SVCMC Inc., formerly known as Saint Vincents Catholic Medical Centers of New York (Saint Vincent), has agreed to pay $29 million to resolve allegations that it violated the False Claims Act by knowingly retaining erroneously inflated payments received from the Department of Defense for healthcare services provided to retired military members and their families. Saint Vincent is one of six health plans participating in the Uniformed Services Family Health Plan (USFHP) program, which is a federal health insurance program funded by the Defense Health Agency (DHA), a component of the Department of Defense. Under the USFHP program, DHA pays Saint Vincent capitated rates to provide healthcare services to military personnel, retirees, and their families. The complaint alleged that, in 2012, Saint Vincent learned that errors had been made in the calculation of the capitated rates resulting in substantial overpayments to Saint Vincent and the other five USFHP plans over the preceding four years. According to the government’s complaint, instead of notifying the government of the overpayments or repaying the funds, Saint Vincent, along with the other five USFHP plans, took steps to conceal the existence of the overpayments from DHA, continued to submit invoices at the inflated payment rates, and conspired to avoid paying the money back.
