The Justice Department has joined eight separate whistle-blower lawsuits against Health Management Associates, a for-profit hospital chain based in Naples, Fla.
The lawsuit describes a wide-ranging strategy involving sophisticated software, financial incentives and threats to inflate the company's payments from Medicare and Medicaid by admitting patients, regardless of whether a patient needed hospital care.
The lawsuits against HMA provide a look at the pressure being put on doctors and hospital executives to emphasize profits over patients, with similar accusations being raised at other hospitals in the United States as healthcare undergoes sweeping changes.
One tactic used by HMA: scorecards on display, tracking physicians admitting patients over 65 years old into entered the emergency department. Failing physicians received a red scorecard.
Another strategy implemented to reach admission goals was using a software program called Pro_med, which monitored the percentage of patients being admitted on a daily basis.
HMA also faces sharehold lawsuits and a federeal securities investigation. In a statement, the hospital defended its quality of medical care.
The mastermind allegedly behind the fraud was former CEO Gary D. Newsome, whose compensation for three years before his departure was $22 million.
Examples stated in the lawsuit include a baby in Georgia who was admitted to the hospital with a fever with a body temperature of 98.7 degrees, and a 18-year-old Medicaid patient with a cut on his right knee who was admitted, even though he could have been trated and discharged.
Anyone can be a whistleblower. Becoming a whistleblower means that you are taking steps toward making your company the best it can be, ensuring that it operates within the laws of your state and the United States. A person who blows the whistle is also known as the relator. The lawsuit may be referred to as a whistleblower lawsuit, a False Claims Act lawsuit or a qui tam lawsuit.
Time is of the essence in whistle-blower and qui tam cases. While the process for a whistle-blower claim varies depending on the alleged illegal action, all whistle-blower claims are treated as first-come, first-serve to encourage prompt reporting of fraud or wrongdoing. If you are aware of corporate wrongdoing or fraud, it's critical that you contact an attorney at at our law firm as soon as possible.
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Source: The NY Times, "Hospital Chain Said to Scheme to Inflate Bills," Jan. 23, 2014.