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Attorney General Olens Intervenes in Medicaid Fraud Lawsuit Involving Massive Kickback Scheme

By   /   August 1, 2013  /   Comments

Special to the Journal

Attorney General Sam Olens has intervened in a whistleblower lawsuit against 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; and Clinica de la Mama (Clinica) involving a massive Medicaid fraud scheme related to illegal kickbacks.

Beginning as early as 2000, the defendant hospitals entered into written contracts with Clinca for translation and other services. In reality, the true aim of the Clinica agreements was to achieve increased Medicaid patient referrals by using Clinica to recruit emergency Medicaid patients and steer them to the hospitals. The hospitals would then bill Georgia Medicaid for the associated services.

“These hospitals allegedly paid Clinica kickbacks camouflaged as interpreter service payments to funnel emergency Medicaid patients their way and increase their bottom line,” said Olens. “As Attorney General, I take seriously my responsibility to protect the integrity of Georgia Medicaid and to ensure that those who defraud the program are held accountable.”

The complaint seeks damages and civil penalties on behalf of the State of Georgia. It alleges that 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 federal Anti-Kickback Statute expressly prohibits hospitals from paying any person or entity to recruit patients for any federal or state healthcare program, which includes Georgia Medicaid. In order to obtain Medicaid funds for the patients recruited by Clinica, the hospitals made numerous false statements testifying that they did not relate the Anti-Kickback Statute. As a result, the defendants received Medicaid funds to which they were not entitled based on the false statements.

The scheme was discovered by whistleblower Ralph (Bill) Williams, a former Chief Financial Officer (CFO) at HMA Monroe. Shortly after being hired as CFO, he came across HMA Monroe’s contract with Clinica, but could not identify any services that had been provided. When Williams questioned the contract, he learned that it was actually for the referral of emergency Medicaid patients.





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