Lawsuit claims hospitals defrauded Medicaid
by Kate Brumback, Associated Press
July 31, 2013 11:50 PM | 870 views | 0 0 comments | 13 13 recommendations | email to a friend | print
ATLANTA — Two large hospital operators paid kickbacks to clinics that directed expectant mothers living in the country illegally to their hospitals and filed fraudulent Medicaid claims on those patients, according to a federal whistleblower lawsuit unsealed Wednesday.

Health Management Associates and Tenet Healthcare Corporation and their affiliates entered into contracts with clinics operated by Hispanic Medical Management and Clinica de la Mama and their affiliates, the lawsuit says. The clinics then referred pregnant women living in the country without authorization to for profit hospitals operated by HMA and Tenet in exchange for kickbacks from fraudulent Medicaid claims, the lawsuit says.

Paying for or accepting payment to arrange for medical treatment under federally funded programs is prohibited by the Medicare and Medicaid Patient Protection Act, known as the anti-kickback statute.

An HMA representative said in an email that the company does not comment on pending litigation.

Tenet issued a statement on behalf of its hospitals named in the lawsuit saying it believes the agreements “were appropriate and provided substantial benefit to women in underserved Hispanic communities served by those hospitals. The services provided under these agreements included translation, determination of Medicaid eligibility, and other services designed to improve the delivery of obstetric care and increase the likelihood of a safe birth and a healthy baby.”

Numbers for Hispanic Medical Management and Clinica de la Mama could not immediately be found.

The whistleblower lawsuit, filed on behalf of the federal government and the state of Georgia by Ralph Williams, a former chief financial officer for HMA, says the kickback scheme went on for more than a decade. The state of Georgia has also joined the lawsuit to recover state Medicaid funds.

Clinica recruits pregnant women who are in the country illegally to its prenatal clinics using the slogan, “we care about your health, not your immigration status,” the lawsuit says. The clinics then directed these vulnerable patients to the HMA and Tenet hospitals, which pay for the referrals, the lawsuit says.

Those in the country illegally are not eligible for regular Medicaid coverage, but hospitals can be reimbursed for treatment of emergency services provided to those in the country illegally, and childbirth is considered an emergency medical condition under Medicaid.

The lawsuit says Williams began working at HMA in April 2009 and one of his duties was to monitor contracts and approve the payment of bills. Shortly after he arrived, he discovered a contract between an HMA hospital in Monroe and Clinica for Spanish interpreter services, the lawsuit says. He investigated and found no evidence of interpreter services, but eventually found that Clinica was being paid for referring pregnant women in the country illegally “for government subsidized deliveries,” the lawsuit says.

Soon after he voiced his concerns about the fraudulent arrangement to company leaders, Williams was fired without reason, the lawsuit says.

The lawsuit says Williams’ direct supervisor had previously worked for Tenet in South Carolina. The lawsuit alleges that Tenet used a similar scheme in a number of its hospitals, including Atlanta Medical Center and its south campus in East Point, North Fulton Hospital in Roswell, Spalding Regional Hospital in Griffin, Sylvan Grove Hospital in Jackson, and Hilton Head Hospital in Hilton Head, S.C.

HMA has its corporate headquarters in Naples, Fla., and Tenet’s main office is in Dallas, Texas.

WSB-TV first reported on the lawsuit.

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