ATLANTA - A former chief financial officer of a metro-area hospital says his employer and another company used recruiters to funnel pregnant women in the U.S. illegally to give birth at several Georgia hospitals, then billed Medicare and Medicaid for the births.
A judge unsealed Ralph (Bill) Williams' federal
whistle-blower lawsuit against hospital giants Tenet Healthcare and Hospital Management Associates, or HMA, Wednesday.
The suit alleges the companies entered into contracts with several local outreach clinics, including Clinica de la Mama and Clinica de la Bebe, paying hundreds of thousands of dollars each year for patients to be sent to those for-profit hospitals.
"To me it was pay for patients, pure and simple. I said this is an illegal agreement, it is a kickback situation," Williams told Channel 2 investigative reporter Jodie Fleischer.
Williams said shortly after joining Walton Regional Medical Center, in Monroe, as CFO, he uncovered a contract designated for
"translation services" for which he was unable to find any services provided.
After inquiring further, he said the hospital's CEO explained the contract was actually for referral of pregnant patients. Walton Regional Medical Center has since changed names to Clearview Regional Medical Center.
"In my 30-years-plus, I had never seen an egregious situation like this," said Williams, "I felt like I absolutely had to go to the authorities about that."
The lawsuit aims to recover hundreds of millions of dollars in claims paid by Medicare and Medicaid, going back at least a decade.
"It's illegal to buy patient referrals," said attorney Marlan Wilbanks, who filed the case on Williams' behalf.
Wilbanks added, "Our hope is that the individuals and companies that are involved in directing this very specific population to a very specific place have to return all the money that's tainted by their illegal actions."
Georgia Attorney General Sam Olens has also joined in the case in an effort to recover Medicaid money for Georgia taxpayers from these hospitals.
"Their true aim was the recruitment and referral of undocumented immigrant women who would be eligible for emergency Medicaid services when they gave birth... [which] resulted in the state's payment of tens of thousands of ineligible Medicaid claims over the course of more than a decade."
In a statement Olens said, "These hospitals allegedly paid Clinica kickbacks camouflaged as interpreter service payments to funnel emergency Medicaid patients their way and increase their bottom line. As Attorney General, I take seriously my responsibility to protect the integrity of Georgia Medicaid and to ensure that those who defraud the program are held accountable.”
Williams said the hospitals' motivation was to increase admissions, reimbursements and profits.
"They get paid a significant amount of money for that delivery as an emergency care situation," said Williams. "The costs may be more significant at one particular hospital versus another."
"It's not only a fraud against the taxpayer, it's a fraud against all hospitals who would ordinarily be getting that patient population," said Wilbanks.
Wilbanks says public hospitals, like Grady Hospital, in downtown Atlanta, are particularly hard-hit.
"It hurts them because it removes potentially a portion of the population that would be coming there for services that they would be compensated for by the government." said Wilbanks.
Wilbanks says the increased level of indigent care also qualified the hospitals for a more significant share of public money that offsets those costs.
The lawsuit also accuses Tenet Healthcare of the same practice, including Atlanta Medical Center, in Atlanta, and its south campus, in East Point; North Fulton Hospital, in Roswell; and Spalding Regional Medical Center, in Griffin.
In a statement, a Tenet Healthcare spokesperson said the agreements with the clinics were appropriate and "provided substantial benefit to women in underserved Hispanic communities served by those hospitals."
The hospital group said,
"The services provided under these agreements included translation, determination of Medicaid eligibility, and other services designed to improve the delivery of obstetric care and increase the likelihood of a safe birth and a healthy baby."
An HMA spokesperson said the company does not comment on pending lawsuits.
Taxpayers would likely have foot the bill for those births no matter where the patients went, but Wilbanks points out that paying for the referral of patients is illegal, regardless of whether they need the services or not.
He says the clinics promised no questions about immigration status, which attracted patients from all over the country, not just the Atlanta area.
"So we get more than our share, as a result of this type of service, of illegal undocumented Hispanic women who come here to give birth for free on the
taxpayers' tab," said Wilbanks.
Wilbanks and Williams say they hope the lawsuit puts a stop to the practice and sends a message.
"It's not just enough when you catch somebody paying kickbacks and cheating to have them pay back what they stole. We don't let bank robbers just give back the money that they
took," said Wilbanks.