. According to the NY Daily News, NYC Health and Hospitals paid a total of $123 million in 2017 alone to settle malpractice lawsuits. The highest payout went to Samantha Miller, a woman whose newborn baby was left severely disabled during labor and delivery. According to the complaint, monitors showed that the baby’s heart rate and oxygen levels were dropping, but doctors postponed Miller’s Cesarean section and did not address the issues for seven hours. Miller received $8.1 million to cover the costs of caring for a child who will need constant medical attention for the rest of its life.
Based on reports of negligence, understaffing, and malpractice, we are concerned that Medicaid and Medicare fraud is happening at NYC Health + Hospitals as well. A large portion of NYC Health + Hospitals’ patients are low income and/or uninsured.
In addition to Medicare and Medicaid, the company offers its own low-cost insurance plan called MetroPlus Health, which is one of the city’s largest providers of government-sponsored health insurance.
Our team of investigators would be interested to know of any fraud against this or any other insurance program.
Lawsuits, Million-Dollar Settlements, and Investigations at NYC Health + Hospitals
NYC Health + Hospitals has made headlines for allegations of fraud, medical negligence, wrongful death, and labor and employment violations. The company has spent millions of dollars to settle lawsuits and comply with state regulations.
NYC Health & Hospitals Medicaid Fraud Lawsuit
According to a former NYC Health & Hospitals employee, the company billed the government for more than $1.4 billion in fraudulent Medicaid claims over the course of seven years. Whistleblower Andrew Gelbman filed a qui tam lawsuit in 2017 alleging that NYC Health & Hospitals submitted hundreds of false claims and manipulated data to increase profits.
Gelbman worked as an IT specialist, and part of his role included performing work on eMedNY, a computer screening system that uses an algorithm to determine if a claim is Medicaid reimbursable. NYC Health and Hospitals uses eMedNY across all of its facilities to automatically submit claims for reimbursement. When eMedNY determines that a claim is ineligible, it is flagged for further administrator review.
Gelbman’s complaint alleged that administrators intentionally altered data in eMedNY so that ineligible claims were still being submitted to the government. These included claims that were submitted without proper authorization, claims that were submitted by providers who were not enrolled in the Medicaid system, and claims that were submitted multiple times or had already been paid by another insurer.
When Gelbman raised this issue in meetings with New York City and NYS Department of Health representatives, he alleges he was told that not submitting the false claims would lead to “financial ruin” and “political problems” for New York City and its public health care providers.
Unfortunately, district court dismissed the qui tam claim, saying that Gelbman didn’t have enough knowledge of the scheme. The 2nd Circuit Court of Appeals upheld the ruling. Gelbman appealed to the Supreme Court, but the court declined to hear the case.
However, even though Gelbman’s case was unsuccessful, it doesn’t mean that fraud is not happening at NYC Health and Hospitals. The case was not dismissed because Gelbman was lying; it was dismissed because he couldn’t provide enough evidence. A similar qui tam lawsuit may be successful in the future if another whistleblower can provide more facts related to the fraud.
Our investigators are looking into potential Medicaid fraud at NYC Health and Hospitals, and they are interested in speaking to anyone with knowledge of fraud. If you are aware of a fraud scheme involving eMedNY, or any other type of fraud scheme, contact our office.
NYC Health + Hospitals Medicaid Fraud and Negligence in Manhattan
Fraud at New York City Health and Hospitals Corporation may date back more than three decades.
In 1989, three employees at Bellevue Hospital Center in Kips Bay, Manhattan approached the New York Times to blow the whistle on Medicaid fraud at the hospital. The employees alleged that supervisors pressured them to change patient information to make it appear that they were eligible for Medicaid. According to the Times, the employees were told to make up information about patients’ jobs, addresses, and income levels, sometimes going so far as to say patients were homeless when they weren’t.
The report was so shocking that it triggered an investigation by New York’s special prosecutor for Medicaid fraud and caused the NYC Department of Health to issue new guidelines for hospitals. The rules required hospitals across the city to provide more documentation of patients’ circumstances. The changes also made it more difficult for patients to be labeled as homeless. Although there have been no reports of Medicaid fraud at Bellevue since then, it’s very possible that fraudsters have found ways to get around the updated rules.
