The Greater New York Hospital Association, three hospitals and three medical colleges have filed a lawsuit against the federal government "to end unfair and coercive audits" in one of HHS' nationwide fraud probes.
The investigation at issue is the Physicians at Teaching Hospitals initiative (PATH), which looks at how teaching hospitals bill Medicare for the services of resident physicians.
The lawsuit was filed April 16 in U.S. District Court in New York. At least three other lawsuits have been filed by healthcare trade groups challenging various federal healthcare fraud investigations (April 13, p. 3).
In its lawsuit, the GNYHA alleges that PATH audits "are applying a set of billing and documentation requirements that was not in effect during the time frames being audited."
HHS, which backed off PATH audits in five states last July (Feb. 9, p. 6), should also let New York off the hook, the suit argues.
"The federal government has indicated it will proceed with the PATH audits in New York based solely on several articles that appeared during the 1970s in a newsletter published by one of the New York carriers," the GNYHA said in a statement.
However, the newsletter was not an official source of Medicare information, said GNYHA General Counsel Susan Waltman.
"It was a chatty newsletter that promoted the carrier's services," Waltman said. "It includes graphics of hula dancers and bullfighters. Doctors would have seen a lot of pictures and promotions, but how would they know it was the official publication on Medicare rules?"
The GNYHA asserts that some officials with the carrier, Empire Blue Cross and Blue Shield, and HHS don't consider the newsletter the official word on Medicare.
Plaintiffs include 1,343-bed Beth Israel Medical Center, Columbia University, Memorial Sloan-Kettering Cancer Center, 1,086-bed Mount Sinai Medical Center, the Mount Sinai School of Medicine and New York University School of Medicine.
Five New York-area hospitals have received PATH audit letters from HHS: Beth Israel, Long Island Jewish Medical Center in Queens, Mount Sinai, University Hospital of Brooklyn-State University of New York Health Science Center at Brooklyn and University Hospital of SUNY at Stony Brook on Long Island.
The Healthcare Association of New York State, a statewide association of hospitals and health systems, is a plaintiff in the Association of American Medical College's lawsuit challenging PATH, pending in U.S. District Court in Los Angeles. That lawsuit has gathered a total of 45 plaintiffs, including hospitals and trade organizations like the American Hospital Association.
HANYS has no plans to join the GNYHA lawsuit, said a spokeswoman for the association.
GNYHA spokeswoman Mary Johnson said the association thinks it is covered by the AAMC's lawsuit, but it filed its own complaint to raise issues unique to New York. The GNYHA worked closely with the AAMC in putting together its lawsuit.