Medicaid Whistleblower Pay-for-Patient Schemers Plead Guilty By Tod Aronovitz | 08/20/14 | 0 Comment

Two health care executives from the Atlanta area recently pleaded guilty in connection with the payment of illegal kickbacks to clinics in exchange for Medicaid patient referrals, the Justice Department announced. The patients were often undocumented Hispanic women who were pregnant and uninsured.

According to a story in South Carolina’s The Beaufort Gazette, prosecutors were tipped off by a whistleblower, Ralph Williams. Williams, who worked for one of the Georgia hospitals, says he was fired after expressing concerns about the referrals to hospital executives, his Medicaid whistleblower lawsuit contends.

The two charged were: Gary W. Lang, former Chief Executive Officer of an Atlanta-area hospital that was enrolled as a provider in the Georgia Medicaid program, and Tracey Cota, the co-owner and chief operating officer of Hispanic Medical Management, Inc. dba Clinica de la Mama (Clinica), a Georgia-based corporation that operated a chain of medical clinics.

Both pleaded guilty to conspiracy to violate the Anti-Kickback Statute by paying and receiving illegal compensation in exchange for Medicaid patient referrals to hospitals in the Atlanta area and Hilton Head Island, South Carolina.

Through court documentation, it was revealed that the clinics provided prenatal care mainly to undocumented Hispanic women. Because of their immigration status, these patients normally are ineligible for Medicaid. However, Medicaid in Georgia and South Carolina partially covered and paid certain costs associated with women’s labor and delivery, newborn care at hospitals, and physicians’ professional fees for providing labor and delivery services.

Prosecutors said from a time spanning July 2000 through July 2012, Cota conspired with Lang and other hospital executives from Atlanta and one hospital from Hilton Head Island to pay kickbacks to Clinica for the referral of its patients to the hospitals. The hospitals were able to carry out this scheme by disguising the kickbacks as contracts with Clinica for providing services such as translation services and Medicaid eligibility determination services.

In reality, the arrangement was made so the hospitals could illegally pay Clinica for patient referrals. As a result of those referrals, Medicaid ultimately reimbursed the hospitals more than $100 million.

“These medical executives enriched themselves by using uninsured pregnant women and newborn babies as commodities, whose health care could be bought and sold for kickbacks and bribes,” said Principal Deputy Assistant Attorney General Marshall L. Miller of the Justice Department’s Criminal Division. “Unlawful payments for patient referrals can lead to increased Medicaid costs, corrupt medical decision-making, overutilization of medical services, and unfair competition—and most importantly, insufficient or inadequate care for patients. The Justice Department is committed to investigating and prosecuting those who illegally pay for patients.”

“Our federal health care programs depend on providers exercising independent judgment in the best interests of patients,” said U.S. Attorney Sally Quillian Yates. “These illegal referral arrangements resulted in women being steered to deliver their babies at hospitals on the basis of Clinica’s and the hospitals’ financial self-interest, regardless of whether it was in the women’s best interest.”

Lang and Cota were charged in separate criminal informations on June 28. They are scheduled for sentencing on January 15, 2015 in the Medicaid whistleblower case.

How to Report Miami Medicare Fraud

Healthcare professionals or medical billing employees who have knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a Medicaid whistleblower in what is known as a “qui tam” lawsuit, a private party may collect up to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss your case.