Illinois Hospital Agrees to Pay $12.5 Million to Settle Allegations of Billing Error

SPRINGFIELD, Ill. – St. Elizabeth’s Hospital of the Hospital Sisters Health System (“St. Elizabeth”) in O’Fallon, Illinois, this week agreed to pay $12.5 million to resolve allegations that it committed billing errors that may have resulted in an overpayment for services. A lawsuit alleged that the hospital submitted claims for urgent care services billed at a higher level of service. When the errors were brought to the attention of St. Elizabeth, the hospital fully cooperated with the Department of Justice’s investigation.  

The settlement resolves a qui tam, or whistleblower, lawsuit. St. Elizabeth is not admitting any wrongdoing but has agreed to settle the claims to avoid the expense and uncertainty of litigation. The claims resolved by the settlement are allegations only, and there has been no determination of liability. Under the False Claims Act, private citizens, known as relators, can bring suit on behalf of the United States and share in any recovery.

The settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the Central District of Illinois; the Office of the Inspector General of the Office of Personnel Management; the Inspector General’s Office of the Department of Health and Human Services; the Office of the Inspector General for the Department of Defense; the Federal Bureau of Investigation, Springfield Field Office; and the Illinois State Police Medicaid Fraud Control Unit.

“I would like to commend the excellent work of our investigators, their law enforcement partners, and the U.S. Attorney’s office for their tireless efforts on this complex case,” said U.S. Office of Personnel Management Deputy Assistant Inspector General for Investigations Conrad J. Quarles. “Safeguarding the integrity of the Federal Employees Health Benefits Plan is of the utmost importance to our Office and benefits millions of Federal employees, retirees, and dependents who rely on the program.”

Assistant U.S. Attorney Kimberly Klein and Department of Justice Trial Counsel Allie Pang represented the government during the settlement process. To learn more about the U.S. Attorney’s Office for the Central District of Illinois, please visit https://www.justice.gov/usao-cdil.