Saint Vincents Catholic Medical Centers Pays $29 Million to Resolve Fraud Allegations
Saint Vincents Catholic Medical Centers of New York, one of six healthcare systems alleged to have fraudulently retained years of inaccurately inflated government medical care payments, settled a Department of Justice (DOJ) lawsuit by agreeing to pay $29 million, according to a news release by Phillips & Cohen, a Washington, DC-based law firm.
The allegations were first made in a whistleblower lawsuit filed by Phillips & Cohen LLP. Saint Vincent is one of six health plans participating in the Uniformed Services Family Health Plan (USFHP) program, which is a federal health insurance program funded by the Defense Health Agency (DHA), a component of the Department of Defense (DOD), a news release by the DOJ stated on February 14. DHA pays Saint Vincent capitated rates to provide healthcare services to military personnel, retirees, and their families. The complaint alleged that, in 2012, Saint Vincent learned that errors had been made in calculating the capitated rates, resulting in significant overpayments to Saint Vincent and the other five USFHP plans over the preceding four years. Instead of notifying the government of the errors, Saint Vincent, along with the other five USFHP plans, took steps to conceal the existence of the overpayments from DHA, continued to submit invoices at the inflated payment rates, and conspired to avoid paying the money back.
“Those who receive public funds, including participants in government healthcare programs, must return funds to which they are not entitled,” said Acting Assistant Attorney General Brett A. Shumate, head of the Justice Department’s Civil Division, in a statement. “Together with our partners across the federal government, we will hold accountable those who knowingly violate this obligation to the American taxpayers.”
“The government’s methodical and thorough investigation and intervention resulted in the settlement with Saint Vincents,” said Amy Easton, a partner and whistleblower attorney at Phillips & Cohen, in a statement.
