A settlement has been reached to resolve False Claims Act allegations against Health Management Associates LLC.
Health Management Associates (HMA), agreed to pay the sum to resolve criminal and civil claims as part of a deal in which a subsidiary also agreed to plead guilty to conspiring to commit healthcare fraud.
According to the government, allegedly HMA knowingly billed Medicare and other government insurance programs for higher-paying inpatient services that should have been billed as outpatient or observation services, paid money to physicians in return for patient referrals, and submitted inflated claims for emergency department fees.
Allegedly, HMA set mandatory admissions rate benchmarks for patients presented at hospital emergency departments in order to boost its revenue and threatened to fire doctors who did not increase admissions.
Reportedly, from 2003 to 2011, two of HMA’s hospitals in Florida also billed federal healthcare programs for services referred to them by doctors who received free office space and direct payments in exchange.
Furthermore, allegedly excessive payments were made to a large physician group and a local surgeon in exchange for patient referrals by two hospitals owned by HMA in Pennsylvania.
“The FBI will not stand by when there are allegations that a company operates a corporate-wide scheme to increase their financial gain at the expense of the U.S. government," Johnson said in the release. "We appreciate those who come forward with allegations of criminal misconduct and recognize the importance of the public’s assistance in our work.”
HMA was acquired by Community Health Systems, based in Franklin, Tennessee, in January 2014.
The allegations resolved by the settlement were from eight whistleblower lawsuits filed under the False Claims Act, which permits private parties to sue on behalf of the government for false claims and to receive a share of any recovery. The eight whistleblower suits were filed in various districts and were transferred to federal court in the District of Columbia as part of a multi-district litigation meant to speed the handling of the complex cases.
