March 31, 2014 — The nation’s Medicaid program has been established with tax dollars from the state and federal governments to serve those truly in need. Medicaid fraud by unprincipled hospitals and medical providers only drives up the cost of health care for everyone. The U.S. Department of Justice (DOJ) relies on whistleblowers with a conscience to identify fraudulent schemes and notify the government by filing a False Claims Act lawsuit. The qui tam provisions in the statute give health care insiders the means to do what’s right. Informants who bring a claim on the government’s behalf may be compensated with a significant share of any proceeds from the lawsuit.
Whistleblower Lawsuit Alleges Tenet Hospitals Paid Kickbacks to Obstetric Clinics in Georgia and South Carolina in Exchange for Referral of Medicaid Patients
A whistleblower lawsuit has been filed in federal court in Georgia alleging Tenet Healthcare Corp. (Tenet), four Tenet hospitals and a Health Management Associates Inc. (HMA) hospital engaged in a scheme to pay kickbacks to obstetric clinics in exchange for the clinics’ referral of Medicaid patients to the hospitals for labor and delivery. Named in the False Claims Act lawsuit, in which the government has intervened, are Tenet, two Tenet hospitals in Georgia — North Fulton Regional Hospital and Atlanta Medical Center, two in South Carolina — Hilton Head Hospital and Spalding Regional Hospital, and one Georgia facility owned by HMA — Clearview Regional Medical Center (formerly Walton Regional Medical Center). Tenet and HMA (recently acquired by Community Health Systems) are two of the largest hospital chains in the nation.
According to the DOJ, the five hospitals made kickback payments to Hispanic Medical Management d/b/a Clinica de la Mama (Clinica), which runs a group of affiliated clinics providing obstetric services to low income Hispanic women, including undocumented workers. The clinics then referred their patients to the hospitals, which provided delivery services. To hide the nature of the payments, the hospitals allegedly recorded them as payments for various services that Clinica provided to the hospitals. The hospitals then allegedly billed Medicaid for the delivery services, in violation of the federal Medicare and Medicaid Anti-Kickback Statute.
The purpose of the Anti-Kickback Statute is to prevent doctors from making medical decisions that are based more on financial incentives than the health of their patients. The law makes it a crime to make or receive payments in exchange for medical services or supplies that are reimbursable by federal healthcare programs such as Medicaid.
Insiders Collaborate with the Government to Stop Kickbacks in Health Care Industry
Health care insiders, especially those working in billing and accounting, frequently are the first to root out kickback schemes and False Claims Act violations. Many informants, however, are unsure about how to file a whistleblower lawsuit. With qui tam lawyers in Dallas, Los Angeles and the Washington D.C. area, Waters & Kraus guides tipsters through the process, watching out for their interests. Contact us by email or phone our whistleblower attorneys at 855.784.0268 to learn more about collaborating to fight health care fraud.
