Eight Qui Tam Whistleblowers Set Government on to Trail of Alleged Unnecessary Inpatient Hospital Admissions

Years before the investigative television show 60 Minutes ran a segment questioning the inpatient admission practices of Health Management Associates (HMA), eight qui tam lawsuits were filed under seal, detailing the alleged fraud for the federal government. These actions were filed by relators from various states and from various rungs of the HMA corporate ladder. Recently, the federal government announced that it was intervening in all eight qui tam actions.

With the government intervening in the qui tam actions, the seals were lifted on the underlying complaints, permitting the public a view behind the underlying allegations. There is notable uniformity, with all of the qui tam actions alleging Stark law, anti-kickback law, and False Claims Act violations relating to unnecessary inpatient hospital admissions. The lawsuits also collectively allege that HMA used improper kickback payments and pay for referrals to induce physicians to admit patients whose medical conditions did not require admission in order to boost reimbursements from government health programs. The allegations include claims that HMA’s former chief executive officer instituted a corporate directive to pressure emergency department physicians to increase hospital admission rates even if not medically necessary.

Oftentimes, when relators bring qui tam actions against hospital systems, they only see one part of the alleged fraud, and may not have evidence of wrongdoing at other facilities. However, as evidenced in the cases against HMA, employees at other facilities may ultimately file qui tam actions, in the end helping to strengthen each of the cases both individually and part of the whole.

More information for whistleblowers is located at the Nolan Auerbach & White website.