Hospital Allegedly Paid Obstetric Clinic for Referrals of Pregnant Women
Health Management Associates and Clearview Regional Medical Center agreed to pay almost $600,000 to settle claims that the hospital paid kickbacks to an obstetric clinic in return for referrals of pregnant women for labor and delivery.
The hospital's former Chief Financial Officer will receive a whistleblower reward of approximately $120,000 for helping the government pursue the claims. He may receive more money depending on the outcome of related cases against additional defendants.
The hospital was accused of paying kickbacks to an obstetric clinic that provided services to undocumented pregnant women. In return for the payments, the clinic allegedly referred patients to the hospital for deliveries that were reimbursed by Medicaid. While undocumented aliens are not eligible for regular Medicaid benefits, Medicaid will reimburse hospitals for emergency services, including childbirth, for undocumented individuals.
The Anti-Kickback Statute prohibits healthcare providers from paying or receiving anything of value in return for referrals of patients covered by a government healthcare program. Prohibited payments include cash, excessive compensation, low-cost office space, or anything else of value. In this case, the hospital allegedly disguised the kickbacks as payments to the clinics for services.
Once a kickback has been paid, no reimbursement may be sought from Medicare, Medicaid, or any other government healthcare program for any resulting services. It does not matter if the services were medically necessary and actually provided. The kickback renders all resulting claims for reimbursement "false claims" under the False Claims Act.
The former CFO pursued the case against the hospital and others under the qui tam, or whistleblower, provisions of the False Claims Act. These provisions allow private citizens to pursue claims on behalf of the government and to share in any recovery. Successful whistleblowers are entitled to rewards of between 15% and 30% of the amount the government recovers.
If you have evidence that a hospital or other healthcare provider is paying kickbacks in return for patient referrals, then you should consult with an experienced whistleblower lawyer immediately. Call John Howley, Esq. at (212) 601-2728 to schedule a free and confidential consultation.