In December 2009, Wilbanks & Gouinlock (W&G) filed a whistleblower lawsuit against Health Management Associates (HMA), alleging a deliberate scheme to inflate Medicare reimbursements by pressuring emergency room staff to admit as many Medicare patients as possible—regardless of medical necessity. The case claims that HMA manipulated its ER procedures to boost inpatient admissions, knowing that Medicare pays significantly more for inpatient care than for outpatient or observation services.
According to the lawsuit, HMA collected hundreds of millions of dollars from Medicare by admitting patients who did not meet inpatient criteria. This form of Medicare fraud resulted in large-scale overbilling of the federal healthcare program. W&G played a leading role in evaluating evidence for the U.S. Department of Justice (DOJ) and continues to work closely with federal authorities to hold the company accountable.
The HMA lawsuit has been consolidated with seven similar cases in a multi-district litigation pending in the U.S. District Court for the District of Columbia. The Department of Justice has formally intervened, but stayed the civil proceedings pending the outcome of an ongoing criminal investigation, expected to continue until at least December 2016.
During the litigation, HMA was acquired by Community Health Systems (CHS), one of the nation’s largest hospital chains, further raising the stakes in this high-profile Medicare fraud case.
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