The DOJ announced that SVCMC Inc., formerly known as Saint Vincent’s Catholic Medical Centers of New York (SVCMC), will pay $29 million to resolve allegations of violating the False Claims Act. According to the DOJ, the medical center knowingly retained erroneously inflated payments received from the Department of Defense (DoD) for healthcare services provided to retired military members and their families.
SVCMC is one of six health plans participating in the Uniformed Services Family Health Plan (USFHP) program. This federal health insurance program, funded by the Defense Health Agency (DHA), pays capitated rates to provide healthcare services to military personnel, retirees, and their families. According to the DOJ, in 2012, it was discovered that errors had been made in the calculation of these capitated rates, resulting in substantial overpayments to SVCMC and the other five USFHP plans over the preceding four years. But instead of notifying the government or repaying the funds, SVCMC allegedly took steps to conceal the overpayments and continued to submit invoices at the inflated rates.
This matter was initiated pursuant to the qui tam or whistleblower provisions of the False Claims Act by Jane Rollinson, former Interim Chief Financial Officer at Martin’s Point Health Care, and Daniel Gregorie, former consultant to Martin’s Point Health Care, in the District of Maine. Martin’s Point Health Care was one of the six health plans participating in the USFHP. Ms. Rollison and Mr. Gregorie will receive $5.655 million as part of the settlement.
The settlement was announced by Acting Assistant Attorney General Brett A. Shumate, head of the Justice Department’s Civil Division, who emphasized that “[t]hose who receive public funds, including participants in government health care programs, must return funds to which they are not entitled.” This settlement serves as a reminder to individuals and entities that failure to report and return an overpayment from the government will likely result in liability under the False Claims Act.
The attorneys at Chilivis Grubman represent clients of all types and sizes in connection to False Claims Act investigations and litigation. If you need assistance with such a matter, please contact us today.