Feds Join Emergency Medicine Whistleblower Lawsuits

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.

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