Medicaid Kickback Trend Continues In Hilton Head Hospital

Hilton Head Hospital has been accused of taking kickbacks from clinics that directed illegal aliens to the hospital in order to increase Medicaid payments, says a whistle-blower lawsuit recently filed in federal court.

The lawsuit also alleges that a number of hospitals based in Atlanta, Georgia participated in the fraud. The state of Georgia has filed its own lawsuit in order to recover Medicaid funds paid to the hospitals. South Carolina has not joined the lawsuit, according to the state attorney general’s office.

According to the federal pleading, Health Management Associates, Tenet Healthcare Corp. and Hilton Head Hospital paid kickbacks to clinics to round up illegal Hispanic women for the purpose of prenatal care. The women were then directed to the defendant’s hospitals for newborn care and deliveries which were paid for by Medicaid. Hispanic Medical Management operated these prenatal clinics.

Hospitals cannot pay clinics referral fees for directing patients to them for Medicaid reimbursement, according to both state and federal law. It is also unlawful to treat illegal aliens with taxpayer money unless it is an emergency. Childbirth, though, is considered a medical emergency under rules stated in Medicaid.

Tenet Healthcare, which is the parent company of Hilton Head, denied the allegations in the lawsuit, stating that the agreement between Hilton Head and Hispanic Medical Management was appropriate, according to The State newspaper in South Carolina.

“We believe the agreements between Hispanic Medical Management (HMM) and Hilton Head Hospital were appropriate, and that Hilton Head provided much needed health care services to underserved pregnant women,” according to a statement given by Tenet spokeswoman Ashley Walton that appeared on islandpacket.com.

Details from the case show that the Clinica de la Mama opened eight years ago and closed in 2011. Hilton Head Hospital was identified as the only facility in South Carolina that dealt with Clinica de la Mama or Hispanic Medical Management, Walton said in her statement. At present, prenatal care for illegal aliensis now handled by a different branch of Hilton Head in Bluffton.

Tenet insisted that its contracts called only for interpretation services, according to its statement. Referrals to the hospital of women who were pregnant were never part of the deal.

However, federal prosecutors in the U.S. Justice Department said that the purpose of the referrals was to grab more money via Medicaid payments. The process involved giving kickbacks to Clinica in return for referrals. In addition, the lawsuit claimed that doctors were paid money for delivering infants.

The Georgia state attorney’s office claims that the kickbacks were cloaked as interpreter services.

Ralph Williams, the whistle-blower who brought the suit, was fired after expressing concerns about the practice.

Related:

http://www.islandpacket.com/2013/09/12/2681043/hitlon-head-hospital-implicated.html
http://www.healthleadersmedia.com/content/COM-296322/Hilton-Head-SC-Hospital-implicated-in-alleged-Medicaid-kickback-scheme
http://www.thestate.com/2013/09/13/2977702/hilton-head-hospital-implicated.html