by: Jodie Fleischer Updated:
ATLANTA - Channel 2 Action News has learned the U.S. Justice Department has issued a Statement of Interest in the case against several local hospitals accused of paying kickbacks to bring in undocumented pregnant women.
It's the first indication the feds will try to recover more than $100 million in Medicare money billed for those patients; patients a local whistle-blower says should not have gone to those hospitals in the first place.
"I definitely feel the right thing is being done now by the state of Georgia and by the Department of Justice, and I sincerely appreciate their tremendous efforts over the last four years in that investigation," whistle-blower Bill Williams told Channel 2 investigative reporter Jodie Fleischer.
Williams says he discovered the alleged scheme during his brief time as chief financial officer at Walton Regional Medical Center in Monroe, Ga., now known as Clearview.
Williams uncovered a contract listed for "translation services," with a group of clinics for tens of thousands of dollars each month. He asked the company CEO about it.
"I absolutely lost my job over all that, within a few months of taking that job," Williams said.
He said his hospital and seven others around Georgia, contracted with recruitment clinics located in Hispanic communities, including Norcross and Forest Park, to funnel in pregnant women who were in the U.S. illegally.
He said it was all organized by the hospitals' parent companies, Health Management Associates and Tenet. At least one executive worked for both companies.
"Kickbacks were paid by Tenet and HMA to buy referrals of pregnant Hispanic women," said Marlan Wilbanks, an Atlanta-based attorney who represents Williams.
Wilbanks said the for-profit hospitals including Atlanta Medical Center, North Fulton Hospital in Roswell, Spalding Regional Medical Center in Griffin, and Barrow Regional Medical Center in Winder, took patients away from already publicly supported hospitals like Grady in downtown Atlanta, and reaped lucrative Medicare and Medicaid payouts for those births.
"In a whistleblower case, naturally the defendants' first reaction is to deny it. But to have the federal and state government come in and say, 'the law that you're citing is wrong,' is very significant," said Wilbanks.
He says taxpayers weren't the only victims. The pregnant women paid an initial fee of $1,700 when they first went to the
clinics for care many of them could have received for free elsewhere.
With allegations of kickbacks and health care fraud, there could even be a criminal investigation. The CEO of the clinics denies any wrongdoing.
"We never steered anyone, we never sent anyone. It was the patient-doctor relationship
that determined where that patient was going to go," said Ed Cota, CEO of Clinica de la Mama.
Cota said he's been operating since 1998 with no problems and that an attorney reviewed all of his clinic's contracts with the hospitals.
But with no questions asked about immigration status, Williams says the clinics attracted patients from all over the country. He said as a result, the hospital execs billed Medicare and Medicaid, with profits in the hundreds of millions of dollars.
"They knowingly implemented the scheme," said Williams. "I personally think that a number of those higher level executives should never work in the hospital and health care business again."
In a statement from Tenet hospitals, they said:
“We filed a Motion to Dismiss in the matter of USA ex. rel. Ralph D. Williams v. Health Management Associates, et al., because we believe the service agreements between Hispanic Medical Management (HMM) and Atlanta Medical Center, North Fulton Hospital, Spalding Regional Hospital and Hilton Head Hospital appropriately provided substantial benefit to women in underserved Hispanic communities.
"The services were medically necessary and increased the likelihood of a safe birth and a healthy baby while reducing the overall cost to the Georgia Medicaid program.
"The documents filed in response to our motion to dismiss do not address the fundamental legal problems in the underlying lawsuit. More importantly, the government’s efforts to encourage this lawsuit will further chill the work of providers seeking to close the health care gap affecting many minority communities.”
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