The federal government has joined eight whistleblower lawsuits alleging that Health Management Associates Inc. (HMA) billed federal health care programs for medically unnecessary inpatient admissions from the emergency departments at HMA hospitals. The lawsuits also allege that HMA paid kickbacks to doctors for inpatient admissions and referrals. The lawsuits were filed by individual citizens under the qui tam, or whistleblower, provisions of the False Claims Act. This statute allows individual citizens to start a lawsuit “under seal” (in secret) on behalf of the government when they believe that defendants submitted false claims for government funds. The government then has the right to join the lawsuit. If the government recovers money as a result of the lawsuits, the individual whitleblowers will receive rewards of between 15% and 25% of the amounts the government recovers. One of the lawsuits alleges that HMA and its former CEO pressured emergency department physicians and hospital administrators to raise inpatient admission rates, regardless of medical necessity. Another lawsuit also alleges that patients were improperly admitted for surgical procedures that should have been done on an outpatient basis. The allegations of kickbacks include claims that HMA paid bonuses, awarded contracts, and gave other incentives to physician groups that staffed HMA emergency rooms in return for admitting patients regardless of medical necessity. The kickbacks allegedly included direct payments, free office space and staffing, paying inflated prices for physician-owned assets, providing sham medical directorship contracts, and selling assets to physicians for below fair market value. Paying anything of value for referrals of Medicare and Medicaid patients violates the Anti-Kickback Statute. When a hospital submits claims for patient referrals made by a doctor with whom the hospital has a financial relationship, it also violates the Stark Law (also known as the Physician Self-Referral Law). Both the Anti-Kickback Statute and the Stark Law are based on the principle that physicians should make decisions based solely on their professional judgment and the best interests of the patient, without regard to improper financial incentives. FBI Assistant Director Ron Hosko said that the government’s decision to join the whistleblower lawsuits should send a clear message that investigating false claims for emergency medical services is “a very high priority for the FBI.” If you are aware of false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney immediately. You may be entitled to a large reward. To arrange a free and confidential consultation with an experienced whistleblower attorney, call John Howley Esq. at (212) 601-2728, or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.
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A 35 year old Emergency Medical Technician (EMT) is facing up to 10 years in prison, a $250,000 fine, and other penalties for creating false run sheets or trip reports that were used to bill Medicare and Medicaid for ambulance services. The EMT pleaded guilty to health care fraud after government investigators discovered a scheme by his employer, Brotherly Love Ambulance, Inc., to submit false claims to Medicare and Medicaid. The EMT was accused of creating run sheets or trip reports indicating that patients needed ambulance services, when he knew that they were able to walk or to be transported by less expensive wheelchair vans. The false run sheets resulted in Medicare and Medicaid paying his employer for ambulance transports that were not medically necessary. Unfortunately, this EMT went along with the scheme. If he had sought legal advice, he would have learned not only that he was putting himself at risk, but also that he could earn a large reward for reporting the fraud. Under the False Claims Act, an individual who helps the government prevent Medicare or Medicaid fraud is entitled to a reward of up to 30% of the amount the government recovers. In this case, the EMT could have earned a reward of as much as $600,000. Instead, he is now facing the possibility of spending the next 10 years in prison. Do not go to prison for your employer’s fraud. If you suspect that your employer is submitting false claims to government healthcare programs, then you should consult with an experienced Medicare and Medicaid fraud attorney immediately. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. |
John Howley, Esq.
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