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News: Dignity Health Resolves False Claims' Suit with $37 Million Settlement

CDI Strategies, November 6, 2014

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Inpatient admissions for patients undergoing cardiovascular procedures such as implants of stents and pacemakers and elective kyphoplasty procedures appears to be the culprit behind a $37 million dollar False Claims Act settlement between the government and Dignity Health, according to a recent report from the OIG.

Dignity, formerly known as Catholic Healthcare West, is based in San Francisco and is one of the five largest hospital systems in the nation with 39 hospitals in California, Nevada, and Arizona.

The suit examined records related to elective cardiovascular scheduled surgeries from 2006 through 2010 at 13 Dignity facilities, with the government alleging such surgeries should have been billed as outpatient surgeries. Additional the OIG reviewed records from 2000 to 2008, finding four hospitals inappropriately billing for elective kyphoplasty procedures treatments.

“Lastly, the government alleged that from 2006 through 2010, 13 hospitals admitted patients for certain common medical diagnoses where admission as an inpatient was medically unnecessary and appropriate care could have been provided in a less costly outpatient or observation setting,” the OIG report states.   

“Charging the government for higher cost inpatient services that patients do not need wastes the country’s vital health care dollars,” said Acting Assistant Attorney General Joyce R. Branda for the Justice Department’s Civil Division.  “This department will continue its work to stop abuses of the nation’s health care resources and to ensure patients receive the most appropriate care.”

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