OWNER OF CHRISTUS ST. JOSEPH HOSPITAL IN HOUSTON, TEXAS
TO PAY $220,000 TO SETTLE MEDICARE FRAUD ALLEGATIONS

WASHINGTON, D.C. – CHRISTUS Health Gulf Coast, owner and operator of CHRISTUS St. Joseph Hospital, of Houston, Texas, has agreed to pay $220,000 to settle claims that the hospital defrauded the Medicare Program from April 1997 to June 2000, the Justice Department announced today.

The civil settlement resolves allegations that the hospital defrauded Medicare by knowingly requesting reimbursement for $78,000 in non-recoverable costs at the Garden Oaks and Seabrook Senior Centers, two outpatient senior health clinics formerly operated by St. Joseph Hospital. The hospital improperly billed Medicare for evaluation and management (E&M) services and supplies incident to a physician's services. Recovery of the costs of E&M services provided by non-physicians is limited by applicable regulations. St. Joseph Hospital unlawfully obtained reimbursement for E&M services and supplies provided without the direct personal supervision of a physician, among other violations of the Medicare Part B regulations.

"This settlement again demonstrates the United States' commitment to protecting federal funds from fraud and abuse," said Robert D. McCallum, Assistant Attorney General in charge of the Civil Division. "The federal health care system operates on the good faith and honesty of its providers, and we will actively pursue those who misuse the system for financial gain."

The allegations arose from a lawsuit filed by two former employees of the hospital under the qui tam or whistleblower provisions of the False Claims Act, a federal law that allows private individuals to sue on behalf of the United States. The whistleblowers' share of the settlement totals $33,000. The lawsuit was unsealed in Houston, Texas.

The civil investigation and settlement were jointly handled by the Office of the United States Attorney for the Southern District of Texas and the Civil Division of the Department of Justice, with assistance from the Department of Health and Human Services Office of Inspector General.

The case is entitled United States ex rel. Connie Kaisler and Thereze Rendon v. Christus Health Gulf Coast d/b/a Christus St. Joseph Hospital, Civil Action No. 01-CV-1592 (S.D. Tex.)..

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