Two of the Largest Healthcare Companies in Georgia Face Whistleblower Accusations of Medicaid Fraud, Kickbacks
According to a whistleblower lawsuit that was unsealed in federal court late on Wednesday, July 31st, Tenet Healthcare Corp – the third-largest publicly traded US hospital chain – and Health Management Associates were accused of paying kickbacks to a Georgia clinic in exchange for referrals of specific pregnant women, then filing fraudulent Medicaid claims.
The two massive hospital operators allegedly entered into contracts with clinics operated by Hispanic Medical Management and Clinica de la Mama, paying kickbacks to the companies in exchange for referrals of pregnant women living illegally in the United States. The companies then filed Medicaid claims on behalf of those women, and paid the kickbacks out of the Medicaid fraud for over a decade.
The Medicare and Medicaid Patient Protection Act, also known as the anti-kickback statute, prohibits paying for or accepting money to arrange for medical treatment with federal funds and under federal programs.
Those in the country illegally are not eligible for federal health care programs like Medicaid and Medicare. However, hospitals can receive some reimbursement for emergency medical services to those with no health care or illegal status, and Medicaid considers child birth to be an emergency medical condition.
The state of Georgia joined the Medicaid fraud whistleblower suit after it was unsealed on Wednesday to help recover some tax payer funds that were lost due to the fraud.
“These hospitals 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 said in a statement. “As attorney general, I take seriously my responsibility to protect the integrity of Georgia Medicaid and to ensure that those who defraud the program are held accountable.”
Medicaid Fraud Lawsuit to Recover Taxpayer Dollars
The whistleblower lawsuit was filed by Ralph Williams, a former chief financial officer for Health Management Associates (HMA), in 2009. He alleges in his lawsuit that the Medicaid fraud kickback scheme went on for more than a decade.
According to his lawsuit, Williams began working for HMA in April 2009. One of his primary duties was to monitor contracts and approve payment for bills. Just after he arrived, however, he discovered that a contract between HMA’s hospital in Monroe, GA, and Clinica for Spanish interpreter services was being paid, but no interpreter services were offered at the clinic. Instead, Williams discovered that the contract existed to cover Medicaid fraud and kickbacks for “government subsidized deliveries.”
Williams voiced his concerns to the company, and shortly thereafter was fired for no reason.
The whistleblower lawsuit also alleges that Williams direct supervisor at HMA had also worked for Tenet in South Carolina, and that Tenet used a similar Medicaid fraud scheme at a number of its hospitals and clinics in South Carolina and Georgia.
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