Former Executive of a Tenet Hospital Charged Along With Clinic Owner and Operator in $400 Million Fraud and Bribery Scheme
A former executive of a Tenet Healthcare Corporation-owned hospital and the owner and operator of an Atlanta-area chain of pre-natal clinics were charged in a superseding indictment that also added additional charges against another former Tenet executive for their alleged roles in an over $400 million fraud and bribery scheme. The indictment alleges that the scheme victimized the United States government, the Georgia and South Carolina Medicaid Programs and patients of Tenet hospitals.
Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Special Agent in Charge David J. LeValley of the FBI’s Atlanta Division and Special Agent in Charge Derrick L. Jackson of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Atlanta Field Office made the announcement.
Bill Moore, 61, of John’s Creek, Georgia, and Edmundo Cota, 64, of Dunwoody, Georgia, were charged in an indictment returned on September 26, 2017, in the Northern District of Georgia. The indictment charges Moore, who formerly served as the chief executive officer of Atlanta Medical Center, Inc., in Atlanta, Georgia, with one count of conspiracy to defraud the United States and pay and receive health care bribes, two counts of wire fraud, one count of falsifying corporate books and records, and one count of major fraud against the United States. The indictment charges Cota, who served as the president and chief executive officer of Hispanic Medical Management, Inc., which did business as Clinica de la Mama, and later Cota Medical Management Group, Inc., with one count of conspiracy to defraud the United States and pay and receive health care bribes, three counts of receiving health care bribes and three counts of wire fraud.
Additional charges were brought against a third defendant, John Holland, 60, of Dallas, Texas, who was originally charged in January 2017. Holland, who formerly served as a senior vice president of operations for Tenet Healthcare Corporation’s Southern States Region and as chief executive officer of North Fulton Medical Center, Inc., in Roswell, Georgia, is now charged with one count of conspiracy to defraud the United States and to pay and receive health care bribes, three counts of paying health care bribes, five counts of wire fraud, one count of falsifying corporate books and records, and one count of major fraud against the United States.
The indictment alleges, among other things, that from approximately 2000 to approximately 2013, Holland, Moore and Cota engaged in a scheme to defraud the United States, the Georgia and South Carolina Medicaid Programs, and patients who attended Cota’s pre-natal clinics and were referred to Tenet hospitals. The indictment also alleges that Holland and Moore caused the payment of bribes in return for the referral of patients to Tenet hospitals in the Southern States Region, including Atlanta Medical Center, Inc., North Fulton Medical Center, Inc., Spalding Regional Medical Center, Inc. and Hilton Head Hospital. The indictment alleges that Holland and Moore took affirmative steps to conceal the scheme by, among other methods, circumventing internal accounting controls, falsifying Tenet’s books, records and reports, and making, and causing to be made, false representations to the federal government. According to the indictment, these bribes helped Tenet bill the Georgia and South Carolina Medicaid Programs for over $400 million, and Tenet obtained more than $149 million in Medicaid and Medicare funds based on the resulting patient referrals.
The indictment further alleges that, to effectuate the scheme, Holland, among other things, personally made false and fraudulent statements to HHS-OIG in connection with Tenet’s 2006 Corporate Integrity Agreement (the CIA), in which he falsely certified to HHS-OIG that Tenet was in compliance with the terms of participation in the Medicare and Medicaid Programs and the terms of the CIA, when in fact he knew that Tenet was paying for illegal patient referrals. Holland’s certifications were included as part of Tenet’s yearly annual reports that were mailed to the HHS-OIG monitor. During the duration of the CIA, from 2007 through 2011, Tenet received over $10 billion in payments from federal health care programs – money that Tenet would not have received had the company been excluded from participation in federal health care programs, the indictment alleges.
In October 2016, North Fulton Medical Center, Inc., and Atlanta Medical Center, Inc., pleaded guilty to conspiring to defraud the United States and to violate the Anti-Kickback Statute. Tenet subsidiary Tenet HealthSystem Medical Inc. and its subsidiaries (THSM) also entered into a non-prosecution agreement (NPA) with the government at that time. Under the terms of the NPA, THSM and Tenet will avoid prosecution if they, among other requirements, cooperate with the government’s ongoing investigation and enhance their compliance and ethics program and internal controls. Tenet also agreed to retain an independent compliance monitor to address and reduce the risk of any recurrence of violations of health care bribery by any entity owned in whole, or in part, by Tenet. Tenet and its subsidiaries also agreed to pay over $513 million to resolve the criminal charges and civil claims arising from the matter.
An indictment is merely an allegation, and the defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.
The FBI’s Atlanta Field Office, HHS-OIG and the FBI Healthcare Fraud Unit Major Provider Response Team are conducting the investigation. Assistant Chief Sally B. Molloy and Trial Attorneys Angela Adams and Scott Armstrong of the Criminal Division’s Fraud Section are prosecuting the case.
The Criminal Division’s Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine locations across the country, has charged nearly 3,000 defendants who have collectively billed the Medicare program for more than $11 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
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