Georgia joins federal whistleblower lawsuit alleging Medicaid fraud

Georgia this week joined a federal whistle-blower lawsuit alleging two hospital chains illegally used kickbacks to recruit pregnant women to give birth in their delivery rooms at taxpayer expense.

As first reported by WSB-TV Wednesday, the complaint accuses Health Management Associates Inc. and Tenet Healthcare Corp. of submitting tens of thousands of Georgia Medicaid claims that were ineligible because of the alleged kickbacks. The lawsuit was unsealed Wednesday in a federal court in Athens.

Hundreds of millions of dollars in taxpayer money is at stake, said Marlan Wilbanks, an attorney representing the federal whistle-blower in the case. Georgia joined the lawsuit seeking to recover Medicaid money.

HMA declined to comment. Tenet released a statement Wednesday saying the hospital-clinic agreements that are the focus of the lawsuit “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. “These services are important to addressing the healthcare gaps that affect many Hispanic patients and other minority communities.”

Several Tenet and HMA hospitals in Georgia are named in the suit. Among them are Atlanta Medical Center, Atlanta Medical Center South Campus and Spalding Regional Medical Center. The suit alleges those hospitals illegally paid Clinica de la Mama and Clinica de Bebe hundreds of thousands of dollars through sham contracts to refer pregnant illegal immigrants to their delivery rooms. Those patients would be eligible for emergency Medicaid benefits, the lawsuit says.

The federal whistle-blower, Bill Williams, filed his suit in 2009. The judge in the case sealed the lawsuit while the Justice Department looked into the allegations, Wilbanks said. DOJ declined to comment Wednesday.

Williams told WSB-TV he discovered the alleged kickback scheme when he worked as the chief financial officer for HMA. His attorney said Williams was fired within a month of protesting the alleged scheme. If his lawsuit is successful, Williams would be entitled by law to receive 15 percent to 30 percent of the money the government recovers from the defendants, his attorney said.

The judge lifted the seal on the lawsuit Wednesday at the request of Williams and state officials, allowing them to move forward with their case, Wilbanks said.

“It’s an egregious scheme that violated federal law, the anti-kickback statute, and I feel like it is not a gray area,” Williams said. “I believe that it’s praying on a very vulnerable population and people that would generally trust people in the healthcare business.”

Georgia filed court papers Tuesday to join the federal lawsuit.

“These hospitals allegedly paid Clinica kickbacks camouflaged as interpreter service payments to funnel emergency Medicaid patients their way and increase their bottom line,” Attorney General Sam Olens said in a prepared statement.