Effective Compliance Program Leads To Self-Disclosure for New York Hospital

The benefits of an effective compliance program and self-disclosure are demonstrated by a case involving Our Lady of Lourdes Memorial Hospital, a 242-bed hospital located in Binghampton, N.Y. Lourdes paid the government $3.38 million after it discovered that it had been overpaid by Medicare for hyperbaric oxygen therapy services from February 2008 through September 2013, according to an Oct. 16 announcement by the Department of Justice. Lourdes claimed the services as if they were performed as provider-based even though they did not qualify for that under Medicare regulations. The improper billing was found as a result of Lourdes’s internal auditing program, part of its compliance program, and was immediately corrected and then reported to the government. Because Lourdes took the action it did and then cooperated with the government investigation, it was required to pay far less than the treble damages and other monetary penalties that government prosecutors could have imposed. In addition, Lourdes was not required to enter into a corporate integrity agreement or comply with other onerous compliance measures. There were never any allegations that patient care was compromised in any way. Lourdes President David J. Patak said in a statement, “Lourdes has always been dedicated to enhancing the health and well-being of this community and we hold ourselves accountable to the highest standards of integrity.” “Today’s settlement is an excellent example of how voluntary self-disclosure benefits both the integrity of health care programs and providers who discover and report evidence of improper billing in their organization. Lourdes should be commended for the manner in which it handled the disclosure” said U.S. Attorney Richard S. Hartunian. Takeaway: This case demonstrates the real financial and reputational benefits of an effective compliance program when a compliance issue is discovered.