This is the first in a series of articles investigating Meadowlands Hospital Medical Center. In this story we take a look at the facility’s AmeriMama birth-tourism program. Our second story details the hospital’s questionable business practices; the third, its ties to powerful NJ politicians..
A company based in the Meadowlands Hospital Medical Center has been advertising online to Russian citizens, encouraging pregnant women to come to the Secaucus facility to give birth — a process that makes the baby automatically eligible for U.S. citizenship and connects the hospital to a growing and relatively unknown international phenomenon known as “birth tourism.”
Unlike the situation involving “anchor babies,” in which impoverished illegal immigrants move to the United States, where their children automatically become citizens, birth tourists generally intend to return home. Their child’s citizenship is meant as insurance in case family members wish to leave their native country at some point.
The MHMC service, called “AmeriMama,” promotes tour packages that offer to coordinate medical services at Meadowlands Hospital and help the family establish a comfortable life in the area for up to six months. A Russian-language website — which was active for more than a year and taken down after NJ Spotlight raised questions about its content — promised to secure citizenship papers, passports, and travel visas for the baby for fees ranging from $8,500 to $27,500, depending on the level of assistance involved; airfare, housing, and living expenses appear to cost extra. (The AmeriMama Facebook page remains active.)
While families generally return to their home countries after giving birth, their babies can eventually enjoy the benefits of American, or dual, citizenship — and parents have the right to apply for residency after several decades. Plus, the quality of medical care is often better in this country and more focused on the patient’s comfort, the site explains.
“Childbirth in New York is the best investment in the future of your family!” reads a translation of the website undertaken by NJ Spotlight — even though the hospital is in New Jersey.
Despite the promotion, AmeriMama does not appear to have been particularly successful; many beds have remained empty in the maternity ward and hospital in general in recent years. AmeriMama began in December 2014, according to the website, but sources connected to the hospital said it has been going on informally for even longer.
The hospital’s continual struggle appears to have encouraged them to look for a buyer. In July, a new corporation submitted a request to the state to take over Meadowlands Hospital’s operation. Details on the applicant have yet to be made public, but state officials said they are reviewing the proposal.
An ‘insurance policy’
Experts said birth tourism is a growth industry, especially among the expanding middle and upper classes in countries that suffer from environmental, economic, or other instabilities — like China and Russia. It is not illegal for foreigners to give birth in the U.S., but it is illegal to lie to immigration officials about the reasons for a visit, something that experts said can happen in some birth-tourism cases.
The business depends on the “birthright clause” of the 14th Amendment to the U.S. Constitution, which guarantees babies born in this country to foreign parents automatically qualify for citizenship. Designed to promote equality, regardless of parental background, the clause became a target last fall for Republican candidates for the presidential nomination.
“It’s an insurance policy,” explained Doris Meissner, head of the Migration Policy Institute. “These are people who have the means and the options within their own society,” she said, “but they want to keep a foot in both countries just in case something goes wrong.”
While the scope of the phenomenon is hard to document, Meissner said she has heard of services in Florida that cater to Russian birth tourists, and another that connects Nigerians with a maternity practice in Houston. Similar operations have been discovered recently in Los Angeles, San Francisco, Seattle and, a few years ago, in Flushing, Queens. The concept is so familiar abroad it was the subject of a recent Chinese romantic comedy.
AmeriMama seemed an unusual model to Meissner, who said most services do not offer a complete package that includes logistics and medical care combined, and most are not tied to one specific hospital. The website praised AmeriMama’s connection to MHMC and its physicians and featured the hospital’s logo prominently.
Meadowlands officials decline comment
Meadowlands Hospital officials declined repeated requests to discuss AmeriMama, the hospital’s operations, or its potential sale. The hospital’s CEO did not respond to emails and calls, and other hospital leaders refused repeated invitations made through various channels to talk about the program. The facility’s lobbyist, Princeton Public Affairs, which was paid some $160,000 in 2015 to represent the hospital, also opted to not answer questions about the facility’s birth-tourism program.
Al Gaburo, with Princeton Public Affairs, did confirm that the current ownership group is not part of the corporation seeking to purchase the facility. “We look forward to working with the Department of Health and all regulatory agencies as we go through the process. We believe the end product will be a win-win for the community and the patients served by MHMC,” he said.
