Two former employees of Martin’s Point Health Care, whose whistleblowing led the federal government to sue the Maine-based company and five other health care providers were rewarded with more than $5.65 million from a settlement with a New York hospital.
SVCMC Inc., formerly known as Saint Vincent’s Catholic Medical Centers of New York agreed to pay $29 million to resolve allegations that it knowingly kept inflated payments from the U.S. Department of Defense for health care services given to retired members of the military and their families, the U.S. Department of Justice announced on Friday.
The case stems from reports of the fraud by whistleblowers Jane Rollinson and Daniel Gregorie, who worked for Martin’s Point and initiated a complaint on behalf of the government in 2016 against Martin’s Point, Brighton Marine Inc., Christus Health, Johns Hopkins Medical Services Corporation, PacMed Clinics, and US Family Health Plan Alliance, Inc. The federal government intervened in the action in 2023.
According to the complaint, in June 2012, the health care service companies learned that calculation errors had inflated the rates they had been paid in prior years. In response, they took steps to conceal the overpayments from the government and continued to submit invoices at the higher payment rates.
During discussions about rates for the subsequent year, the complaint alleges some of the companies asked the government to continue paying them at the higher rates even though they knew rates were inflated by errors.
The complaint alleges the companies violated the False Claims Act.
SVCMC is the first of the health care companies to settle with the federal government.
As part of the settlement, Rollinson, a former interim chief financial officer at Martin’s Point, and Daniel Gregorie, a consultant to the CEO and board of directors who later served on the company’s board of trustees, will receive $5.655 million, according to the DOJ.
The case against Martin’s Point and the other defendants continues.
Martin’s Point previously denied any wrongdoing in a statement in March 2024.
“The Government and Martin’s Point agreed on those rates. Now, the Government has alleged that it made forecasting errors when negotiating those rates more than 12 years ago,” the company wrote, adding, “Martin’s Point is confident that the evidence in this case will show that Martin’s Point met its obligations under the USFHP contract and did not receive an overpayment.”
On Friday, the DOJ said the federal government “is continuing to pursue the remaining claims in this case.”
