In a recently-revealed False Claims Act case, the United States has elected to intervene against Naples, Florida-based Health Management Associates, Inc. after uncovering serious allegations of fraud. Currently, four whistleblower cases are pending against the company both in the Middle District of Georgia and Southern District of Florida. The cases involve allegations of unlawful kickbacks and fraudulent claims for reimbursement to federal healthcare entities like Medicare and Medicaid.
The FCA is historically successful in recovering billions of dollars in healthcare fraud on behalf of American taxpayers. The statute contains anti-kickback language which prohibits inappropriate financial relationships between doctors and pharmaceutical companies which ultimately involve federal reimbursement. Under the FCA, liable companies could face damages up to three times the value of the actual allegation – a measure designed to deter others from considering similar conduct. Additionally, the FCA contains a qui tam provision which provides the original whistleblower(s) with up to 30 percent of the ultimate recovery. In healthcare cases, this award is usually sizable as settlements have reached the billion-dollar mark.
A cause of action under the FCA is originally filed by an individual with original, firsthand knowledge of fraud. The person is usually a former or current employee of the defendant who was either forced to participate in or exposed to fraudulent business practices. From there, the U.S. government can, at its discretion, intervene in the case and exercise its own investigations with the help of the Department of Health and Human Services and the Office of Inspector General.
Case Against HMA, Inc.
The allegations against HMA, Inc. involve, among other things, the assertion that physicians employed by one its 71 hospitals were encouraged to admit certain numbers of emergency room patients each year in order to raise revenue and meet quotas. These ER admissions were not always necessary, according to the complaints, and were designed to garner greater reimbursement from federal healthcare programs. Other allegations allege similar quota-style requirements with regard to hospital admissions – resulting in the admission of patients who likely did not require an overnight stay in one of HMA’s widespread Southeastern medical facilities.
The investigations into HMA’s operating procedure are ongoing and were revealed pursuant to an agreement by all parties reached earlier this year. The U.S. government will continue to review HMA’s records and the case will either proceed to a trial or result in a sizable settlement.
Work With a Whistleblower Attorney
Working with an experienced whistleblower attorney is the best option for you if you are aware of fraudulent misconduct involving U.S. government money. While healthcare cases are the most common, fraud can occur in virtually any profession involving a U.S. contract or reimbursement procedure. As we have reported in the past, some fraudulent behavior is virtually undetectable, and employees may be hesitant to come forward for fear they could be incorrect. By working with an attorney, you can help determine whether you have an actual whistleblower case and the possible opportunity to recover a sizable reward.