Hospitals Defraud Medicaid

ATTORNEY NEWSLETTER

As chief financial officer for a large hospital operator, Ralph Williams was tasked with monitoring contracts and bill pay between his employer, Healthy Management Associates (HMA) and its partners. After discovering inconsistences in the contracts and payments, Williams began an investigation of the contracts. Williams discovered HMA; a Florida-based hospital, was providing kick-backs to local clinic s that referred pregnant patients living in the country illegally. In an effort to defraud Medicaid, HMA, as well as Tenet Healthcare Corp; a Dallas-based corporation, would then classify the childbirth service as an emergency medical procedure; qualifying the procedure for federal reimbursement. For more than a decade, HMA would disguise payments made to local clinics for referring expecting mothers as payments for interpreter services, services Williams was unable to find during his investigations. Known as the anti-kickback statute, Medicare and the Medicaid Patient Protection Act prohibits the practice of compensating health care providers for arranging medical services that are federally funded. Knowing this, Williams expressed his concerns to company superiors, who responded by firing Williams without cause. The unsealed whistleblower lawsuit goes on to allege that Tenet employed similar arrangements in hospitals throughout Georgia and South Carolina.

Evans Law Firm, Inc. regularly handles whistleblower, qui tam and False Claims Act. If you are aware of workplace FCA violations, contact Evans Law Firm, Inc. in California at 415-441-8669 for a free and confidential consultation, or email [email protected].