A more recent New York Times expose reveals widespread negligence at another NYC Health & Hospitals facility in Manhattan. In 2010, the NYS Health Department investigated Harlem Hospital Center, now known as NYC Health + Hospitals/Harlem, for allegedly leaving more than 5,000 echocardiograms (EKGs) unread by doctors.
From 2005 to 2010, thousands of patients who received cardiac testing did not have their conditions reviewed by a doctor. At least six patients did not receive necessary medical care as a result. By some measures, more than 200 patients whose EKGs were not read died not long after their tests were performed, although it’s not possible to confirm that the deaths were related to unread EKGs.
The hospital admitted that technicians, rather than doctors, were responsible for reading tests and marking clearly abnormal results for further review. The EKGs that were not marked, however, were “essentially forgotten in a computer.” In some cases, patients with borderline EKG results never had their tests reviewed by a doctor.
Harlem Hospital doctors claimed they had to rely on technicians to read EKGs because the hospital was so understaffed. However, NYC Health & Hospitals itself admitted that doctors at similarly sized hospitals were able to keep up with the number of tests at their facilities.
It’s unclear whether Harlem Hospital faced any penalty from the state for the issue. The hospital conducted an internal investigation and reached out to patients whose EKGs were not read, but it has never said anything publicly about changing its EKG review system.
NYC Health & Hospitals Negligence and Labor Violations in Brooklyn
In 2009, NYC Health & Hospitals paid $2 million to settle a private lawsuit with the family of Esmin Green, a woman who died in the waiting room of Kings County Hospital Center in Brooklyn while waiting to be seen by a doctor. Green was taken to the hospital involuntarily after presenting symptoms of psychosis. She waited in the hospital’s psychiatric emergency room for almost 24 hours before she collapsed and died.
Surveillance footage of Green’s 24-hour wait and subsequent death went viral in 2008 amidst a Department of Justice investigation of Kings County Hospital Center, which was renamed NYC Health + Hospitals/Kings County in 2015.
The video footage shows security guards and staff members ignoring Green as she lay motionless on the floor, and medical staff didn’t show up to revive her for more than an hour after she collapsed.
Although Green’s death shocked people across the country, a 2010 Department of Justice investigation revealed much more. The DOJ got involved after another lawsuit, filed by the New York State Mental Hygiene Legal Service and the New York Civil Liberties Union in 2007, claimed that the Kings County psychiatric unit was “a chamber of filth, decay, indifference and danger.”
DOJ investigators confirmed this allegation, finding that patients were not treated for suicidal behavior, subjected to needless physical restraints and drugs, and routinely abused by staff and other patients.
The 2007 lawsuit was settled in 2010, when Kings County agreed to new safety regulations and federal oversight. Under the agreement, the hospital was required to admit no more than 25 patients to the ER at one time and to check on each patient every 15 minutes. It was also required to reduce wait times to 10 to 13 hours—still an incredibly long time to wait for medical care.
Although NYC Health + Hospitals/Kings County agreed to this settlement in court, it seems as though they haven’t adhered to it. A former nurse administrator at the hospital filed another lawsuit in 2017, this time alleging that she was fired for speaking up about chronic understaffing at the hospital. Her lawsuit alleges that stretched-thin staff has led to patient death and waiting times lasting as long as four days.
Cornelia Williams, the whistleblower who filed the lawsuit, claims she regularly saw patients waiting for 40 or more hours. She witnessed the death of a 20-year-old woman from an asthma attack when there were not enough nurses to attend to her. Another time, an ER patient died from an allergic reaction to morphine. The allergy was never documented on the patient’s chart.
Williams alleges she was fired in 2016 because she repeatedly complained about understaffing. Her lawsuit is pending, but she is not the only person to speak up about understaffing and insufficient training at NYC Health and Hospitals.
NYC Health + Hospitals Wrongful Death in Queens
In 2017, NYC Health + Hospitals agreed to pay $350,000 to the family of Wendy Alexander, a 49-year-old developmentally disabled woman who died in the psychiatric emergency room at Queens Hospital Center, now known as NYC Health + Hospitals/Queens. Alexander was transferred from her group home to the psychiatric ER in January 2016 when she became agitated. Although Alexander’s aide informed Queens Hospital staff that Alexander was on a puree diet, this was not noted in the hospital’s computer system. As a result, a nurse gave Alexander a sandwich. She began to choke and eventually went into cardiac arrest because an “inexperienced” resident doctor didn’t treat her quickly enough.
