On Wednesday, BayCare Health System Inc. and entities that operate four affiliated Florida hospitals, have agreed to pay the United States $20 million to resolve allegations that BayCare violated the False Claims Act by making donations to the Juvenile Welfare Board of Pinellas County (JWB) to improperly fund the state’s share of Medicaid payments to BayCare.
The four hospitals are Morton Plant Hospital, Mease Countryside Hospital, Mease Dunedin Hospital, and St. Anthony’s Hospital.
The Florida Medicaid program provides medical assistance to low-income individuals and individuals with disabilities, and is jointly funded by the federal and state governments.
Under federal law, Florida’s share of Medicaid payments must consist of state or local government funds, and not “non-bona fide donations” from private health care providers, such as hospitals. A non-bona fide donation is a payment, in cash or in-kind, from a private provider to a governmental entity that is then returned to the private provider as the state share of Medicaid.
The private provider’s donation triggers a corresponding federal expenditure for the federal share of Medicaid, which is also paid to the private provider. This unlawful conduct causes federal expenditures to increase without any corresponding increase in state expenditures, since the state share of the Medicaid payments to the provider comes from and is returned to the provider. The prohibition of this practice ensures that states are in fact paying a share of Medicaid payments and thus have an incentive to curb Medicaid costs and prevent unnecessary services.
The United States alleged that between October 2013 and September 2015, BayCare knowingly caused false claims for federal Medicaid matching funds to be submitted to the United States. Specifically, the United States alleged that during this time, BayCare made improper, non-bona fide cash donations to JWB knowing that JWB would and then did transfer a portion of the cash donations to the State of Florida’s Agency for Health Care Administration for Florida’s Medicaid Program.
The funds transferred by JWB to the state were “matched” by the federal government before being returned to the BayCare hospitals as Medicaid payments, and BayCare was thus able to recoup its original donations to JWB and also receive federal matching funds, in violation of the federal prohibition on non-bona fide donations.
BayCare’s donations to JWB increased Medicaid payments received by BayCare, without any actual expenditure of state or local funds.
“Medicaid is a partnership between the federal government and state governments,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “When the federal government provides Medicaid matching funds, there must be a corresponding expenditure by the state, or a local unit of government. When private parties make unlawful, non-bona fide donations to state or local governments, they undermine a key safeguard for ensuring the integrity of the Medicaid program.”
“Millions of Floridians depend on the Medicaid Program for medical care and related services,” said U.S. Attorney Roger B. Handberg for the Middle District of Florida. “Our office is committed to protecting the integrity of the Medicaid Program, and we will use all available civil remedies to recover the ill-gotten gains obtained by those who defraud it and other government health care programs.”
“When health care providers participate in fraud schemes to boost federal payments, they do so at the expense of federal health care programs,” said Special Agent in Charge Omar Pérez Aybar of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “Our agents will continue to coordinate with our law enforcement partners to root out health care fraud and hold bad actors accountable for their actions.”
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Larry Bomar, a former hospital reimbursement manager in Florida.
Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States ex rel. Bomar v. Bayfront HMA Medical Center LLC, et al., Civil Action No. 8:16-cv-03310-MSS-JSS (M.D Fla.). Mr. Bomar will receive $5 million as his share of the settlement.