Tenet, HMA Named in Federal Kickback Suit

John Commins, for HealthLeaders Media , February 20, 2014

The whistleblower suit was brought forward in 2009 by Ralph D. Williams, the former CFO at HMA who claims that he was fired after he discovered the payments. Williams said in his complaint that HMA paid Clinica between $15,000 and $20,000 each month for the referrals, and that the payments were disguised as "translation services" and "eligibility determination services."

Williams said that executives at HMA Monroe anticipated a 56.2% rate of return on a $1.8 million investment in Clinica's "Hispanic Maternity Program."

Williams alleged in the suit that he was told by HMA executive Gary Lang that a similar arrangement with Clinica existed at Tenet's Hilton Head Hospital, where Lang once worked as a marketing executive. The suit also alleges that HMA "cloned its kickback model from Tenet in order to receive additional Medicaid patient referrals and revenues."
Under the whistleblower provisions of the False Claims Act Williams could be eligible for a portion of any settlement money. The lawsuit is being heard in the Middle District of Georgia.

HMA and its former CEO Gary Newsome are also defendants in a separate whistleblower lawsuit out of South Carolina that alleges that the Naples, FL-based company orchestrated a "massive scheme to boost company profits and defraud Medicare and Medicaid by unlawfully inducing and pressuring hospital emergency room doctors to increase the rate of ER-to-hospital admissions over a period of at least four years."

The Justice Department said that since January 2009 it has recovered more than $19 billion through False Claims Act cases, with more than $13.4 billion of that amount recovered in cases involving fraud against federal healthcare programs.

John Commins is a senior editor with HealthLeaders Media.

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