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March 6, 2014 Healthcare Fraud

Government Intervenes in False Claims Act Case Against Tenet Healthcare

In yet another case involving unlawful patient referrals, Tenet Healthcare Corp. and four of its Southeast-area hospitals are facing allegations of misconduct under the False Claims Act. The False Claims Act has been extremely pivotal in bringing kickback schemes to light and continues to hold doctors, hospitals, and pharmaceutical professionals to the highest ethical standards. Under the FCA and its applicable anti-kickback provisions, it is considered a false claim to the government to request reimbursement from Medicare or Medicaid for any patient obtaining services through the “taint” of a kickback. Kickbacks generally take the form of a hospital or hospital management corporation offering benefits, cash, or equity in exchange for doctors referring a certain number of patients to their facilities. At the heart of the government’s disdain for kickback schemes is its dedication to ensuring patients are receiving high-quality, unbiased care at a facility chosen based on informed counsel from a physician who truly has the patient’s best interests at heart.

Basis of Allegations Against Tenet Healthcare

The allegations against Tenet Healthcare involve certain hospitals in Georgia and South Carolina, owned by Health Management Associates, Inc., paying kickbacks to OBGYN clinics in exchange for referrals to those hospitals for labor and delivery. Alarmingly, the government’s allegations reveal that Tenet targeted clinics which serve a client base comprised of mostly undocumented Hispanic women. Under the terms of a kickback deal between Tenet Healthcare and Health Management Associates, Inc. (who is a common FCA offender), Tenet received benefits for referring as many women as possible to HMA-run hospitals. This allegation offends the general purpose of the doctor-patient relationship, which is built upon the premise that doctors are to refer patients to certain facilities based on the patient’s unique needs, not for personal gain. The FCA was triggered in these cases because these women were recipients of Medicaid benefits during their pregnancies, making each subsequent submission for reimbursement a false claim against the government.

In an effort to put a stop to this type of exploitation, the government has also chosen to intervene against the OBGYN clinics involved in the scheme. These clinics are run by an entity known as Hispanic Medical Management d/b/a Clinica de la Mama. In a review of documents and records, it was discovered that the kickbacks paid to Clinica were disguised on bills and invoices as obstetric and prenatal services provided by Clinica.

Government’s Response

The Department of Justice worked in concert with the U.S. Attorney’s Offices for the Middle and Northern Districts of Georgia, the Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, and the Office of the Attorney General for the State of Georgia. The case was originally filed by an unnamed relator and was given attention by the DOJ presumably after a review of the widespread and extensive fraud allegedly perpetuated by this hospital group and related entities.

In a statement, the U.S. Attorney for the Middle District of Georgia is quoted as saying:

“In a time when too many people were struggling to get health care for themselves and their children, Tenet and these hospitals plundered a system set up for those truly in need. This kind of scheme drives up costs for everyone, not just the vulnerable patients and groups like those targeted in this case.”

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