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St. Anthony Hospital Fined $475,000 for Medicare Fraud
Oklahoma City, Oklahoma — The owner of St. Anthony Hospital, SSM Health Care of Oklahoma, Inc. (‘SSM’), has been fined $475,000 to settle claims of improper billing for inpatient services that should have been outpatient, announced Sanford C. Coats, United States Attorney for the Western District of Oklahoma.
The United States alleged that from February 1, 2007, through February 28, 2009, SSM billed Medicare for inpatient services that should have been billed as outpatient services which resulted in higher reimbursements to SSM. Specifically, it was alleged that individuals who presented at the emergency room, and patients who were scheduled for planned medical procedures, were admitted into the hospital and the services billed on an inpatient basis when they should have been billed on an outpatient basis.
The United States alleged that potential liability existed for SSM under the False Claims Act (31 U.S.C.§§3729-3733), the Civil Monetary Penalties Law (42 U.S.C. §13201-72), the Program Fraud Civil remedies Act (31 U.S.C. §§3801-3812, and common law. In order to resolve these claims, SSM agreed to pay $475,000 to the government. In reaching this settlement, SSM did not admit liability, and the government did not make any concession regarding the legitimacy of the claims.
The case was investigated by the United States Department of Health and Human Services Office of Inspector General and was prosecuted by Assistant United States Attorney Ronald R. Gallegos. The agreement allows the parties to avoid the delay, expense, inconvenience, and uncertainty involved in litigating the case.
The alleged scheme involved improper billing for inpatient services, resulting in higher reimbursements for SSM. This is a serious offense, and SSM’s actions demonstrate a blatant disregard for the law and the trust placed in them by the public.
The settlement comes as a relief to the government, which can now allocate these funds towards more pressing issues. However, the fact remains that SSM’s actions were unacceptable, and they must be held accountable for their actions.
As we continue to uncover more cases of healthcare fraud, it is clear that the system is broken and in need of reform. It is up to our leaders to take action and ensure that those who engage in such activities are brought to justice.
Key Facts
- State: Oklahoma
- Category: White Collar Crime|Fraud & Financial Crimes
- Source: DOJ Press Release ↗
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