Whistleblower Sheds Light on Dangerous Medicaid Scam that Put Pregnant Women at Risk

May 5th, 2015

IU Health and HealthNet is accused of scamming government healthcare out of millions of dollars and putting patient safety at risk. The accusations come from a whistleblower lawsuit alleging the companies allowed nurse midwives to care for high-risk pregnant women who qualified as low-income patients.

The whistleblower in the case is Dr. Judith Robinson, who worked at the director of women’s health services at HealthNet and medical director of ob-gyn services at IU Health Methodist Hospital. Instead of the hospital caring for the low income patients, they passed them onto nurse midwives, but still submitted bills to government healthcare programs as if they had treated the women. Dr. Robinson claims her positions were terminated after she questioned the safety of making the patient referrals.

High-Risk Patients Never Saw Doctors

According to Dr. Robinson’s claims, many high-risk patients never saw doctors and weren’t called into until emergencies arose. In many cases, by the time a doctor arrived it was too late. The lawsuit alleges at least one mother’s death and brain damage in several children resulted from the questionable practices.

The lawsuit also refers to an email Dr. Robinson sent to her employers during the spring of 2013 identifying more than a dozen clients that nearly died and two that experienced what she called “terrible outcomes” within an eight month span. Dr. Robinson asked that the broken system be fixed, but received a response from her supervisor claiming her concerns were “premature.”

In the email, the doctors cited cases involving:

  • A patient admitted to the hospital at 40 plus weeks for labor induction due to high blood pressure. The patient was sent home by a nurse midwife after two days, but returned two days later in labor and with a baby that had an abnormal heartrate. The patient required an emergency C-section and gave birth to a baby with permanent brain damage.
  • A patient with diabetes, high blood pressure, and other risk factors was sent home without ever seeing a doctor, despite labor being imminent.
  • A patient who, after gaining 15 pounds in a short period of time during her pregnancy, visited the hospital at 37 weeks. The nurse midwife determined the patient had pre-eclampsia. Later, the patient was rushed to the hospital for an emergency C-section after the baby’s heartbeat stopped. Because the nurse midwives had given the woman dinner, she aspirated while under anesthesia and died, and her son suffered permanent neurological damage.

Cutting Costs with Unqualified Care

In the majority of these cases, nurse midwives were used to cut costs. Nurse midwives affiliated with IU Health and HealthNet earned $108,632 on average in 2010, while obstetrician-gynecologists received an average salary of $349,976. Despite the cost-saving measures, the program still billed Medicaid as if patients had received treatment from doctors.

There are currently 24 nurse midwives in the program and nine ob-gyn doctors. Though the current website for IU Health and HealthNet warn that most patients do not see a doctor during their treatment, Indiana policy states that nurse midwives may not provide services to Medicaid members that are considered to have high-risk pregnancies.

Those familiar with the details of the lawsuit claim that if it is successful damages could reach the $100 million mark.

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