Delaware News

Delaware Medicaid to receive $7.6 million for alleged false claims caused by Christiana Care Health System

Department of Justice | Department of Justice Press Releases | News | Date Posted: Friday, December 22, 2023


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Attorney General Kathy Jennings announced Friday that Delaware’s Medicaid program would receive $7,666,379.00 following a settlement that would resolve federal False Claims Act (FCA) and Delaware False Claims and Reporting Act (DFCRA) allegations against Christiana Care Health System (CCHS).

The case, which was initiated by a whistleblower, 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.

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.

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Delaware Medicaid to receive $7.6 million for alleged false claims caused by Christiana Care Health System

Department of Justice | Department of Justice Press Releases | News | Date Posted: Friday, December 22, 2023


Navy blue background featuring the Delaware state seal in the center

Attorney General Kathy Jennings announced Friday that Delaware’s Medicaid program would receive $7,666,379.00 following a settlement that would resolve federal False Claims Act (FCA) and Delaware False Claims and Reporting Act (DFCRA) allegations against Christiana Care Health System (CCHS).

The case, which was initiated by a whistleblower, 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.

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.

image_printPrint


Graphic that represents delaware news on a mobile phone

Keep up to date by receiving a daily digest email, around noon, of current news release posts from state agencies on news.delaware.gov.

Here you can subscribe to future news updates.