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Former HMA employee accuses chain of Medicare fraud

A former FBI agent who became an in-house watchdog for Health Management Associates says HMA fired him for doing his job too well.

Paul Meyer’s lawsuit against the Naples-based hospital chain says he repeatedly reported to top administrators that hospitals were deliberately overbilling Medicare. Instead of fixing the problem, Meyer’s suit says, the company fired him in September.

In legal documents, HMA denied wrongdoing and filed a counterclaim, saying it had to fire Meyer because he would not return confidential documents. HMA needed the documents to comply with two subpoenas, the counterclaim says.

Lawyers for both parties declined to make public statements regarding the litigation. But both sides maintain that this is a private wrongful dismissal case and that the federal government is not involved.

Yet the Department of Health and Human Services, parent agency for Medicare, issued a separate subpoena to Meyer for the documents. He reportedly turned them over to HHS.

It’s unclear whether the federal government is investigating the fraud accusation because such a case would likely be filed separately and sealed. Lawyers are not permitted to acknowledge a sealed case, said an attorney familiar with such cases, Tim McCormack at Phillips & Cohen law firm in Washington, D.C.

This isn’t the first time that a former HMA employee has accused the chain of Medicare fraud. A 2010 suit brought by J. Michael Mastej, former CEO of Physicians Regional Medical Center, accused HMA of conducting an elaborate “kickback scheme” that included taking four doctors to the 2008 Masters golf tournament.

The U.S. Department of Justice investigated, but decided not to join the case. The federal government joins only a small percentage of qui tam (“whistle-blower”) lawsuits filed by private individuals against contractors accused of government fraud.

If such a suit leads to a settlement, most of the money goes back to the government. But the whistle-blower may get 15 per cent or more, which sometimes amounts to millions of dollars.

In the Meyer case, documents say he retired after 30 years with the FBI, working in the health-fraud unit in Miami. He went with HMA in January 2010, monitoring four of the chain’s 22 Florida hospitals.

His lawsuit says he told top administrators verbally and by e-mail of “unlawful activities” at the Pine Ridge and Collier campuses of Physicians Regional Medical Center in Naples. He said the hospitals reaped higher Medicare payments by systematically misclassifying outpatient treatment as an inpatient admission.

HMA ignored Meyer’s reports and then “purposefully shielded him from any information regarding an investigation and follow-up,” according to court documents.

After Meyer threatened to report his findings to the government, the chain fired him, the document states.

--Health News Florida is an independent online publication dedicated to journalism in the public interest. Questions or comments can be sent to Carol Gentry, Editor, at 727-410-3266 or Carol.Gentry@HealthNewsFlorida.org.