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Catholic Health to pay $6 million for alleged false claims

The Catholic Health System will pay $6 million to satisfy a federal case against it for allegedly filing false medical claims to government health care agencies, the U.S. Attorney's Office reported this afternoon.

The alleged incidents occurred between 2007 and 2014.

The health system was accused of submitting false claims to Medicare for rehabilitation therapy services it provided at nursing homes and other facilities in the region, including Father Baker Manor, St. Francis Williamsville, and the McAuley Residence, according to Assistant U.S. Attorney Kathleen A. Lynch.

[PDF: Department of Justice announces settlement]

“A healthcare system that is infected with dishonesty is susceptible to one of the worst afflictions known to mankind—human greed,” said Acting U.S. Attorney James P. Kennedy, Jr. “Today’s settlement demonstrates our unwavering commitment to eradicating this cancer from our federal health care programs.”

Federal prosecutors said the services "were administered to beneficiaries at levels that were unreasonable, not medically necessary, and unsupported by the medical records," according to a statement the U.S. Attorney's Office issued this afternoon.

Catholic Health, in a statement, said that the organization admitted no liability or wrongdoing in the settlement, and that the government investigation was based on a small sample of cases.

"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," officials said.

"Catholic Health maintains that therapy was provided pursuant to physician-approved and monitored plans of care. Moreover, Catholic Health maintains that while its rehabilitation patients received more intense therapy on average than patients at other facilities, its patients’ stays were significantly shorter than national averages – meaning the more intense level of therapy services resulted in Catholic Health patients returning home faster," officials said.

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