SVCMC Inc., previously known as Saint Vincents Catholic Medical Centers of New York, has agreed to a $29 million settlement to address allegations of violating the False Claims Act. The accusations involve knowingly retaining inflated payments from the Department of Defense for healthcare services provided to retired military members and their families.
Saint Vincent is one of six health plans involved in the Uniformed Services Family Health Plan (USFHP) program, funded by the Defense Health Agency (DHA). Under this program, DHA pays capitated rates for healthcare services. Allegations suggest that in 2012, Saint Vincent discovered errors in rate calculations leading to overpayments over four years but did not report or repay these funds. Instead, it allegedly concealed the overpayments and continued billing at inflated rates.
“Those who receive public funds, including participants in government health care programs, must return funds to which they are not entitled,” stated Acting Assistant Attorney General Brett A. Shumate. “Together with our partners across the federal government, we will hold accountable those who knowingly violate this obligation to the American taxpayers.”
Dr. David C. Krulak from TRICARE Health Plan expressed gratitude towards the Justice Department for resolving the case on behalf of TRICARE and DHA.
The settlement resolves claims under the qui tam provisions of the False Claims Act by whistleblowers Jane Rollinson and Daniel Gregorie in Maine. Rollinson previously worked at Martin’s Point Health Care, part of USFHP, while Gregorie served as a consultant and later on its Board of Trustees. They will receive $5.655 million as part of the settlement.
The investigation was a joint effort between several legal entities including the Civil Division’s Commercial Litigation Branch and U.S. Attorney’s Office for Maine with assistance from DHA.
This resolution underscores governmental efforts against healthcare fraud using tools like the False Claims Act. Reports about potential fraud can be directed to Health and Human Services at 800-HHS-TIPS.
The allegations resolved by this settlement remain unproven without any determination of liability.