San Francisco-based Dignity Health has agreed to pay the United States $37 million to settle allegations that 13 of its hospitals in California, Nevada and Arizona knowingly submitted false claims to Medicare and TRICARE by admitting patients who could have been treated on a less costly, outpatient basis, the Justice Department announced today.
According to the allegations, Dignity Health, formerly known as Catholic Healthcare West, charged the government for higher-cost inpatient services that patients did not need, wasting the country’s vital healthcare dollars.
“Charging the government for higher cost inpatient services that patients do not need wastes the country’s vital health care dollars,” said Acting Assistant Attorney General Joyce R. Branda for the Justice Department’s Civil Division. “This department will continue its work to stop abuses of the nation’s health care resources and to ensure patients receive the most appropriate care.”
The settlement resolves allegations that 13 Dignity Health hospitals knowingly overcharged Medicare and TRICARE for inpatient services for patients who should have been treated on a less costly, outpatient basis.
The United States alleged that from 2006 through 2010, 13 Dignity hospitals billed Medicare and TRICARE for inpatient care for certain patients who underwent elective cardiovascular procedures (e.g., stents, pacemakers) in scheduled surgeries when the claims should have been billed as outpatient surgeries.
“This settlement demonstrates this office’s commitment to protecting our federal health care programs,” said U.S. Attorney Melinda Haag for the Northern District of California. “We will continue to aggressively and appropriately pursue False Claims Act allegations of wrongdoing in the health care industry.”
As part of today’s agreement, Dignity entered into a corporate integrity agreement with the U.S. Department of Health and Human Services – Office of Inspector General (HHS-OIG) requiring the company to engage in significant compliance efforts over the next five years.
Kathleen Hawkins, a former employee of Dignity, will receive approximately $6.25 million as part of the settlement. Hawkins filed the lawsuit under the qui tam or whistleblower provisions of the False Claims Act, which permit private citizens to bring lawsuits on behalf of the United States and obtain a portion of the government’s recovery.
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Key Facts
- State: California
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release ↗
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