Medicare and Medicaid fraud whistleblower lawsuits filed against a hospital chain, Health Management Associates, alleged that it pressured emergency room doctors to increase their patient admission rate so that the company would be paid greater amounts of money by Medicare and Medicaid. The New York Times, Hospital Chain Said to Scheme To Inflate Bills, reports as follows:

Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red.

It is also reported that a customized software program called Pro-Med was used to monitor the percentage of patients being admitted so that the physicians scoreboards could be updated daily. A hospital executive who protested that the new protocols "were clinically inappropriate and would result in unnecessary test and admissions" was told "do it anyway."

There have been filed eight separate whistleblower lawsuits against Health Management Associates in six states, which have been "brought by an array of physicians, individual hospital administrators and compliance officers [.]" In addition, the administrator for a company, EmCare, that provided emergency room physicians to a number of HMA hospitals claims that she herself was fired by EmCare when she refused to follow HMA's directives and fire doctors who admitted fewer patients than HMA wanted.

The whistleblower lawsuits have been filed under the federal False Claims Act. The False Claims Act allows individuals to file suit, essentially on behalf of the federal government, against companies or contractors who engage in fraudulent activities and, as a result, received payments of money from a federal program that they are not entitled to. These cases against Health Management Associates claim that the hospital chain worked up a system by which patients were unnecessarily admitted to the hospital and unnecessary tests and procedures were performed all for the purpose of driving up their bill and increasing the amount of money paid the hospital chain by Medicare and Medicaid. The False Claims Act allows the whistleblower who brought the lawsuit to retain 15 – 25% of the monies recovered.

Lexington, Kentucky Medicare fraud and whistleblower lawyer Robert Abell represents individuals and employees in whistleblower lawsuits under the False Claims Act; contact him at 859-254-7076.


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