Release date: 3/26/2019
(RALEIGH) Attorney General Josh Stein today announced that he has reached a $25,990.04 settlement with Health Management Associates LLC (HMA) to resolve allegations that the company submitted claims, or caused claims to be submitted, to government healthcare programs for inpatient services that were medically unnecessary and should have been billed as outpatient or observation services. Attorney General Stein is joined in the settlement by 16 other states and the federal government.
“This healthcare company manipulated patients to get more taxpayer money through Medicaid,” said Attorney General Josh Stein. “My office will continue to hold organizations and individuals accountable when they take part in wasteful and fraudulent practices.”
The settlement resolves allegations that from January 1, 2008, through December 31, 2012, HMA offered and provided remuneration to EmCare, a company that contracts to provide emergency department physicians, to increase emergency department admissions at HMA hospitals. These inpatient admissions for Medicaid and Medicare beneficiaries were medically unnecessary.
Pursuant to a settlement HMA has entered with the United States, HMA will pay up to $74.97 million to the federal government and the states, depending on the number of states that join the settlement.
A National Association of Medicaid Fraud Control Units (“NAMFCU”) team participated in the settlement negotiations with HMA on behalf of the states and included representatives from the offices of the Attorneys General for the states of Florida, North Carolina, Washington, and the commonwealths of Virginia and Pennsylvania. The North Carolina settlement agreement was reached by the Medicaid Investigations Division of the North Carolina Department of Justice and the North Carolina Division of Health Benefits.
About the Medicaid Investigations Division (MID)
The Attorney General’s MID investigates fraud and abuse by healthcare companies and providers, as well as patient abuse and neglect in facilities that are funded by Medicaid. Medicaid is a joint federal-state program that helps provide medical care for people with limited income. To date, the MID has recovered more than $850 million in restitution and penalties for North Carolina.
To report Medicaid fraud in North Carolina, call the North Carolina Medicaid Investigations Division at 919-881-2320.
Laura Brewer (919) 716-6484 ###