State, USA Step Into Lawsuit Against Tenet

(CN) - Tenet Healthcare and Health Management Associates paid kickbacks to clinics that steered undocumented pregnant women to their hospitals, then filed fraudulent Medicare and Medicaid claims for their care, according to an unsealed federal whistleblower complaint.

The lawsuit was filed by Ralph D. Williams, a former chief financial officer at Health Management Associates' Monroe Hospital in northern Georgia.

Williams claims that shortly after being hired he came across contracts for translation services with several local outreach clinics operating collectively under the banner of Clínica de la Mama, but could not identify the specific services they provided.

Upon investigation, he says, he discovered the defendants were paying the clinics hundreds of thousands of dollars a year in kickbacks, disguised as interpreter service payments, to funnel in emergency Medicaid patients and increase their bottom line.

Paying for or accepting money to arrange for medical treatment is prohibited by the Medicare and Medicaid Patient Protection Act. Medical centers that do so are no longer eligible to submit claims or receive money from Medicare or Medicaid.

Named as defendants are Health Management Associates, Inc. (HMA, Inc.); HMA Monroe, LLC; Tenet Healthcare Corporation and its subsidiaries Atlanta Medical Center, North Fulton Hospital, Sylvan Grove Hospital and Spalding Regional Medical Center; Hilton Head Hospital in South Carolina; and Clínica de la Mama.

Williams claims that in a fraudulent scheme dating back to 1999, "Defendant Clínica recruits pregnant, undocumented Hispanic women to its prenatal clinics with the well-publicized slogan 'we care about your health, not your immigration status.' Clínica directs this vulnerable and malleable population of patients who will be Medicaid beneficiaries when they deliver their babies, from its clinics to the HMA and Tenet Hospitals ('Defendant Hospitals') who pay for referrals. The Defendant Hospitals intentionally pay illegal kickbacks for Clínica Medicaid patient referrals and submit false or fraudulent claims for payment to Medicaid for obstetric services provided to Clínica patients."

Undocumented aliens are not eligible for regular Medicaid coverage, so, Williams claims, the hospitals relied on Medicaid's Emergency Medical Assistance program, which does provide payment to healthcare providers for emergency services to undocumented aliens, including for childbirth.

The lawsuit, in which the United States and Georgia have intervened, claims the defendants violated the federal Anti-Kickback Statute, the Georgia Medicaid False Claims Act and the Georgia Medical Assistance Act by conspiring to fraudulently bill Georgia Medicaid for tens of thousands of ineligible Medicaid claims.

The plaintiffs seek hundreds of millions of dollars in actual damages, treble damages, and civil penalties of $5,500 to $11,000 per claim

A Tenet Healthcare spokesperson said in a statement that the agreements with the clinics were appropriate and "provided substantial benefit to women in underserved Hispanic communities served by those hospitals."

"The services provided under these agreements included translation, determination of Medicaid eligibility, and other services designed to improve the delivery of obstetric care and increase the likelihood of a safe birth and a healthy baby.

"We believe the agreements ... were appropriate and provided substantial benefit to women in underserved Hispanic communities served by those hospitals. The services provided under these agreements included translation, determination of Medicaid eligibility, and other services designed to improve the delivery of obstetric care and increase the likelihood of a safe birth and a healthy baby," Tenet said.

Subscribe to Closing Arguments

Sign up for new weekly newsletter Closing Arguments to get the latest about ongoing trials, major litigation and hot cases and rulings in courthouses around the U.S. and the world.

Email *

Submit