W&G in Litigation - Wilbanks & Gouinlock Law

Representation for Whistleblowers Contact Us info@wilbanksgouinlock.com 404-842-1075

Updates on Pending Unsealed Cases

U.S. and Georgia ex rel. Williams v. Tenet Healthcare,
Health Management Associates, Clinica de la Mama, et., al.

October 3, 2016:  Since 2009, W&G has been prosecuting a massive False Claims Act case against one of the biggest hospital companies in the country, Tenet Healthcare Corporation.  Today the case officially settled for $368M.  Tenet also agreed to pay $145M in criminal restitution.  W&G’s client is whistleblower Bill Williams, an Army veteran and former hospital finance executive.  Mr. Williams will receive a portion of the civil settlement funds.   Click here for the W&G press release.

The suit alleged that Tenet and four of its hospitals in Georgia and South Carolina, entered into an illegal arrangement with a business called “Clinica de la Mama” that operated walk-in obstetric clinics for undocumented Hispanic women.  The suit alleges that under the arrangement, Tenet paid Clinica to locate and refer to Tenet’s hospitals pregnant, undocumented women who would have their babies at Tenet hospitals at government expense.  Women who are not U.S. citizens are not eligible for regular Medicaid but because labor is an emergency condition, Emergency Medicaid pays for the services.  Paying for referrals of Medicaid patients violates the federal Anti-Kickback Statute and applicable Georgia laws.  The State of Georgia joined W&G in prosecuting the case in 2013 and the U.S. Department of Justice joined in 2014.  Tenet was represented in the case by two major law firms, Alton & Bird, LLP in Atlanta and Latham & Watkins, LLP in Washington, DC and Los Angeles, CA.  The complaints, with copies of actual Tenet documents attached as exhibits, are available below.

Click here for the qui tam complaint and exhibits:

Click here for the State of Georgia’s Complaint:

Click here for the United States Complaint in Intervention and exhibits:

Click here for Court Order Denying Tenet’s Motion to Dismiss the Complaints


U.S. ex rel. Williams v. Health Management Associates (“HMA”)

July 21, 2016: U.S. ex rel. Williams v. Health Management Associates (“HMA”), pending in a consolidated multi-district litigation in the United States District Court for the District of Columbia. The U.S. Department of Justice has intervened in two cases brought by W&G on behalf of clients based on their insider knowledge of HMA rigging its emergency room procedures to admit as many Medicare patients as possible regardless of whether they met the medical criteria to be admitted to a hospital. Medicare pays hospitals more for services rendered to patients that have been admitted to the hospitals rather than being treated on an outpatient basis. HMA’s actions took hundreds of millions of dollars from Medicare that it was not entitled to and resulted in 8 different cases being filed against the company. W&G has taken a lead in reviewing evidence for the Department of Justice. The case is currently stayed pending settlement discussions between HMA and the Department of Justice.


U.S. ex rel. Bernsten v. Prime Healthcare, et. al

July 21, 2016: U.S. ex rel. Bernsten v. Prime Healthcare, et. al, pending in the United States District Court for the Central District of California. The U.S. Department of Justice has joined W&G and its co-counsel (James, Hoyer, Newcomer & Smiljanich of Tampa, FL) in successfully defeating an attempt by Prime Healthcare to get the case dismissed. W&G is now assisting the Department of Justice in its investigation of Prime Healthcare’s scheme to admit as many Medicare patients as possible to its hospitals across California regardless of whether the patients met the medical criteria to be admitted to a hospital. Prime Healthcare’s founder and CEO, Dr. Prem Reddy, instructed physicians and other medical staff to admit patients because the Medicare payments are higher for inpatient treatments. Prime Healthcare altered medical records to increase inpatient admissions and the amount of reimbursements its hospitals obtained from Medicare. Prime trained its staff to exaggerate patients’ medical conditions on certain forms to justify admitting them as inpatients and to increase the Medicare reimbursements even when the information on the forms was not supported by the patients’ medical records. The U.S. Department of Justice has joined in the prosecution of the case.

Click here for the qui tam complaint

Click here for the United States Complaint in Intervention