Health Management Associates, LLC Resolution and
United States v. Carlisle HMA, LLC
Court Docket No.: 1:18-cr-00288 (D. D.C.)
Court Assigned: The case of United States v. Carlisle HMA, LLC is assigned to United States District Judge Reggie B. Walton, United States District Court for the District of Columbia, E. Barrett Prettyman United States Courthouse 333 Constitution Avenue, N.W., Washington, D.C. 20001.
Health Management Associates, LLC Resolution: Health Management Associates, LLC (HMA), formerly a U.S. hospital chain headquartered in Naples, Florida, will pay over $260 million to resolve criminal charges and civil claims relating to a scheme to defraud the United States. The government alleged that HMA knowingly billed Medicare, Medicaid, and TRICARE for inpatient services that should have been billed as outpatient or observation services, paid remuneration to physicians in return for patient referrals, and submitted inflated claims for emergency department facility fees. HMA was acquired by Community Health Systems Inc. (CHS), a major U.S. hospital chain, in January 2014, after the alleged conduct at HMA occurred. Since July 2014, HMA has been operating under a Corporate Integrity Agreement (CIA) between CHS and the HHS-OIG.
As part of the criminal resolution, HMA entered into a three-year Non-Prosecution Agreement (NPA) with the Criminal Division’s Fraud Section in connection with a corporate-driven scheme to defraud Medicare, Medicaid and TRICARE by unlawfully pressuring and inducing physicians serving HMA hospitals to increase the number of emergency department patient admissions without regard to whether the admissions were medically necessary. The scheme involved HMA hospitals billing and obtaining reimbursement for higher-paying inpatient hospital care, as opposed to observation or outpatient care, from Medicare, Medicaid, and TRICARE, increasing HMA’s revenue. Under the terms of the NPA, HMA will pay a $35 million monetary penalty. Under the terms of the NPA, HMA and CHS, the current parent company, agreed to cooperate with the investigation, report allegations or evidence of violations of Federal health care offenses, and ensure that their compliance and ethics program satisfies the requirements of an amended and extended CIA between CHS and HHS-OIG.
United States v. Carlisle HMA, LLC: As part of the criminal resolution in this case, an HMA subsidiary, Carlisle HMA, LLC, formerly doing business as Carlisle Regional Medical Center, has agreed to plead guilty to one count of conspiracy to commit health care fraud. The plea agreement remains subject to acceptance by the court. Up until 2017, Carlisle HMA, LLC owned and operated Carlisle Regional Medical Center, an acute care hospital located in Carlisle, Pennsylvania. Carlisle HMA, LLC was charged in a criminal information filed on September 25, 2018, in the District of Columbia with conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1349. Specifically, the criminal information charges Carlisle HMA, LLC with conspiracy to execute a scheme and artifice to defraud Medicare, Medicaid and TRICARE.
According to admissions made in the resolution documents and in the criminal information, HMA instituted a formal and aggressive plan to improperly increase overall emergency department inpatient admissions at all HMA hospitals, including at Carlisle Regional Medical Center. As part of the plan, HMA set mandatory company-wide admission rate benchmarks for patients presenting to HMA hospital emergency departments – a range of 15 to 20 percent for all patients presenting to the emergency department, depending on the HMA hospital, and 50 percent for patients 65 and older (i.e. Medicare beneficiaries) –solely to increase HMA revenue. HMA executives and HMA hospital administrators executed the scheme by pressuring, coercing and inducing physicians and medical directors to meet the mandatory admission rate benchmarks and admit patients who did not need impatient admission through a variety of means, including by threatening to fire physicians and medical directors if they did not increase the number of patients admitted.
For more information about the Health Management Associates, LLC Resolution and the case of United States v. Carlisle HMA, LLC, please see below:
Press Release – September 25, 2018
Health Management Associates, LLC Settlement Agreements
Health Management Associates, LLC NPA and Attachments
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Victim Impact Statement Form.
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