Health Management Associates (HMA), a former hospital chain operating across the United States, agreed in September 2018 to pay $260 million to resolve multiple False Claims Act lawsuits filed by whistleblowers and to enter a criminal guilty plea in connection with fraudulent billing practices.
This landmark healthcare fraud settlement exposed a systemic scheme to increase inpatient hospital admissions, regardless of medical necessity, in violation of federal healthcare laws.
Among the whistleblowers who played a pivotal role in uncovering the fraudulent practices at HMA were Ralph Williams and Dr. Craig Brummer, both represented by Wilbanks & Gouinlock (W&G).
Their independent complaints, later consolidated as part of the False Claims Act settlement, revealed widespread Medicare and Medicaid fraud within the HMA hospital system.
Click here to read the Wilbanks & Gouinlock press release on the HMA settlement.
While their lawsuits were filed separately, both Williams and Brummer provided firsthand evidence of HMA’s fraudulent hospital admission practices.
Both whistleblowers exposed a corporate scheme that pressured physicians and hospital staff to prioritize financial gain over patient care. Their False Claims Act complaints revealed that:
Dr. Brummer attended daily meetings where emergency department physicians were pressured to increase inpatient admissions, regardless of medical necessity, to maximize Medicare and Medicaid reimbursements.
Ralph Williams observed HMA leadership setting aggressive system-wide goals for increased hospital admissions, even when patients could have been treated in outpatient settings.
These fraudulent practices violated federal healthcare regulations, including:
HMA’s $260 million settlement resolved a wide range of fraud allegations, but the claims filed by Dr. Brummer and Mr. Williams directly led to a $62.5 million recovery.
Their whistleblower complaints also contributed significantly to the criminal case against HMA, resulting in:
As a result of these whistleblower disclosures, HMA and its leadership faced accountability, marking one of the largest False Claims Act settlements in the hospital industry.
The HMA False Claims Act settlement highlights the critical role whistleblowers play in exposing fraudulent healthcare practices. Without the courage of employees like Williams and Brummer, the systemic abuse of government healthcare programs might have continued unchecked.
The False Claims Act (FCA) empowers private individuals—known as qui tam relators—to file lawsuits on behalf of the government when they have evidence of fraud. In return, successful whistleblowers may receive a percentage of the recovered funds as a reward.
In this case, Williams and Brummer’s decision to come forward not only led to millions in recoveries but also set a precedent for holding hospital systems accountable for fraudulent admission schemes.
If you have evidence of fraud in healthcare, government contracts, or other federal programs, you may be eligible to file a False Claims Act lawsuit. Contact our office for a free consultation:
This article is for informational purposes only and should not be considered legal advice.
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