Negative publicity began to swirl around now-shuttered Health Management Associates back in 2012 when news magazine “60 Minutes” aired a segment alleging that the hospital chain pressured emergency room doctors to admit patients whether they needed care or not. The pressure on HMA escalated two years later when the New York Times reported that the company inflated its Medicare and Medicaid payments by pressuring physicians to admit at least half of patients age 65 and above.
Now two physician groups have agreed to pay more than $33 million to settle health care fraud allegations that they received illegal kickbacks for patient referrals to HMA facilities.
A Texas physicians group has agreed to pay $29.6 million to settle claims that it received kickbacks for recommending that patients who could have been treated in outpatient settings be admitted to HMA hospitals.
The Justice Department says that the benefit to HMA was clear: Medicare pays about three times more for inpatient care than outpatient treatments.
A Pennsylvania-based physician group has agreed to a separate settlement of $4 million. The group also agreed to hand over to the Justice Department a portion of proceeds from the sale of its HMA holding.
The DOJ said two whistleblowers in the Texas case are to split more than $6.2 million from the settlement.
Two former HMA executives are to receive an unspecified portion of the $4 million settlement of the Pennsylvania case, the DOJ said.
Before talking to investigators about possible Stark Law or Anti-Kickback Statute violations, speak with an attorney experienced in health care law representation.