Rhode Island Hospital to Pay $5.3 Million for Ordering Unnecessary Hospital Stays Billed to Federal Health Care Programs
U.S. Attorney’s Office, U.S. Department of Health and Human Services, FBI Investigation Determines Medically Unnecessary Doctor-Ordered Overnight Stays Billed to Medicare and Medicaid

PROVIDENCE, RI—Rhode Island Hospital will reimburse federal health care programs approximately $2.6 million dollars and will pay the federal government approximately $2.7 million in double and triple damages for ordering medically unnecessary overnight patient hospital stays and then submitting claims for payment to federally funded Medicare and Medicaid programs.

An investigation by the United States Attorney’s Office for the District of Rhode Island; Office of Inspector General of the U.S Department of Health and Human Services (OIG-HHS); and the Federal Bureau of Investigation determined that during the period from January 1, 2004, through December 31, 2009, medically unnecessary overnight hospital admissions were ordered for approximately 260 patients who underwent stereotactic radiosurgery, otherwise known as Gamma Knife treatment. The investigation also revealed that Rhode Island Hospital’s claims for reimbursement for the overnight admissions to Medicare and Medicaid falsely represented that the admissions were medically necessary when, in fact, they were not.

According to a Civil Settlement Agreement, OIG-HHS reserves all rights to institute, direct, or to maintain any administrative action seeking exclusion against Rhode Island Hospital and/or its officers, directors, and employees from Medicare, Medicaid, and all other federal health care programs. In addition, the Agreement stipulates that the federal government does not release Rhode Island Hospital from any criminal liability or liability to the Internal Revenue Service in this matter.

“Health care organizations accused of billing for medically unnecessary services by abusing Medicare and Medicaid rules to put the profit motive before quality health care services will be identified and held responsible,” said Susan J. Waddell, Special Agent in Charge of the region covering Rhode Island for the Office of Inspector General of the Department of Health and Human Services. “This settlement reflects the determination of OIG and the Department of Justice to protect taxpayer funded health care services for those in need.”

The investigation for the United States Attorney’s Office was led by Assistant U.S. Attorney Dulce Donovan. The matter was also investigated by the Office of Inspector General of the U.S Department of Health and Human Services and the Federal Bureau of Investigation