Recently, Nolan Auerbach & White announced the successful resolution of its client’s 5-year-long civil False Claims Act case against Dignity Health (formerly named Catholic Healthcare West). The qui tam case was brought in November 2009 by client Kathleen Hawkins, a former Dignity Health Director of Medical Management. Dignity Health has agreed to pay $36,744,423 to resolve Ms. Hawkins’ qui tam lawsuit.
The settlement included the resolution of allegations that thirteen (13) of Dignity’s Hospitals, from January 1, 2006 through December 31, 2010, knowingly submitted or caused to be submitted claims for payment to the Federal Healthcare Programs for scheduled cardiovascular procedures, billing these services as inpatient procedures when they should have been billed as outpatient procedures. The settlement involved claims submitted by the Dignity Hospitals that met, inter alia, all of the following criteria: (a) For beneficiaries whose length of stay after inpatient admission was one (1) day or less; (b) For beneficiaries whose admission did not originate in the Emergency Department.
The settlement also resolves allegations that from January 1, 2006 through December 31, 2010, twelve (13) Dignity Hospitals knowingly submitted or caused to be submitted claims for payment to the Federal Healthcare Programs for certain inpatient admissions, billing these services as inpatient when they should have been billed as outpatient or observation services. The settlement involved claims submitted by the Dignity Hospitals that met, inter alia, all of the following criteria: (a) For beneficiaries whose length of stay after inpatient admission was (1) day or less; (b) For beneficiaries who were not transferred in from or transferred or discharged to another acute care facility, did not leave the Dignity Hospital to which they originally presented against medical advice, and did not die while in a Dignity Hospital.
Pursuant to the qui tam statute, the United States agreed to reward Ms. Hawkins with a relator’s share of 17%.
More information for whistleblowers is located at the Nolan Auerbach & White website.