Tenet Healthcare Corporation and two of its subsidiaries have agreed to pay $513 million to settle claims regarding False Claims Act (FCA) and Anti-Kickback Statute (AKS) violations. The alleged anti-kickback violations occurred when pre-natal care clinics referred pregnant woman to Tenet’s hospitals. The pre-natal clinics were informing soon-to-be mothers that the childbirth would have to take place in a Tenet hospital if the mother wanted Medicaid to cover the cost accompanying childbirth.
The AKS prohibits paying kickbacks to induce referrals for services that are paid by Federal health care programs. In Lance Gould’s book, Whistleblowers: A Brief History and A Guide to Getting Started, Lance explains:
The AKS arose out of Congressional concern that payoffs to those who can influence health care decisions corrupt professional health care decision-making. These actions could result in Federal funds being diverted to pay for goods and services that are medically unnecessary, of poor quality, or even harmful to a vulnerable patient population.
These referrals to Tenet Hospitals were harmful to a vulnerable patient population, expectant mothers. When the expectant mothers were informed that they had to deliver in a Tenet hospital, the women no longer believed they were allowed to select the hospital of their choice. Consequently, they drove long distances to Tenet hospitals in order to deliver their child. These referrals not only placed the expectant mothers’ health and safety at risk, but endangered unborn children. U.S. Attorney John Horn of the Northern District of Georgia had this to say about the case:
Our Medicaid system is premised on a patients’ ability to make an informed choice about where to seek care without undue interference from those seeking to make a profit. Tenet cheated the Medicaid system by paying bribes and kickbacks to a pre-natal clinic to unlawfully refer over 20,000 Medicaid patients to the hospitals. In so doing, they exploited some of the most vulnerable members of our community and took advantage of a payment system designed to ensure that underprivileged patients have choices in receiving care.
The case against Tenet was filed by Ralph D. Williams − a Georgia resident − under the qui tam provisions of the FCA and the Georgia False Claims Act. Mr. Williams had served as Chief Financial Officer for one of the hospitals involved. As we have written on numerous occasions, these qui tam provisions permit ordinary citizens to become whistleblowers and file suit on behalf of the government. The provisions also provide incentives for ordinary residents to step up and become whistleblowers. Some of these incentives include protection against retaliation and a percentage of what the government recovers. Mr. Williams will receive $84.43 million for his part in the case.
Sources: U.S. Department of Justice; Gould, C. Lance. Whistleblowers: A Brief History and a Guide to Getting Started.
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