BUFFALO, N.Y.-Acting U.S. Attorney James P. Kennedy, Jr.
announced today that the Catholic Health System, Inc. has agreed to pay
$6,000,000 to resolve allegations that its subsidiary, Home & Community
Based Care (formerly known as "Continuing Care"), violated the False
Claims Act by submitting false claims to government health care programs. Assistant
U.S. Attorney Kathleen A. Lynch, who handled the case, stated that between
January 1, 2007, and December 31, 2014, Catholic Health submitted or caused to
be submitted, false claims to Medicare for rehabilitation therapy services. The
services were provided by Catholic Health at long and short-term skilled
nursing care and post-acute care facilities including Father Baker Manor, St.
Francis Williamsville, and the McAuley Residence. The services were
administered to beneficiaries at levels that were unreasonable, not medically
necessary, and unsupported by the medical records. Specifically, Catholic
Health submitted false claims for payment related to Ultra High Resource
Utilization Group (“RUG”) levels during the relevant time at these facilities. “A
healthcare system that is infected with dishonesty is susceptible to one of the
worst afflictions known to mankind—human greed,” said Acting U.S. Attorney
James P. Kennedy, Jr. “Today’s settlement demonstrates our unwavering
commitment to eradicating this cancer from our federal health care programs.”
“When health care companies charge federal government health
programs for medically unnecessary services just to boost profits, taxpayers
are victimized and the health care industry’s reputation takes a hit,” said
Health and Human Services, Office of Inspector General, Office of
Investigations Special Agent-in-Charge Scott J. Lampert. “Our agency will continue to hold companies
accountable for such greed-fueled schemes.”
Catholic Health System, Inc. was named as a defendant in a
qui tam, or whistleblower, lawsuit brought under the False Claims Act, which
permits private citizens to bring lawsuits on behalf of the United States and
receive a portion of the proceeds of any settlement or judgment awarded against
a defendant.
As part of the False Claims Act settlement agreement and in
exchange for a release of OIG’s permissive exclusion authority, Catholic Health
has agreed to enter into a five-year corporate integrity agreement with OIG.
The settlement is the result of an investigation by the
Department of Health and Human Services, Office of Inspector General, Office of
Investigations, under the direction of Special Agent-in-Charge Scott Lampert. The
claims resolved by these settlements are allegations only, and there have been
no determinations of liability.
