Christus St. Vincent Regional Medical Center paid the price — $563,810 — for a former hospital-employed doctor's fraudulent charges against federal insurance programs.
In separate statements Wednesday, the U.S. Attorney's Office and the Santa Fe hospital said they reached a settlement in a case accusing a doctor who no longer works at Christus St. Vincent of making fraudulent claims. Christus didn't name the doctor in its statement, but the U.S. Attorney's Office identified him as Dr. Arthur Caire.
The U.S. Attorney's Office in Albuquerque said Caire "caused fraudulent claims" to be made to Medicare, Medicaid, the Federal Employees Health Benefit Program and TRICARE, an insurance program for military service members, military retirees and their families.
The hospital self-reported the violations in early 2020, according to the U.S. Attorney's Office. It said the fraudulent claims spanned about seven years, from 2013 to 2020.
Caire, a urologist, currently works at the Arizona Institute of Urology in Tucson. He couldn't be reached for comment.
Arturo Delgado, a spokesman with Christus St. Vincent Regional Medical Center, said he couldn't comment on whether the hospital is trying to recover the money from the doctor.
Delgado said in the statement Christus St. Vincent was glad to resolve the case, "which was identified by the hospital as part of its internal compliance program." He said the hospital is "committed to operating consistently with all applicable laws."
The U.S. Attorney's Office said the hospital billed government insurers "for services Dr. Caire did not provide or properly supervise." The problem became evident to law enforcement in early 2020.
“Health care providers play an essential role in rooting out and preventing fraud,” acting U.S. Attorney Fred Federici said in the agency's news release. “We acknowledge and appreciate the hospital’s decision to come forward and cooperate with our investigation.”
The U.S. Attorney's Office's statement said the nation spends more than $1 trillion a year on health care for people in the federal insurance programs. The federal government recovered more than $3.6 billion in 2018-19 through medical fraud judgments and settlements, the office said.