CORPUS CHRISTI – Christus Spohn Health Systems Corporation has shelled out more than five million dollars to the federal government to settle a lawsuit over false claims made to Medicare.
Back in 2008, Spohn Shoreline’s case management director Cecilia Guardiola filed a lawsuit under the False Claims Act, alleging that the six Christus Spohn hospitals in the Coastal Bend were routinely billing Medicare for inpatient procedures, but only performing less serious outpatient procedures.
Medicare pays more for inpatient care when compared to outpatient. Prosecutors say many of the patients billed were out of the hospital within 24 hours.
According to the federal lawsuit filed in 2008 against Christus Spohn, Guardiola complained about the practice to hospital administrators, but was ignored.
The lawsuit reads, “Mrs. Guardiola resigned her position at Christus Shoreline in April 2007 after hospital officials and physicians repeatedly refused to follow her advice, preferring to continue defrauding government-funded health insurance programs.”
Under federal law, Guardiola is eligible to receive 20 percent of the settlement, or in this case, about a million dollars.
She now lives out of state.
Her attorney in Houston could not be reached to confirm the payment.
Christus Spohn responded to questions about the lawsuit and settlement with the following written statement:
“Christus Spohn Health System cooperated fully with the U.S. Department of Justice regarding allegations of admitting patients to inpatient status for outpatient procedures. Christus Spohn disagrees with the government’s overall characterization of this issue. We remain committed to our core value of Integrity.”
Spohn also claimed that it was responsible for catching the error through an audit, not Guardiola.
“The issue of whether patient care is inpatient or outpatient is incredibly complex. As a result we conduct regular internal audits; it is through this review process, that we uncovered the issue and began corrective action well before learning of the government’s investigation.”
“We are glad to put this issue behind us and move forward with our continued focus on providing the highest quality of care to all those we are privileged to serve.”
Click the following link to view the federal lawsuit against Christus Spohn filed in February of 2008.
Click the following link to view the terms of the settlement reached in April.