[img-narrow:/assets/16/0808/2054] Two principal owners active in the hospital’s operation, Tamara Dunaev, the board’s vice chair, and longtime chairman Dr. Richard Lipsky, met with NJ Spotlight briefly after testifying in an ongoing labor trial. They both declined to discuss AmeriMama or the hospital in any detail.
Hospital staff members also declined to speak on the record out of fear they would be fired or otherwise punished by hospital owners.
Like other New Jersey businesses, AmeriMama is registered with the Treasury Department; the limited information the company filed lists the owner as Alexey Grigoryev, at 55 Meadowlands Parkway, Secaucus — the hospital address. Treasury had no other information on Grigoryev and NJ Spotlight could not locate him through multiple Internet searches, hospital officials, or other sources.
When stopped after the recent court hearing in Newark, Dunaev said she wasn’t familiar with AmeriMama and declined to identify Grigoryev or explain his relationship to the hospital.
“I don’t know anything about this,” Dunaev said. “It’s not us. Lots of services use that (Meadowlands Hospital) address.” But she said it was not unusual for foreigners to give birth at regional hospitals.“Everybody does this,” she added.
Dawn Thomas, a spokeswoman for the state Department of Health, which oversees the state’s 72 acute-care hospitals, suggested the state does not have a direct role in monitoring a service like AmeriMama. “The Department of Health does not oversee how hospitals recruit patients,” she said, adding, ““Hospitals recruiting international patients is a national practice.”
News of the service came as a surprise to the New Jersey Hospital Association, the industry trade group.
“I’m not aware of this particular program — it’s not something that NJHA tracks or that we’ve encountered from a policy perspective,” explained Kerry McKean Kelly, the vice president for communications and member services. “But in a general sense, U.S. hospitals serving international patients is a pretty common practice. We have excellent healthcare here, and there’s international demand for it.”
Experts note that many American hospitals run programs to care for foreign citizens; some, like Deborah Heart and Lung, in Browns Mills, make it part of their mission to treat poor patients from abroad. Others actively pursue international patients who can pay full price for specialized care or treatments they can’t receive at home. (Unless there are pregnancy complications, childbirth isn’t usually among these.)
[inbar-start:title=Richard Zinovy Lipsky: Doctor, Entrepreneur, Man on the Move|summary=This colorful Russian doctor is not one to hide his light — or his achievements on two continents — under a bushel|intro=A doctor who specialized in pain management when he practiced in New Jersey, Richard Lipsky is chairman of Meadowlands Hospital Medical Center’s board of directors.]
He let his New Jersey medical license lapse in June 2013, according to the New Jersey Division of Consumer Affairs. New York State records show that Lipsky remains registered and eligible to practice medicine in New York, through April 2018.
Meadowlands is not Lipsky’s first hospital. In 2010, he and his brother Mikhail bought Columbus Hospital in Newark and turned it into a long-term care facility. According to the 2015 Meadowlands Hospital license renewal, Richard Lipsky is the 51 percent owner of Columbus. Lipsky previously operated another facility now owned by his brother, Xanadu Adult Medical Day Care, in Passaic, which has received multiple state violations.
Lipsky, 66, was born in Russia. He received his medical degree from Leningrad State University in 1973.
In testimony before the National Labor Relations Board during a dispute over unfair labor practices at MHMC, Lipsky talked extensively about his background: “I was a class valedictorian (in high school), so let me brag.”
After graduating from medical school, he “was sent to work in a small hospital in rural northern European part of Russia. As Lipsky described it, “I spent two years there running the place.”
Lipsky said he did postgraduate training in Moscow, went to work at a regional hospital in Minsk, resigned in 1978 and came to the United States in 1979. He missed the licensing exam for foreign doctors, worked first as a bartender and then as a senior research scientist at Columbia University. While there, he passed his exam and started a residency at Cabrini Medical Center in New York.
Lipsky said he did an anesthesiology residency at St. Vincent Hospital and was hired by Westwood Anesthesia Associates, where he worked through 2007.
