A settlement has been reached in a whistleblower class action lawsuit brought against Dignity Health (formerly Catholic Healthcare West) who is accused of submitting false claims and overbilling to Medicare and TRICARE (a mility healthcare program).
The whistleblower that filed the orignal lawsuit will receive approximately $6.25 million, whereas the entire settlement amount that Dignity Health agreed to pay is $37 million.
Filed in 2009, the complaint alleged that from 2006 through 2010, 13 Dignity hospitals billed Medicare and TRICARE for inpatient care for certain patients who underwent elective cardiovascular procedures in scheduled surgeries when the claims should have been billed as outpatient surgeries. Additionally allegations included that from 2000 through 2008, four of the Dignity hospitals billed Medicare for beneficiaries undergoing elective kyphoplasty procedures, which are minimally-invasive and performed to treat certain spinal compression fractures that should have been billed as less costly outpatient procedures. The complaint also 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.
