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Hilton Head Hospital Faces Medicaid Fraud Charges

Hilton Head Hospital Accused of Medicaid Fraud and Kickbacks

medicaid fraud
The parent company of the Hilton Head Hospital allegedly committed Medicaid fraud by giving kickbacks to an island clinic for directing expectant mothers who were illegal immigrants living the US to the hospital for care, in order to increase Medicaid revenue.

The company is denying the charges, which came out of a federal whistleblower lawsuit unsealed recently.

The lawsuit names the Hilton Head Hospital as a defendant, and accuses several hospitals in the Atlanta, Georgia area of also being involved in the Medicaid fraud. The state of Georgia has also filed a Medicaid fraud lawsuit against the hospital, which parallels the federal whistleblower lawsuit.

Reportedly, the parent company, Tenet Healthcare Corporation, and another health care group, Health Management Associates, paid clinics to recruit pregnant, undocumented women, usually Hispanic, for prenatal care, then referred the women to the parent company’s hospitals for deliveries in order to get more money through Medicaid to pay for the women’s health care. Undocumented workers and immigrants cannot receive federal benefits like Medicaid or Medicare – however, Medicaid considers childbirth an emergency condition, and Medicaid makes exceptions for medical emergencies.

“We believe the agreements between Hispanic Medical Management (HMM) and Hilton Head Hospital were appropriate, and that Hilton Head provided much needed health care services to underserved pregnant women,” according to an emailed statement from Tenet spokeswoman Ashley Walton.

According to an email, the referring clinic who received kickbacks in the Medicaid fraud scheme, Clinica de Mama, closed in 2011, after opening in only 2006.

Tenet operates only one hospital, Hilton Head Hospital, in South Carolina. The company denies the Medicaid fraud charges, and says that its agreement with Clinica was “designed to improve obstetric care and increase the likelihood of a safe birth and a healthy baby.” It was not to defraud the federal government, as the whistleblower lawsuit alleges.

“These services are important to addressing the health care gaps that affect many Hispanic patients and other minority communities,” according to the company’s statement.

However, according to both the federal whistleblower lawsuit and the Georgia lawsuit, Tenet offered kickbacks to Clinica for referrals. Physicians also earned professional fees for deliveries to undocumented women.

“These hospitals allegedly paid Clinica kickbacks camouflaged as interpreter service payments to funnel emergency Medicaid patients their way and increase their bottom line,” Georgia Attorney General Sam Olens has said in a statement.

The Strom Law Firm Protects Medicaid Fraud Whistleblowers in South Carolina

Common whistleblower actions include:

  • Health care fraud, including Medicare and Medicaid fraud,
  • defense contractor fraud, and
  • other kinds of fraud

Qui tam lawsuits have been, and continue to be, a very effective and successful tool in combating government procurement and program fraud.

Bolstered by amendments passed by Congress in 1986, the law has armed private citizens who have independent and direct knowledge of fraud, with a weapon to prosecute government contractors and others who are defrauding the Government.

If you have first-hand knowledge of government fraud occurring at your place of employment or your doctor’s office, including Medicaid fraud, the attorneys at the Strom Law Firm can help protect your rights. In order to help the government provide the best possible services, Medicare and Medicaid fraud must be reported as soon as possible. The attorneys at the Strom Law Firm understand the complexity of qui tam and whistleblower suits, and we offer free, confidential consultations to discuss the facts of your case. Contact us today.803.252.4800



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