Around 2001, Lipsky said he started a private pain management practice. Once bitten by the entrepreneurial bug, he bought part of a surgery center in Hawthorne and opened the Essex Surgery Center in Hackensack in 2005. He said “it wasn’t actually mine. It belonged to my ex-wife and my children.”
In 2007, he bought Roseland Surgery Center, and, Lipsky said he “basically rebuilt the whole thing at a huge cost.” Meadowlands hospital paid the center $600,000 for equipment and supplies a few years later.
By 2009, he started downsizing: Essex Surgery closed in 2009 and he dissolved Roseland five years later.
Meanwhile, he was working on a deal to buy Meadowlands Hospital, which he closed on with partners on January 11, 2010. As Lipksy told the NLRB judge:
“Sometime in 2009 an idea came to me that I want to buy a hospital. I met with my nearest and biggest competitors, which were owners of Bergen Ambulatory Surgery Center. Tamara Dunaev and Pavel Pogodin. And we were personally friendly, despite the fact that we were competing for doctors. So we decided to move together to buy the hospital.”
Lipsky said he was tipped to the hospital’s availability by Raj Mukjerji, “one of my PR people” and now a state assemblyman.
It’s not clear where Lipsky actually resides.
New York physician licensing records list Lipsky’s address in Woodcliff Lake. Property records show that property, assessed at $890,000 last year, is owned by Rimma Lipsky, who is believed to be his ex-wife. New Jersey licensing documents list a Park Ridge address. A search of public records also turned up addresses in Haworth and Bal Harbor and Miami Beach, Florida.
In 2003, he was married to Nadia Lipsky, a former Mrs. Russia who emigrated to the United States in 1994. She and Lipsky founded the Opiate Detoxification Institute to study and treat addiction. Lipsky dissolved the LLC in December 2014.
New Jersey hospitals sometimes deliver babies of foreigners who come here for various, often-unstated reasons, but the numbers are small. Generally, these mothers are uninsured and poor, so the cost of their birth is added to the facility’s Charity Care tab, some of which is eventually reimbursed by the state.
And no other hospital in New Jersey is known to be actively advertising its maternity services to paying foreign clients in search of citizenship for their children.
Jeanne Otersen, Chief of Staff for the Health Professionals and Allied Employees, the state’s largest healthcare union, said there is a clear distinction between nonprofit facilities caring for poor, pregnant immigrants and the model Meadowlands, a for-profit facility, has employed. One is mission driven, she said, “The other is a business enterprise.”
State Sen. Joseph Vitale (D-Middlesex), longtime Health Committee chairman and previous critic of the hospital’s operations, said AmeriMama raises new concerns. He said the service appears to fit a long pattern of unusual and potentially dangerous business ventures launched by the hospital’s current leadership, which took control in 2010.
“I have never observed a hospital in New Jersey that has behaved like this,” Vitale said, recalling past efforts to provide a questionable autism treatment, a focus on lucrative auto-accident claims, and Lipsky’s involvement elsewhere with a controversial opiate detox program. “And now this. It’s like medical Travelocity.
“I just question their capacity to do what’s right,” Vitale continued, noting that — since the facility does not have its own neo-natal intensive care unit — newborns with critical issues might need to be transferred to another hospital for appropriate care, something that wasn’t addressed in AmeriMama’s online information. “They have a license to operate a hospital, to provide medical care — it’s a privilege, not a given right.”
Renewed calls for greater oversight
Meadowlands Hospital is known in the industry for its checkered history and unorthodox business models. It has paid millions in government fines for tax violations, many hundreds of thousands to state regulators for administrative violations, and has been cited for numerous health and safety violations.
Leaders are now contesting the latest round of state fines and objecting to filing financial information, as required by law, and remain locked in legal action with the nurse’s union. Payment disputes have also led to court battles with several insurance companies. And now a new group of investors is seeking to take control.
A recent report from the Leapfrog Group, a nonprofit that monitors healthcare quality nationwide, suggested Meadowlands is struggling to provide optimal care in the maternity ward, as well as other areas. Data released in October showed the hospital properly screened mothers and newborns for key conditions, but had an extremely high rate of elective early deliveries — chemically induced births that add convenience but can prove harmful for both the baby and the mother.
