According to the settlement agreement, “This is neither an admission of liability by Christus parties, nor a concession by the government that its claims were not well founded.”
Former case manager for Christus, Cecilia Guardiola, sued the hospital in 2008, claiming that Spohn was overbilling Medicaid for patient visits purposely.
The settlements states, “Realtor (Guardiola) alleged that the Hospitals were improperly submitting claims for outpatient surgical procedures using DRG codes. Realtor also alleged that Hospitals submitted claims for short-term outpatient visits (visits that should last less than 24 hours and should be coded as ‘patient observation’ services) as if they required an overnight hospital stay, therefore qualifying the services as an inpatient service.”
The investigation by the government concluded that the allegations are a violation of the Texas Medicaid Fraud Prevention Act and the Federal False Claims Act. The false claims took place between November 2003 and November 2009.
Of the $5.1 million that Christus paid, $329,104 went to State of Texas, just over a million went to Guardiola, $145,355.43 went to her attorney and the rest to the government.