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, a federal whistleblower lawsuit unsealed last month said. It was alleged that Naples, Fla.-based Health Management Associates and Dallas-based Tenet Healthcare Corp. and their affiliates entered into contracts with clinics operated by Hispanic Medical Management and Clinica de la Mama and their affiliates. 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.
As we have written previously, paying for or accepting money to arrange for medical treatment under federally funded programs is prohibited by the Medicare and Medicaid Patient Protection Act (the anti-kickback statute).
The federal whistleblower lawsuit, filed 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. Georgia Attorney General Sam Olens said in a statement:
These hospitals paid Clinica kickbacks camouflaged as interpreter service payments to funnel emergency Medicaid patients their way and increase their bottom line. 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.
The lawsuit alleges that 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 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. According to the lawsuit, Williams began working at HMA in April 2009 and one of his duties was to monitor contracts and approve the payment of bills. The following allegations in the lawsuit states:
• Shortly after he arrived, he discovered a contract between an HMA hospital in Monroe and Clinica for Spanish interpreter services;
• 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.
• Soon after he voiced his concerns about the fraudulent arrangement to company leaders, Williams was fired without reason.
It’s alleged in the lawsuit that Williams’ direct supervisor had previously worked for Tenet in South Carolina. The lawsuit alleges further 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.
Source: Claims Journal
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