While most hospitals in the region — and across the country — induce fewer than 3 percent of births, Meadowlands prompted nearly three out of four babies in 2014, despite its history of rarely inducing labor. MHMC performed Caesarian-section deliveries one in four times, which closely aligns with Leapfrog’s target.
But the hospital had a high rate — 43 percent — of episiotomies, a surgery done to quickly expand the birth canal during delivery, which can lead to complications; the Leapfrog target is 5 percent.
Some observers said the high early-elective delivery rate might be explained by the hospital’s efforts to seek out and schedule births for women traveling here from abroad, but others said it merely reflects the choice of local mothers — and their doctors, who often crave the convenience.
But healthcare advocates are concerned about the findings and the impact of the hospital’s extremely low census, or daily patient count. Multiple studies have confirmed that the more procedures a facility or doctor performs, the better the likely outcome. State data shows that MHMC had one in four beds filled at most times in 2011 and 2012, but the occupancy rate had dropped to 16 percent by last year.
Leaders at HPAE said that AmeriMama’s existence, which NJ Spotlight brought to their attention, raised questions about the state’s oversight of the hospital. The union now represents some 300 Meadowlands workers and is locked in a legal dispute with the hospital over what it calculates to be $3.7 million in lost wages and benefits. The National Labor Relations Board is expected to issue a ruling soon..
“We would again raise the concern of how this latest venture meets the mission of the hospital to care for the local community, how it effects the hospital’s financial viability, and what it says about the Department of Health’s capacity to provide proper oversight of Meadowlands,” Otersen said.
State health officials defend their oversight of Meadowlands Hospital, noting they participate in quarterly board meetings, called for an outside monitor, and have levied nearly $200,000 in fines for late financial filings. The DOH said it followed proper protocol in approving the hospital’s 2010 sale, which involved its conversion to a for-profit operation, and in renewing its annual operating license ever since. The most recent license was issued on March 15.
But Otersen, with HPAE, said the state should do more. “The Department of Health should know what our hospitals are doing,” Otersen said.”And if they don’t, that’s a serious concern. And if they do, I should hope they are checking into the quality of care and the impact on the hospital’s viability long-term.”
Meadowlands Hospital, a 230-bed facility on the banks of the Hackensack River, has struggled since 2010. That’s when a group of investors — Dunaev, Lipsky, two other principals, and a host of minor investors connected through a matrix of limited-liability corporations — joined forces to purchase the near-bankrupt facility for $17.6 million from a system that has since been absorbed by Barnabas Health.
The AmeriMama website, which NJ Spotlight had translated from Russian, painted a glowing picture of Meadowlands Hospital. It praised the facility’s cleanliness and high-quality of care, particularly in the maternity ward, and highlighted its high percentage of Russian-speaking staff. The site also bragged of the hospital’s advantageous location, just miles from the cultural and shopping mecca of New York City; according to testimonials from former clients, birth tourism at the Secaucus facility is like a luxury vacation.
“Meadowlands Hospital is considered one of the best not only in New York City, but in the US in general. Here babies are born from Russia, and in consequence become citizens of the two most powerful nations. They are, no doubt, have a great future in store for them,” it read.
Despite these advertised advantages, the online service does not seem to have sparked a stampede. While the 22-bed nursery was once nearly full, only a few infants can now be found there most days. (MHMC is also licensed for 26 pediatric hospital beds and four neonatal bassinets, designed for transitional care, but does not have a NICU onsite.)
In addition to the shopping and tourist attractions, the AmeriMama website underscored the benefits of giving birth near New York City, where the Russian Consulate has an office on 91st St. A visit to the consulate is required to secure dual citizenship for the baby, it noted. Another advantage is the region’s climate, which is closer to what Russians experience at home than the heat and humidity in Florida, another popular birth-tourism destination.
The site also stressed that AmeriMama is a better deal than its competitors and involves less red tape. The program claims to bundle all medical services into the price of each package and doesn’t charge extra for interpreters, single rooms, and unplanned medical needs, like anesthesia or even a caesarian section.