The case went into motion when a group of Queens Hospital nurses wrote an anonymous letter to state investigators detailing the incident. NYC Health & Hospitals didn’t have much to say publicly about Alexander’s death or the lawsuit, simply telling the New York Post “We take all allegations regarding patient care very seriously and meet all reporting requirements with state and federal regulatory agencies to ensure claims are properly addressed.”
The nurses’ anonymous letter sums up the case more clearly: “This was a tragic event that could and should have been prevented.”
NYC Health + Hospitals Negligence in the Bronx
NYC Health + Hospitals/Lincoln, formerly known as Lincoln Hospital and located in the Mott Haven neighborhood of the Bronx, made headlines in 2015 when a patient committed suicide a day after being discharged from the hospital’s Mental Health Center.
Cops talked 25-year-old Kareem Cooley off of a rooftop on East 152nd St. on June 22, 2015 and took him to Lincoln Hospital for psychiatric evaluation. Cooley was admitted and “red-flagged” for treatment by a psychiatrist, but hospital staff released him after a one-night stay. The following day, on June 24, Cooley returned to the same building and followed through on his plans of suicide.
Although there is no record of a lawsuit or investigation related to Cooley’s death, it shed light on what some people say is a culture of negligence at Lincoln.
Sources told the New York Post,
“There have been cases where patients got out quicker from Lincoln Hospital than the cop who brought him in. In one case, they asked the person, ‘Do you want to kill yourself,’ and then when the person said no, they let him go.”
Another told the newspaper,
“If the on-call doctor deems a patient a nonthreat to himself or others, they will give them medication and release them.”
Although wrongful death is not grounds for a False Claims Act lawsuit, it may point to further misconduct happening at NYC Health and Hospitals. Per Medicare and Medicaid rules, it is unlawful to provide substandard care to public insurance beneficiaries. Patient abuse, short-staffing, and poor training may be reasons to take legal action.
NYC Health + Hospitals Whistleblowers May be Entitled to Cash Awards
In 2018, whistleblowers helped the government recover $2.1 billion stolen from Medicaid, Medicare, and TRICARE through fraud schemes. This would not have been possible without the help of hundreds of people who shared their insider information. For their assistance, many of these whistleblowers received significant financial rewards.
Every time a medical provider offers kickbacks, falsifies records, or performs medically unnecessary procedures in the name of profit, it not only siphons money away from Medicaid, but it puts patients at risk.
The False Claims Act is the best tool we have to protect these crucial insurance programs and their beneficiaries.
Although the federal and NYS governments are well aware that health care fraud is happening in New York, they do not have the resources to monitor health care facilities closely enough to prevent or prosecute all fraud. Regulators must rely on tips and first-hand knowledge from whistleblowers to determine where to focus their investigation efforts. Prosecutors also rely on citizens to act as qui tam plaintiffs on the government’s behalf.
The False Claims Act allows for cash payments for whistleblowers whose qui tam lawsuits result in a positive settlement or verdict. Under the terms of the FCA, a successful whistleblower may receive between 15 and 30 percent of the funds recovered through the lawsuit. Since most Medicaid fraud cases involve multimillion-dollar fraud schemes, many whistleblowers earn six, seven, or even eight-figure rewards.
The highest-earning whistleblowers typically enlist the help of an experienced False Claims Act attorney to file a qui tam or False Claims Act lawsuit. Sending a tip to the government through a hotline will not guarantee an investigation, and it will likely bar the whistleblower from receiving any reward. A False Claims Act lawsuit filed properly and in a timely manner will significantly increase the chances of the fraud scheme being shut down.
Call for NYC Health + Hospitals Whistleblowers
Were you ever an employee at a NYC Health + Hospitals affiliated hospital, clinic, long-term care facility, or home health care program?
Do you have information about administrators, doctors, nurses, managers, or other employees who have engaged in fraudulent activity to increase payments from Medicaid?
Are you aware of any other misconduct happening at NYC Health + Hospitals?
Please contact us. We may be able to help you put an end to the fraud, protect future patients, and earn a reward for your efforts. You may be entitled to legal protection and a monetary reward even if you were involved in the fraud, as long as you were not the orchestrator.
Call us today for a confidential review of your case. All information will be kept confidential under attorney-client privilege.