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Two Physician Groups Pay Over $33M to Resolve Whistleblower Claims Involving HMA Hospitals

Posted  December 20, 2017

By the C|C Whistleblower Lawyer Team

Two physician groups, Dallas-based EmCare Inc. and Pennsylvania-based Physician’s Alliance Ltd (PAL), agreed to settlements that resolve claims the groups received illegal kickbacks in exchange for referring patients to hospitals owned by Health Management Associates (HMA). The settlements, announced by the Justice Department yesterday, resolve two separate whistleblower lawsuits alerting the government to the physician groups’ respective schemes.

From 2008 to 2012, EmCare allegedly received kickbacks to recommend patients insured by Medicare be admitted to HMA hospitals for costly inpatient care when their conditions would have been better suited to less expensive outpatient care. In exchange, HMA paid bonuses to EmCare’s physicians, and also conditioned its continued contracts with EmCare on increased patient admissions. EmCare will pay $29.6 million to resolve the allegations.

PAL agreed to a smaller settlement to resolve similar allegations it accepted kickbacks from HMA from 2009 through 2012. The physician group and three of its executives will collectively pay $4 million.

The cases were initiated by whistleblowers under the qui tam provisions of the False Claims Act, which allows private parties to sue on behalf of the government and share in the proceeds collected. For their contributions, the EmCare whistleblowers will receive over $6 million. The PAL whistleblowers’ share of the settlement has not been determined.

In a statement for the Department of Justice, U.S. Attorney for the Western District of North Carolina Andrew Murray said “[i]mproper physician inducements not only compromise sound medical decision-making, but also cost American taxpayers millions in unnecessary medical costs. Such kickback arrangements will not be tolerated.”

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,