“You conclude only one [contract] under which the services will be rendered all necessary specialists, rather than a package of treaties and different accounts,” the homepage stated.
Most families return to Russia within months of giving birth in the United States, but the website highlighted the benefits of American citizenship, should the child choose to return in the future.
The list includes free education, basic healthcare, and other social services and access to the U.S. credit system. An American passport can offer more freedom than a Russian one, the site states, and dual citizenship can allow the child to receive certain tax breaks and an exemption from Russian Army service.
“Before, only very wealthy families could afford birth in the US, but today this service is becoming more accessible. There’s more and more women coming from Russia to give birth in Meadowlands Hospital: businessmen’s wives, business-ladies, women in politics and public policy,” the site stated.
“We are a trusted organization, and we’ve helped deliver many children. We have repeated customers, coming for the births of their 2nd and 3rd children. Meadowlands Hospital is not only one of the best hospitals in New York but in the United States as well. Here, you will receive the best care and service,” it continued, ignoring once again the facility’s actual location.
[img-narrow:/assets/16/0808/2103]Some of these statements raised red flags for Vitale and others who have followed the hospital’s history. Pregnant women in New Jersey have access to a wealth of data comparing the quality of care at hospitals throughout the state, Vitale said, and there are plenty of good facilities to choose from, particularly in North Jersey. Mothers-to-be who travel from Russia for this one facility — which stands to profit from their decision — don’t have the same options.
“They’re leading these women down a rosy path, with talk of shopping and sightseeing,” Vitale said. “But it’s completely profit driven. And it’s a real disservice to the patient. What if there’s a complication with the baby. What happens if it’s serious and they can’t go home? That gets expensive really fast.”
Legal gray zone
Birth tourism operations tend to operate largely underground and in a legal gray zone, making it hard for government officials to locate and even more difficult to prosecute if any violation is identified.
That wasn’t the case in Los Angeles, where complaints in 2012 from neighbors of “maternity hotels” led to a city crackdown on zoning violations and eventually a federal raid in 2015, the largest of its kind to date. In 2011, NBC New York reported on an operation in Flushing, Queens, that provided housing and other assistance to Chinese women traveling here to give birth.
The citizenship of a child born here to foreign parents is guaranteed, but the mother still needs to reach American soil before she delivers. While it is legal to travel to the United States to give birth, visa and customs officials have some discretion and can refuse entry to women they believe will become a burden on the American social system, or for other reasons. It is illegal for travelers to mislead immigration officials, or to coach others to do so, including taking precautions to hide a pregnancy or lie about the purpose of the visit. But violations are extremely hard to pin down and prove in court.
The AmeriMama website did not detail what exactly travelers should tell Russian officials who must issue a visa or American officials with the power to deny them entry once they arrive. It did outline a step-by-step process of preparing for the visit, traveling from Russia, arriving in New York, and going through passport control.
Travelers were encouraged to call the service to discuss any questions they may have — and assured they will know what to say to U.S. immigration officials: “Don’t worry – the answers to these questions you will be prepared in advance.”
AmeriMama representatives meet travelers at the airport, shuttle them to their prearranged housing, and assist them with everything from connecting to Russian TV channels to setting up a bank account to enrolling other children in a Russian-speaking private school, according to the website. The more expensive packages include other perks, like guided shopping and sightseeing, and expedited processing of the baby’s citizenship paperwork.
The website provided a list of documents required for dual citizenship, including a birth certificate for the baby, a Social Security number, a U.S. passport, and various papers from the Russian Consulate. It’s not clear exactly what assistance AmeriMama has provided parents, beyond transportation and logistical help, but the site testifies to the company’s expertise.
“The process of official registration of papers for a child born in America, requires responsibility, knowledge of the procedures and time, and the solution to this difficult task will take the company’s experienced staff at AmeriMama,” it read.
“While we prepare for you the documents, you dedicate time to yourself and the baby,” the website said, urging visitors to enjoy a stroll along the Hudson River or on the “well manicured streets” of New Jersey’s “small cozy towns.”
When the time comes to return to Russia, the website declared: “And here are all the documents ready, your baby is a little older and fully grown, with a light heart and heavy suitcases you can go home!”