DE Medicaid to Receive $7.6-million for Alleged False Claims Caused by Christiana Care Health System
Delaware’s Medicaid program will receive $7,666,379.00 following a settlement that resolves federal False Claims Act (FCA) and Delaware False Claims and Reporting Act (DFCRA) allegations against Christiana Care Health System (CCHS). Delaware DOJ officials say the case came about from a whistle-blower. The case alleges that CHSS provided free or below-market value support services to non-employee doctors, who then referred patients to CHSS. These referrals in turn led to CHSS billing Medicaid.
Additional information from the DOJ:
State and federal authorities maintain that the providing of these 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 (fraudulent) claim, and thus illegal under the FCA and DFCRA.
“Kickbacks harm us all by inducing improper billing to the State’s Medicaid program,” Attorney General Jennings said. “The Delaware Department of Justice will continue to protect our state’s healthcare programs from fraud.”
The settlement resolves allegations that CHSS submitted, or caused the submission of, false claims to Medicaid by providing support services (including CHSS nurse practitioners, hospitalists, and physician assistants) to non-CHSS physicians at no cost or below fair market value. The alleged false claims occurred between April 1, 2011, and September 30, 2013, with respect to the CHSS neonatology department, and between April 1, 2011, and April 14, 2017, with respect to CHSS’s cardiovascular surgery, urology, neurosurgery, and ear nose and throat departments.
This settlement arises from a qui tam action originally filed in April of 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 $2,184,000.00 for Federal fiscal year 2024. The remaining 25 percent, totaling $727,996.00 for FY 2023, is funded by the State of Delaware.
This case was handled for the DOJ by Deputy Attorneys General Ed Black and Stephen McDonald, with support from Legal Administrative Specialists Maria Smigel and Candice Sullivan, all of the Fraud and Consumer Protection Unit’s Medicaid Fraud Control Unit.
