Georgia Healthcare Fraud/Medicare Fraud Enforcement

The federal government sometimes accomplishes this task with the assistance of the Georgia Medicaid Fraud Control Unit (MFCU). Both entities are, in turn, often assisted in their efforts by the bravery and actions of whistleblowers.

Modeled after the federal False Claims Act, the Georgia False Claims Act permits private citizens to bring qui tam actions on behalf of the State of Georgia to recover treble damages and civil penalties. Georgia now has both a state False Claims Act (Georgia Taxpayer Protection False Claims Act, 23-3-120 to 120 to 23-3-127 (as amended by 2016 GA Law 625)) and a Georgia False Medicaid Claims Act (O.C.G.A. § 49-4-168 (2008) et seq.)

Nolan Auerbach & White represents whistleblowers in federal court only. We will bring cases on behalf of whistleblowers under the Georgia qui tam statute as part of an action under the federal False Claims Act. We do so under the Court’s pendent jurisdiction.

The liability provisions of the Georgia False Claims Act, O.C.G.A. § 49-4-168.1(a) provides liability for any person who:

(1) knowingly presents, or causes to be presented to the Georgia Medicaid program a false or fraudulent claim for payment or approval;

(2) knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the Georgia Medicaid program;

(3) conspires to defraud the Georgia Medicaid program by getting a false or fraudulent claim allowed or paid.

False Claims Act cases recently resolved in Georgia include:

A case against Universal Health Services, Inc., UHS of Delaware, Inc.(together, UHS), and Turning Point Care Center, LLC (Turning Point), a UHS facility located in Moultrie, Georgia. The allegations related to False Claims Act violations involving medically unnecessary inpatient behavioral health services and illegal kickbacks. In 2020, the defendants agreed to pay $122 million to resolve the case.

The government’s allegations covered admissions during the time frame of January 2006 through December 2018, involving beneficiaries who were not eligible for inpatient or residential treatment and then failing to properly discharge them, resulting in improper and excessive lengths of stay.  Other allegations included inadequate staffing, training, and/or supervision of staff, and improper use of physical and chemical restraints and seclusion.  In addition to the Department of Justice there were 17 separate United States Attorney’s Offices involved and separate qui tam lawsuits filed; an extraordinary number in our experience.

Our law firm represented a heroic whistleblower Bruce Moilan who filed a whistleblower complaint in 2007 against McAllen Hospitals L.P., d/b/a/ South Texas Health System (a subsidiary of Universal Health Services Inc.).  In 2009, UHS agreed to pay the federal government $27.5 million to resolve allegations that they along with its three hospitals paid kickbacks to physicians in the form of sham medical directorships and leases.  Bruce Moilan was the systems director for material management at the STHS is listed on our law firm’s Wall of Heroes.

Another 2020 case handled by the U.S. Attorney’s Office for the Northern District of Georgia was against Piedmont Health, Inc., an Atlanta hospital system. The case settled  for $16 million, arising out of allegations that Piedmont Health violated the False Claims Act by billing Medicare and Medicaid for procedures at the more expensive inpatient level of care instead of the less costly outpatient or observation level of care and paid an above fair market value to acquire a cardiology group in 2007 in violation of the federal Anti-Kickback Statute.

The United States Attorney’s Office for the Southern District of Georgia announced on June 24, 2020 that Augusta University Medical Center agreed to pay over $2.6 million to settle False Claims Act allegations that it submitted false claims to the Government for medically unreasonable and unnecessary procedures. The procedure involved was referred to as a “Belsey Collis” and billed as a covered procedure, as well as post-surgical follow-up care when in fact it was not covered under Medicare or Medicaid. The whistleblowers were former STG Healthcare employees.

APS Healthcare Midwest paid the United States and the State of Georgia a total of $13 million to settle a False Claims Act qui tam action that alleged that APS submitted false claims to Medicaid, through the Georgia Department of Community Health, for specialty services related to disease management and case management that were not provided.

John D. Archbold Memorial Hospital Inc. agreed to pay the United States $13.9 million to settle allegations that it submitted false claims to Georgia’s Medicaid program. From November 2002 to July 2008, the hospital was alleged to have made false representations to the Georgia Department of Community Health. The hospital allegedly received millions of dollars in Medicaid Upper Payment Limit (UPL) program funds and Disproportionate Share Hospital funds, to which it was not entitled.

St. Joseph’s Hospital of Atlanta and St. Joseph’s Health System agreed to pay $26 million to the U.S. to settle allegations that it violated the False Claims Act by improperly billing Medicare for inpatient admissions and various other services. The allegations arose from a qui tam complaint filed by Tami Ramsey, a nurse and former employee at St. Joseph’s. In her complaint, Ms. Ramsey alleged that from 2000 to 2005, St. Joseph’s had improperly billed ‘outpatient visits’ as ‘inpatient admissions’ which are billed at a higher rate. Additionally, St. Joseph’s allegedly billed Medicare for inpatient admissions related to carotid artery tests which are not covered by Medicare.

Allergan Inc., an American pharmaceutical manufacturer, agreed to pay the United States a total of $600 million to resolve allegations of marketing Botox off-label. The company paid $225 million to resolve civil allegations, as well as a $375 million criminal fine. The civil settlement resolved three qui tam suits filed in federal court in the Northern District of Georgia. The relators: Dr. Amy Lang, Charles Rushin, Cher Beilfuss, Kathleen O’Conner-Masse, and Edward Hallivis, who split a $37.8 million share of the government’s recovery. Two of the relators were represented by Nolan, Auerbach & White.