A program that directed pregnant illegal immigrants to hospitals owned by Tenet Healthcare Corp. and Health Management Associates (HMA) for delivery services in exchange for kickbacks paid to obstetrics clinics primarily serving undocumented Hispanic women is the subject of a whistleblower lawsuit filed in the middle district of Georgia. The lawsuit alleges that four hospitals owned by Tenet in Georgia and South Carolina and one HMA hospital in Monroe, Ga., owned by HMA paid kickbacks to the clinics, known as Hispanic Medical Management (HMM) d/b/a Clinica de la Mama, disguised as payment for services provided by the clinics, like translation and other services. The scheme allegedly dates back to March 2000 and involved millions of dollars in improper claims. This article is compiled from a variety of sources reporting on the case as well a Feb. 19 Department of Justice announcement and a Securities and Exchange Commission (SEC) submittal made by Tenet in 2013. Clinica de la Mama is also named in the lawsuit. Medicaid covers emergency medical assistance services, which includes childbirth services to undocumented aliens; the baby is then eligible for newborn Medicaid coverage. Atlanta attorney Marlan Wilbanks, who represents the whistleblower in this case, said that while […]
A program that directed pregnant illegal immigrants to hospitals owned by Tenet Healthcare Corp. and Health Management Associates (HMA) for delivery services in exchange for kickbacks paid to obstetrics clinics primarily serving undocumented Hispanic women is the subject of a whistleblower lawsuit filed in the middle district of Georgia.
The lawsuit alleges that four hospitals owned by Tenet in Georgia and South Carolina and one HMA hospital in Monroe, Ga., owned by HMA paid kickbacks to the clinics, known as Hispanic Medical Management (HMM) d/b/a Clinica de la Mama, disguised as payment for services provided by the clinics, like translation and other services. The scheme allegedly dates back to March 2000 and involved millions of dollars in improper claims. This article is compiled from a variety of sources reporting on the case as well a Feb. 19 Department of Justice announcement and a Securities and Exchange Commission (SEC) submittal made by Tenet in 2013. Clinica de la Mama is also named in the lawsuit.
Medicaid covers emergency medical assistance services, which includes childbirth services to undocumented aliens; the baby is then eligible for newborn Medicaid coverage. Atlanta attorney Marlan Wilbanks, who represents the whistleblower in this case, said that while Medicaid is not famous for being a generous payer, delivering babies is one exception if the volume is high enough.
The hospitals involved are Tenet hospitals Atlanta Medical Center, North Fulton Regional Hospital, Spalding Regional Hospital, and Hilton Head Hospital in South Carolina, and one HMA facility, Walton Regional Medical Center (since renamed Clearview Regional Medical Center), in Monroe, Ga.
The whistleblower, Ralph Williams, was the chief financial officer at the HMA hospital from April to October 2009. In the course of his duties he discovered a contract with Clinica de la Mama for translation services but could not find evidence that any services were provided. After further investigation, Williams was told by the hospital CEO that the contract was really for referral of pregnant patients, according to statements made by Williams to a local TV news station.
SEC Filing Notes the Pending Lawsuit
Tenet reported the government investigation concerning HMM in its 2013 Form 10-K SEC submission. In the form, Tenet indicates that a May 12 subpoena from the Office of Inspector General requested documents from January 2004 through May 2012 related to its relationship with HMM. The documents say that Tenet has contracts with HMM for translation, marketing, management, and Medicaid eligibility services. Tenet says it submitted a motion to dismiss on Nov. 8, 2013, that is still pending.
The document goes on to say that the potential outcome of the lawsuit, which alleges violations of the anti-kickback statute, could include reimbursing related government program payments received during the subject period, assessing civil monetary penalties including treble damages, excluding individuals or subsidiaries from participation in federal health care programs, or seeking criminal sanctions against current or former employees of the hospital subsidiary companies or the hospital companies themselves.
Tenet has not admitted to any illegal acts and no liability has been attached to the allegations discussed in this article.
This case could turn out to be significant, rivaling some of the cases against pharmaceutical companies. It is unique in the fact that the federal government has intervened in a Medicaid qui tam action, which is rare. It also demonstrates that a potentially improper activity in a health care entity that has, arguably, an effective compliance program can continue for an extensive period before someone within the organization asks about it. Finally, Tenet emerged from a five-year corporate integrity agreement in September 2011.
Takeaway: Whistleblowers are the government’s best source to find problems within an organization that are not obvious by reviewing claims or by other traditional means to detect compliance problems.
