Attorney General Sam Olens joined the United States in announcing that Tenet Healthcare Corporation, and several of its subsidiaries will pay more than $513 million to resolve criminal charges and civil claims relating to a scheme to pay kickbacks in return for patient referrals. Specifically, Tenet will pay $368 million to settle civil allegations that Tenet paid kickbacks to Clinica de la Mama, an obstetric clinic serving primarily undocumented Hispanic women, and related entities to induce the referral of those patients to its hospitals for labor and delivery and therefore, submitted false claims to the Georgia Medicaid program. Certain of these patients were eligible for Medicaid while others qualified for Emergency Medical Assistance, a Medicaid program providing coverage for emergency conditions, including childbirth for undocumented immigrants. The hospitals also obtained additional Medicare reimbursement from the United States based on the influx of these low-income patients.  

Georgia will receive over $110 million as its share of the civil settlement. The global resolution also includes criminal forfeiture totaling over $145 million, and the overall civil settlement with the United States, Georgia, and South Carolina totals more than $368 million. In addition, Atlanta Medical Center, Inc. and North Fulton Medical Center, Inc. have both pleaded guilty to conspiracy to violate the federal Anti-Kickback Statute and to defraud the United States. The Plea Agreements remain subject to acceptance by the court. Tenet HealthSystem Medical, Inc. will enter into a non-prosecution agreement and will be required to cooperate with the Department of Justice and retain an Independent Compliance Monitor for three years.    

Attorney General Sam Olens said, “Tenet took advantage of vulnerable pregnant women in clear violation of the law by paying kickbacks in order to bring their referrals to Tenet hospitals. Through this scheme, Tenet defrauded the Georgia Medicaid program by hundreds of millions of dollars. This is an unprecedented settlement for the State of Georgia and reflects my office’s continued commitment to protecting the interests of Georgia patients and taxpayers by investigating allegations of Medicaid fraud and abuse.”

Department of Community Health Commissioner Clyde Reese said, “On behalf of the Department of Community Health and the Georgia Medicaid program, I would like to express my appreciation and thanks to the U.S. Attorneys Office, Georgia Attorney General Sam Olens, and Attorney General Olens' Medicaid Fraud Control Unit under the leadership of Van Pearlberg, for their diligent efforts to pursue justice in this case. Their efforts will result in a substantial financial recovery to the Medicaid program as a result of wide spread fraud committed by the Defendants in this case. Working together, we are showing those who would contemplate such fraudulent actions that they will not be successful.”

The civil case began with a lawsuit filed by Ralph D. Williams in the Middle District of Georgia under the whistleblower provisions of the federal False Claims Act and the Georgia False Medicaid Claims Act, which allow private citizens to bring civil actions on behalf of the government and share in any recovery obtained. The case is captioned United States ex rel. Williams v. Health Management Assocs., et al., No. 3:09-CV-130 (M.D. Ga.). The State of Georgia was first to intervene in the Civil Action and filed its Complaint in Intervention on July 31, 2013.  The United States also intervened in the Civil Action. Mr. Williams will receive over $12 million from Georgia as his share of the state’s recovery.  

Solicitor General Britt Grant and Senior Assistant Attorney General Nancy Allstrom, Assistant Attorney General Sara Vann, and Assistant Attorney General Elizabeth White of the Medicaid Fraud Control Unit, a division of the Attorney General’s Office, handled the case for the State of Georgia. The Georgia Department of Community Health and the Georgia Division of Family and Children Services assisted with the case.   

Georgia investigated and litigated the case in coordination with the United States Attorney’s Office for the Middle District of Georgia and the Commercial Litigation Branch of the United States Department of Justice’s Civil Division. In addition, the state coordinated its investigation with the Department of Health and Human Services Office of Inspector General, the Criminal Fraud Division of the Department of Justice, the United States Attorney’s Office for the Northern District of Georgia, and the Federal Bureau of Investigation.