ChristianaCare Hospital Wilmington

ChristianaCare to pay $7.6M to settle Medicaid false claims charges

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ChristianaCare Hospital Wilmington

Delaware’s Medicaid program will receive $7.6 million from ChristianaCare following a settlement that would resolve federal False Claims Act and Delaware False Claims and Reporting Act allegations.

Attorney General Kathy Jennings announced Friday that ChristianaCare Health System will pay $7,666,379 to Delaware’s Medicaid program to settle federal and Delaware false claim allegations.

The case, which was initiated by a whistleblower, alleges that ChristianaCare provided free or below-market value support services to non-employee doctors, who then referred patients to the health system.

These referrals in turn led to ChristianaCare billing Medicaid.

State and federal authorities said providing free or below-market value support services induced referrals in violation of Delaware’s Patient Brokering and Anti-Kickback laws.

Because the inducements were unlawful, any resulting billing to Medicaid was a false or fraudulent claim and illegal under the federal and state rules.

“Kickbacks harm us all by inducing improper billing to the State’s Medicaid program,” Jennings said.

The settlement does not incude admission of liability, said Shane Hoffman, ChristianaCare communications director.

“Following a favorable judgement by the court, which dismissed a portion of the claims, we are pleased to settle this matter as we focus forward on meeting the evolving health needs of the diverse communities we serve,” he said. “Our number-one priority is to provide the best possible care to every patient we serve.”

 The use of advanced-practice clinicians to coordinate and provide continuity of care is essential to high-quality, safe care that Christiana provides, he said. The health system will continue to ensure its use of those clinicians to support quality and safety is in accordance with all current guidance and requirements.

” As a nonprofit health care organization with a mission of service to our community, we are committed to providing high-quality, safe care to everyone we serve, especially for critically ill newborns in our NICU,” he said.

ChristianaCare allegations

The settlement resolves allegations that ChristianaCare submitted, or caused the submission of, false claims to Medicaid by providing support services from health system nurse practitioners, hospitalists and physician assistants to non-system physicians at no cost or below fair market value.

The alleged false claims occurred in the ChristianaCare neonatology department between April 1, 2011, and Sept. 30, 2013, and in cardiovascular surgery, urology, neurosurgery and ear nose and throat departments between April 1, 2011, and April 14, 2017.

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This settlement arises from a qui tam action — which allows individuals to sue on behalf of the government — filed in April 2017 in the United States District Court for the District of Delaware.

The Attorney General’s Medicaid Fraud Control Unit receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $2.2 million for Federal fiscal year 2024.  The remaining 25 percent, totaling $727,990 for FY 2023, is funded by the State of Delaware.

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