Government Intervenes in Case Alleging ‘Tens of Thousands’ of False Claims

The federal government will intervene in a qui tam action under the False Claims Act (FCA), against Tenet Healthcare Corp. (THC) and Health Management Associates Inc. (HMA), two of the largest owners and operators of hospitals within the country, reported the U.S. Department of Justice (DOJ). The complaint alleges that multiple obstetric clinics that treated mostly undocumented Hispanic women received kickbacks from numerous hospitals owned by THC and HMA, for referring the women to the hospitals for child birth. The kickbacks were masked as payments for numerous services not provided by the clinics. Further, after the hospitals provided child birth services to the referred women, they allegedly billed Medicaid for the services and in numerous cases received additional Medicare reimbursement for the increase in low-income patients. The false and fraudulent claims submitted to Medicaid amounted in the tens of thousands, according to the complaint.

“My office has made the investigation of health care fraud a priority,” stated U.S. Attorney Michael J. Moore. “In a time when too many people were struggling to get health care for themselves and their children, Tenet and these hospitals plundered a system set up for those truly in need. This kind of scheme drives up costs for everyone, not just the vulnerable patients and groups like those targeted in this case.”

According to the DOJ, the government’s intervention accentuates its resolve to fight health care fraud, and represents another win for the Health Care Fraud Prevention and Enforcement Action Team initiative. “Investigations such as these are a high priority for the FBI, and we are determined to hold accountable providers that enrich themselves at the expense of government programs and damage the public trust,” stated FBI Assistant Director Ronald T. Hosko. “The FBI is dedicated to preventing and combating all forms of health care fraud; working with federal, state and local partners to effectively resolve allegations and engaging with the public to identify potential schemes.”

To date, the DOJ has reported that it has recovered more than $19 billion through FCA cases, since January 2009. Of the total amount recovered, $13.4 billion involved cases of fraud against federal health care programs. Assistant Attorney General Stuart F. Delery noted, “The Department of Justice is committed to ensuring that health care providers who pay kickbacks in return for patient referrals are held accountable.”

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