The Chicago whistleblower lawyers at Goldberg Kohn Ltd. commend the United States Department of Justice on its decision to intervene in a whistleblower lawsuit against Health Management Associates, Inc. (HMA) filed by David Chizewer of Goldberg Kohn on behalf of their client, a well-respected emergency room physician.
The lawsuit alleges that HMA – the country's third-largest for-profit hospital chain, which operates 71 hospitals in 15 states – has, for years, intentionally and systematically admitted patients who did not need to be admitted, and then charged the government for those unnecessary admissions. As alleged in the complaint, HMA established benchmarks for emergency room physicians regarding the percentage of patients that must be admitted to the hospital, and then enforced those benchmarks by incentivizing and pressuring the physicians to meet them. The benchmarks were allegedly driven by HMA's profit projections, not by any health-related criteria. As a result of this scheme, according to the complaint, HMA knowingly and routinely caused patients to be admitted to its hospitals, even though admission was not necessary and, as a result, government health care programs, including Medicare and Medicaid, overpaid HMA for these unnecessary admissions.
Not only does paying incentives to emergency room physicians cause unnecessary inpatient admissions, but it also violates the Anti-Kickback and Stark Statutes, both of which prohibit a hospital from paying physicians to make referrals.
It is important that doctors admit patients only based on what is in the patient’s best interest – not on the profits the hospital intends to generate. The whistleblower attorneys at Goldberg Kohn are gratified that the government has decided to join this important case and has expressed its commitment to “ensuring that health care providers who attempt to misuse federal health care programs for their own profit are held accountable.”
As Assistant Attorney General for the Justice Department’s Civil Division, Stuart F. Delery said in the government’s press release, “Schemes such as this one can contribute significantly to the rising cost of delivering health care and create needless patient risk.”
The lawsuit – captioned United States of America ex rel. Plantz, M.D., et al. v. Health Management Associates Inc., et al., No. 13 CV 1212 (N.D. Ill.) – was filed by a well-respected emergency room physician under the qui tam whistleblower provisions of the False Claims Act, which encourages private citizens to report incidents of fraud against the government by allowing them to sue on behalf of the government and, in exchange, receive a share of any government financial recovery. The Department of Justice has also intervened in seven other whistleblower lawsuits against HMA, all of which allege that HMA improperly admitted patients or had inappropriate financial relationships with physicians.
Goldberg Kohn is proud to represent clients who have the courage and integrity to come forward and report fraudulent activity. We look forward to the opportunity to vindicate the interests of federal and state governments in this case and other cases filed under the False Claims Act.
Please contact us at (312) 863-7222 if you would like to schedule a free, confidential appointment with one of our nationally recognized whistleblower attorneys.