Two major hospital chains are being sued for allegedly paying illegal kickbacks to clinics to treat undocumented immigrants.
Health Management Associates and Tenet Healthcare are being accused of paying clinics to recruit undocumented pregnant women and filing false Medicaid claims after treating them.
The lawsuit, which was filed by HMA's former chief financial officer in Athens, Ga., said "By knowingly entering these contracts with the purpose of receiving patient referral services, defendant hospitals violated federal and state law and submitted false certification to the State Medicaid Program that they were in compliance with such federal and state laws, including the Anti-Kickback Statute."
The scheme allegedly cost the state of Georgia tens of thousands of ineligible Medicaid claims over the past 10 years. The state of Georgia has joined the lawsuit.
Tenet Healthcare operates 49 hospitals nationwide, 10 of which are in Florida including Coral Gables Hospital and Palmetto General Hospital. Health Management Associates operates more than 70 hospitals, with 23 located in Florida.
Hospitals can file Medicaid claims for emergency services provided to undocumented immigrants, including childbirth. Kickbacks for patient referrals are prohibited under the Medicare and Medicaid Patient and Program Protection Act.
A whistleblower or qui tam claim is a lawsuit where the "whistleblower" reports a corporation or an individual who is cheating the United States. Examples include, contractor fraud, Medicare Fraud and tax evaders. Whistleblowers in the United States serve the very important purpose of holding companies and corporations responsible for illegal actions. In this case, the HMA's chief financial officer was the whistleblower.
Without people who are willing to blow the whistle, consumers, employees and the public will continue to suffer harm as a result of the wrongdoing. There are a variety of state and federal benefits offered to whistleblowers to encourage reporting, including protection from employment retaliation and threats, as well as the possibility of multi-million dollar damage awards.
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Source: CNN, "Hospital Chains sued over alleged kickback scheme," Aug. 1, 2013.