Christus St. Vincent Hospital in Santa Fe, New Mexico, reaches settlement for fraudulent health care billing

           ALBUQUERQUE, N.M. – Christus St. Vincent Hospital (CSV) in Santa Fe, New Mexico, and the United States have settled claims that a physician employed by the hospital caused fraudulent claims for payment to be submitted to federal healthcare programs over a span of seven years.

           In early 2020, the hospital self-disclosed to the U.S. Attorney’s Office concerns about the billing practices of Dr. Arthur Caire, an employee of the hospital. “Health care providers play an essential role in rooting out and preventing fraud,” said Acting U.S. Attorney Fred Federici.  “We acknowledge and appreciate the hospital’s decision to come forward and cooperate with our investigation.”

           Following an investigation by the U.S. Attorney’s Office, and with the cooperation of the hospital, the government concluded that the hospital billed government healthcare payors for services Dr. Caire did not provide or properly supervise.  The hospital agreed to pay the United States $563,809.52 to resolve the government’s allegations. The settlement covers Dr. Caire’s entire period of employment at the hospital, which spanned from October 2013 until April 2020, and reimburses multiple federal healthcare programs, including Medicare, Medicaid, TRICARE and the Federal Employees Health Benefit Program.

           The United States Government expends more than $1 trillion dollars annually to provide health care to the beneficiaries of federal healthcare programs.  In Fiscal Year 2019 alone, the federal government recovered more than $3.6 billion dollars attributable to healthcare fraud judgments and settlements.

           Assistant U.S. Attorney Sean Cunniff and Auditor Julie Chappell represented the United States in this matter.