Whistleblower Lawsuit Against HMA Alleges Massive Medicare Fraud Scheme

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.

Improper Hospital Admissions to Boost Revenue

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.

DOJ Joins Case; Litigation Stayed for Criminal Investigation

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.

Report Fraud at No Cost

If you have information about fraudulent practices, contact our office for a free, confidential consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.