Many states have False Claims Act laws that pay whistleblower awards. While state Medicaid fraud cases are typically smaller than comparable federal Medicare cases, these state laws still are an important tool in the fight against fraud and poor healthcare. Last week Georgia’s state attorney general announced the settlement of a case against Health Management Associates and Clearview Regional Medical Center.
According to a prepared statement from the Attorney General’s Office, Health Management Associates agreed to pay $991,925 to the state of Georgia and the federal government to resolve claims that the hospital submitted false claims to the Georgia Medicaid program by providing illegal kickbacks to Clinica de la Mama. The clinic primarily serves undocumented Hispanic women.
The hospital and its then owner, Health Management, allegedly paid the kickbacks in order to induce the clinic to refer their patients to the hospital. Kickback schemes are illegal under state and federal law. The government believes that important healthcare decisions should not be based on kickbacks or bribes.
According to court records, the kickbacks were cleverly disguised as interpreter payments. But for an insider, the scheme likely would not have been uncovered. That insider was Health Management’s former CFO, Ralph Williams. In 2009, Williams became a whistleblower and filed a lawsuit under the Georgia False Medicaid Claims Act.
In announcing the settlement, Georgia Attorney General Samuel Olens said,
“I am pleased to announce that my office, in conjunction with the federal government, has reached a settlement with HMA and Clearview Regional Medical Center to resolve allegations that they paid kickbacks in exchange for patient referrals of vulnerable women. Paying kickbacks for patients violates the law and defrauds Georgia Medicaid. The allegations that the defendants in this case took advantage of undocumented pregnant women about to give birth are extremely troubling. Health care providers’ top priority should be the care of their patients, not their bottom line.”
Georgia’s share of the recovery is about $400,000. Williams, the whistleblower, will receive $83,000 from the state’s share and will likely recover a similar percentage from the larger federal recovery. A second defendant, Tenet Healthcare, has not settled and those claims are on going.
Neither Health Management Associates nor Clearview Regional Medical Center admitted any wrongdoing.
What are the takeaways from this case?
First, whistleblowers should never ignore state False Claims Act cases, especially in smaller cases. State coffers are cash strapped these days and aggressive state prosecutors will often take a case even if it only nets $400,000.
Second, hospitals have become much more sophisticated in their kickbacks schemes. Although the defendants were not required to admit wrongdoing, the evidence suggests a novel scheme using interpreter payments. Tenet is accused of a similar practice but has denied the allegations.
If you have original source knowledge or evidence of an illegal kickback scheme or Medicaid fraud, consider filing a whistleblower lawsuit. Last year the federal government paid out $635 million in awards. This sum doesn’t include millions more in state whistleblower awards. The awards are real.
MahanyLaw – America’s Whistleblower Lawyers
[Want more information? Visit our Tenet Healthcare Medicare fraud page.]