Justice Department Joins Whistleblower Lawsuit Against Tenet Healthcare
The US Department of Justice announced that they would join the whistleblower lawsuit against Tenet Healthcare, which alleges that the company paid kickbacks for patient referrals in order to scam Medicaid.
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.
“Schemes such as this one corrupt the health-care system and take advantage of vulnerable patients,” Stuart Delery, the assistant attorney general for the Justice Department’s civil division, said in a statement.
Tenet operates in 12 states, but the medical facilities named in the whistleblower lawsuit include four hospitals and one HMA – most in Georgia, but one based in Hilton Head, SC.
The FBI claims that the hospitals paid kickbacks to obstetrics clinics in a chain known as Clinica de la Mama, which primarily served “undocumented Hispanic women.” Then the women were referred to their local Tenet organization for childbirth, the company filed a request for refund through Medicaid, as the women were often too poor to afford health care or pay for birthing services.
“My office has made the investigation of health care fraud a priority,” said Michael J. Moore, the U.S. attorney for the Middle District of Georgia. “In a time when too many people were struggling to get health care for themselves and their children, Tenet and these hospitals plundered a system set up for those truly in need.”
Tenet officials deny the whistleblower allegations of kickbacks and defrauding government services. The agreements with the clinics provided “substantial benefits to women in underserved Hispanic communities,” Tenet said. “By ensuring that pregnant women received prenatal care and appropriate treatment during birth, these programs increased the likelihood of a safe birth and a healthy baby while reducing the overall cost to state Medicaid programs.”
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Common whistle blower actions include:
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Qui tam lawsuits have been, and continue to be, a very effective and successful tool in combating government procurement and program fraud.
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