Two hospitals, Health Management Associates and Tenet Healthcare, were accused of paying clinics to enlist undocumented conceiving women then filing fraudulent Medicaid benefits after treating them.
The whistleblower, who is HMA’s former chief financial officer, filed and unsealed the lawsuit on Wednesday in federal courts in Athens, Georgia. Allegedly, it violates anti-kickback statutes by the hospital companies pointing to contracts between them and the Hispanic Medical Management which maneuvers clinics of Clinica de la Mama around the Atlanta metropolitan area.
The lawsuit states, "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 Statue."
According to the lawsuit, the wrongdoings led the state to pay "tens of thousands of ineligible Medicaid claims over the course of a decade."
The state of Georgia has joined the lawsuit. Georgia Attorney General Sam Olens is working to recover state Medicaid funds.
Olens said in a written statement, "These hospitals allegedly paid Clinica kickbacks camouflaged as interpreter service payments to funnel emergency Medicaid patients their way and increase their bottom line."
The suspected scheme came to light after former HMA CFO Ralph Williams marked the contracts with Clinica to his supervisors.
Williams told CNN affiliate WSB-TV in Atlanta, "To me it was pay for patients, pure and simple. I said, 'This is an illegal agreement. It is a kickback situation.'" He said he was finally fired and filed a whistle-blower lawsuit.
Five hospitals among the 49 operated by Tenet Healthcare nationwide and three among the 70 managed by Health Management Associates are in Georgia.
On the other hand, Tenet Healthcare defended the contracts.
"We believe the agreements...were appropriate and provided substantial benefit to women in undeserved 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," the statement released by Tenet Healthcare said. "These services are important to addressing the healthcare gaps that affect many Hispanic patients and other minority communities."
Heather Vizena of HMA would not want to comment on pending litigation.
However, calls to one number listed for Hispanic Medical Management were answered by a person declaring the clinic had new owners and name. Calls to other numbers were unsuccessful.
