Dubuis Health System and Southern Crescent Hospital for Specialty Care, Inc. (Southern Crescent) have agreed to pay the United States $8,000,000 to settle allegations that they submitted false claims to Medicare, the Justice Department announced today. Dubuis Health System manages long-term acute care hospitals in multiple states, including Southern Crescent. Southern Crescent is a long-term acute care hospital located in Riverdale, GA and is part of the CHRISTUS Health System.
Long term acute care hospitals are similar to typical acute care hospitals except that they are certified to focus on patients with more complex medical needs who, on average, remain in the hospital more than 25 days. Long term acute care hospitals receive a higher rate of Medicare reimbursement than do typical acute care hospitals. This settlement resolves allegations that between 2003 and 2009, Dubuis Health System and Southern Crescent knowingly kept patients hospitalized beyond the time considered to be medically necessary, to increase their Medicare reimbursement and to maintain Southern Crescent’s classification as a long-term acute care facility.
"Billing Medicare for patient care that is not necessary or appropriate contributes to the soaring costs of health care. This settlement demonstrates the Department of Justice’s commitment to protect public funds and guard against abuse of the Medicare system,” said Stuart F. Delery, the Acting Assistant Attorney General of the Justice Department’s Civil Division.
“Hospitals that violate the public trust by keeping patients hospitalized beyond what is medically necessary will not be tolerated. Our office will continue to bring cases that enforce our health care laws,” said Kenneth Magidson, United States Attorney for the Southern District of Texas.
This matter was initiated by the filing of a whistleblower complaint under the False Claims Act (FCA). Under the FCA, private citizens can bring suit for false claims on behalf of the United States and receive a share of the recovery obtained by the Government. The whistleblower in this matter, Darlene Tucker, was a former administrator at Southern Crescent. As a result of this settlement, Ms. Tucker will receive $2,160,000 of the United States’ recovery.
This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $10.7 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $14.7 billion.
The case was jointly handled by the U.S. Attorney’s Office for the Southern District of Texas, the Justice Department’s Civil Division, and the Office of the Inspector General of the Department of Health and Human Services. The claims resolved by this settlement are allegations only, and there has been no determination of liability.
The case is captioned United States ex rel. Tucker v. Christus Health and Dubuis Health System, Inc., et al, No. 09-cv-1819 (S.D. Tex.).