Paying for or accepting money to arrange for medical treatment under federally funded programs is prohibited by the Medicare anti-kickback statute. “In a time when too many people were struggling to get healthcare for themselves and their children, Tenet and these hospitals plundered a system set up for those truly in need,” said Michael J. Moore, the U.S. attorney in Macon, Ga.
The lawsuit targets Tenet directly, as well as four of its hospitals: 403-bed Atlanta (Ga.) Medical Center; 93-bed Hilton Head Hospital on Hilton Head Island, S.C.; 196-bed North Fulton Hospital in Roswell, Ga.; and 160-bed Spalding Regional Medical Center in Griffin, Ga. The government's lawsuit also names a fifth hospital defendant, 115-bed Clearview Regional Medical Center, Monroe, Ga., which was owned by Health Management Associates at the time of the alleged conduct. (HMA was bought by Community Health Systems last month.)
Finally, the Justice Department joined the case against the clinics and “related entities” owned by Hispanic Medical Management, which is known as Clinica de la Mama.
The case was filed in 2009 under seal, and was publicly revealed in August. On Tuesday, the Justice Department announced its decision to join the case as a plaintiff.
The whistle-blower who originally filed the case was Ralph D. Williams, a Georgia accountant with decades of experience in healthcare. He accused the hospitals of recruiting pregnant undocumented immigrants through the Clinica clinics by paying for referrals, which is a violation of the federal anti-kickback law that triggers liability under the False Claims Act.
The lawsuit says Clinica is well-known in the local area for its slogan, “We care about your health, not your immigration status.”
Although illegal immigrants are not eligible for regular Medicaid coverage, the program has an emergency medical assistance program to compensate hospitals for emergency services to people living in the country without documentation.
The hospitals, however, say the payments to Clinica were for much-needed programs designed to address the explosion of illegal immigrants whose emergency care—including childbirth—hospitals are required to provide. In a statement responding to the Justice Department's action, Tenet said the company “will continue to vigorously defend against these allegations.”
By providing translation and outreach services, the hospitals say they reduced healthcare costs by increasing the likelihood for safer births.
“By contracting with Clinica to provide both pre-admission and translation services during delivery, the hospitals were able to provide better care and a welcome environment that conveyed to these women that the hospitals' chief concern was not their immigration status but rather their well-being and the well-being of their babies,” Tenet said in a 2013 motion to dismiss the case (PDF). “In doing so, the hospitals were able to remove some of the barriers to healthcare access that plague this population.”
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