by Ben Vernia | May 2nd, 2019
On April 30, the Department of Justice announced that the former CEO of Naples, Florida-based Health Management Associates, LLC, agreed to pay $3.46 million to settle False Claims Act and Antikickback Statute violations. According to DOJ’s press release:
Gary D. Newsome, former CEO of Health Management Associates LLC (HMA), a hospital chain that was headquartered in Naples, Florida, has agreed to pay the United States $3.46 million to settle allegations that he caused HMA to knowingly submit false claims to government health care programs by admitting patients who could have been treated on a less costly, outpatient basis, the Department of Justice announced. The settlement also resolves allegations that Newsome caused HMA to pay remuneration to Emergency Department (ED) physicians in return for referrals.
* * *
The settlement resolves allegations that Newsome caused HMA to pressure ED physicians to increase inpatient admissions by recommending admission without regard to medical necessity. The government claimed that the inpatient admission of these beneficiaries was not medically necessary, and that the care needed by, and provided to, these beneficiaries should have been provided in a less costly outpatient or observation setting. Hospitals generally receive significantly higher payments from Medicare for inpatient admissions as opposed to outpatient treatment; therefore, the admission of beneficiaries who do not need inpatient care, as alleged here, can result in substantial financial harm to the Medicare program.The United States also alleged that Newsome caused HMA to pay remuneration to EmCare, a company that provided physicians to staff HMA hospital EDs, to recommend admission when patients should have been treated on an outpatient basis. As part of the alleged scheme, Newsome caused HMA to make certain bonus payments to EmCare ED physicians and tied EmCare’s retention of existing contracts and receipt of new contracts to increased admissions of patients who came to the ED.
Newsome served as CEO of HMA from September 2008 through July 2013. HMA was acquired by Community Health Systems Inc. (CHS), another hospital chain, in January 2014, after the alleged conduct at HMA occurred.
HMA and EmCare have already resolved their liability to the government for these allegations. In September 2018 HMA entered into a civil settlement under which it paid $61.8 million. Simultaneously, HMA entered into a Non-Prosecution Agreement (NPA) with the Criminal Division’s Fraud Section under which it paid a $35 million monetary penalty. In addition, an HMA subsidiary that formerly owned one hospital pled guilty to a single count of conspiracy to commit healthcare fraud, and paid a $3.25 million fine. In December 2017, EmCare paid $29.6 million to resolve these allegations.
* * *
DOJ announced that the whistleblowers will receive about $725,000 of the settlement (a 21% relators’ share).
