Health Management Associates, LLC Resolution and United States v. Carlisle HMA, LLC

Pending Criminal Division Cases

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.

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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
Information
Health Management Associates, LLC Settlement Agreements
Health Management Associates, LLC NPA and Attachments

If you believe you may be a victim, you can fill out the form below and submit it to our office:
Victim Impact Statement Form.

The information on this website will be updated as new developments arise in the case. If you have any questions, please call the Victim Assistance Line toll-free at (888) 549-3945 or email us at victimassistance.fraud@usdoj.gov.

The Crime Victims’ Rights Act applies only to victims of the counts charged in federal court, and thus individuals may not be able to exercise all of these rights if the crime of which the individual is a victim was not charged. The determination of whether a person or entity qualifies as a victim under the Crime Victims’ Rights Act will be made by the court.

Presumption of Innocence: It is important to keep in mind that defendants are presumed innocent until proven guilty and that presumption requires both the court and our office to take certain steps to ensure that justice is served.

Crime Victims’ Rights Act and Right to Retain Counsel: The Crime Victims’ Rights Act (18 U.S.C. § 3771) applies only to victims of the counts charged in federal court, and thus individuals may not be able to exercise all of these rights if the crime of which the individual is a victim was not charged. Section 377I(c)(2) of this Act requires that we advise you that you have the right to retain counsel. Although the statute specifically sets forth your right to seek advice of an attorney with regard to your rights under the statute, there is no requirement that you retain counsel. The Government may not recommend any specific counsel, nor can the Government (or the Court) pay for counsel to represent you. Government attorneys represent the United States.

If you elect to obtain counsel to represent your interests, please have your attorney notify this office in writing at: U.S. Department of Justice, Criminal Division, Fraud Section, 10th & Constitution Avenue, NW, Bond Building, 4th Floor, Washington, DC 20530, Attention: Victim Witness Unit; fax: (202) 514-3708; or email: victimassistance.fraud@usdoj.gov. If you elect not to retain counsel to represent your interests, you do not need to do anything.

Plea Agreements: Please be aware that many criminal cases are resolved by plea agreement between the Department of Justice and the defendant.  If you want to inform the prosecutor of your views regarding the plea agreement in this case, or any other aspect of the case, please call the Victim Assistance Line toll-free at (888) 549-3945 or email us at victimassistance.fraud@usdoj.gov, and we will put you in touch with the prosecutor.