Catholic Health System to pay $6 million to settle false rehab claims allegations

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A New York-based healthcare system has agreed to pay $6 million to settle allegations that it submitted false Medicare and Medicaid claims for skilled nursing services, authorities announced on Friday.

At least three skilled nursing facilities operated by Catholic Health System Inc. reportedly submitted false claims for Ultra High rehabilitation therapy services that were “unreasonable, not medically necessary, and unsupported by the medical records,” Acting U.S. Attorney James P. Kennedy Jr., said in his announcement. The scheme allegedly ran between January 2007 and December 2014.

“A healthcare system that is infected with dishonesty is susceptible to one of the worst afflictions known to mankind — human greed,” Kennedy said. “Today's settlement demonstrates our unwavering commitment to eradicating this cancer from our federal healthcare programs.”

Catholic Health complained officials' findings were based on a small sample of claims, the Cheektowaga Chronicle reported.

“The government also relied on statistics indicating that rehabilitation services utilization at Catholic Health sub-acute rehabilitation facilities exceeded national averages,” the provider said in a press release. “Determinations of the medical necessity of therapy services made years after care was provided are highly subjective, and Catholic Health does not agree with the government's conclusions concerning the medical necessity of rehabilitation services provided at its facilities.”

The settlement includes no admission of liability or wrongdoing by Catholic Health, which said it chose to settle to avoid the “substantial” resources necessary to continue litigation. The organization also entered into a five-year corporate integrity agreement with the Department of Health and Human Services' Office of Inspector General.