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February 20, 2014

Feds join lawsuit against 2 hospital operators

MACON —

The federal government has joined a whistleblower lawsuit against two large hospital operators accused of filing fraudulent Medicaid and Medicare claims.

The False Claims Act lawsuit was filed last year against Dallas-based Tenet Healthcare Corp. and four of its hospitals in Georgia and South Carolina, as well as a Georgia hospital owned by Naples, Fla.-based Health Management Associates Inc.

The lawsuit claims the hospitals entered into contracts with obstetric clinics operated by Hispanic Medical Management and Clinica de la Mama and their affiliates that primarily serve women living in the country without authorization. The suit says the clinics then referred the women to the hospitals in exchange for kickbacks from fraudulent claims.

Health Management Associates has declined to comment on pending litigation. Tenet said when the lawsuit was unsealed last year that it believes the agreements were appropriate and provided substantial benefit to women in underserved Hispanic communities. Phone numbers for Hispanic Medical Management and Clinica de la Mama, both in Georgia, could not immediately be found.

The federal whistleblower lawsuit, filed by Ralph Williams, a former chief financial officer for Health Management Associates, says the kickback scheme went on for more than a decade. The state of Georgia has also joined the lawsuit to recover state Medicaid funds.

"The Department of Justice is committed to ensuring that health care providers who pay kickbacks in return for patient referrals are held accountable," Stuart F. Delery, the assistant attorney general for the Justice Department's Civil Division, said in a statement. "Schemes such as this one corrupt the health care system and take advantage of vulnerable patients."

The Anti-Kickback Statute makes it illegal to offer, pay, solicit or receive payment to win referrals of items or services covered by Medicare, Medicaid and other federally funded programs. It's meant to make sure that a doctor's medical recommendations are based on the patient's best interest rather than financial incentives.

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