Former Co-Owner Of Atlanta-based Medical Clinic Chain And Former Hospital Executive Plead Guilty To Illegal Pay-for-Patient Conspiracy
ATLANTA –Tracey Cota and Gary Lang have pleaded guilty to conspiracy to violate the Anti-Kickback Statute by paying and receiving illegal remuneration in exchange for Medicaid patient referrals to hospitals in the Atlanta area and on Hilton Head Island, S.C.
“Our federal health care programs depend on providers exercising independent judgment in the best interests of patients,” said United States Attorney Sally Quillian Yates. “These illegal referral arrangements resulted in women being steered to deliver their babies at hospitals on the basis of Clinica’s and the hospitals’ financial self-interest, regardless of whether it was in the women’s best interest.”
“These medical executives enriched themselves by using uninsured pregnant women and newborn babies as commodities, whose health care could be bought and sold for kickbacks and bribes,” said Principal Deputy Assistant Attorney General Miller. “Unlawful payments for patient referrals can lead to increased Medicaid costs, corrupt medical decision-making, overutilization of medical services, and unfair competition – and most importantly, insufficient or inadequate care for patients. The Justice Department is committed to investigating and prosecuting those who illegally pay for patients.”
J. Britt Johnson, Special Agent in Charge, FBI Atlanta Field Office, stated: “Today’s guilty pleas will hold two individuals who were in positions of trust and authority accountable for their participation in a criminal scheme in which decisions on patient care were driven by illegal monetary gain instead of the patients’ best interest. The FBI will continue to partner with HHS-OIG and the Department of Justice to ensure that the many facets of the health care industry operate as intended and are free from those who seek opportunity to illegally profit by manipulating federal programs designed to aid those in need.”
“It is unacceptable that health care providers would scheme to refer uninsured mothers about to deliver their babies to hospitals based on a kickback agreement designed to boost profits rather than based on who would provide the best health care to the mothers and newborns. Our agency is dedicated to unearthing such illegal kickback schemes, which undermine the public’s trust in the medical profession,” said Special Agent in Charge Derrick L. Jackson, U.S. Department of Health and Human Services, Office of Inspector General’s Atlanta Regional Office.
According to United States Attorney Yates, the charges and other information presented in court: Cota was the co-owner and chief operating officer of Hispanic Medical Management, Inc. d/b/a Clinica de la Mama (“Clinica”), a Georgia corporation that operated several medical clinics in the Atlanta, Ga., area and on Hilton Head Island, S.C. These clinics specialized in the provision of prenatal care services to primarily undocumented Hispanic women. Because of their immigration status, the women, who lacked other means of medical insurance, were ineligible for Medicaid coverage. Georgia and South Carolina Medicaid, however, did cover and pay certain costs associated with their labor and delivery and the care of their newborns at hospitals, as well as the professional fees of the physicians providing labor and delivery services. Lang was the Chief Executive Officer of an Atlanta area hospital that was enrolled as a provider in the Georgia Medicaid program.
Between July 2000 and July 2012, Cota conspired with executives from Atlanta area hospitals, including Lang, and from a hospital on Hilton Head Island, to compensate Clinica for the referral of Clinica’s patients to the hospitals. To accomplish this goal, the hospitals contracted with, and paid, Clinica to provide certain services, including translation services and Medicaid eligibility determination services, but the true purpose of the arrangements were to pay Clinica for patient referrals. These referrals ultimately triggered Medicaid reimbursements of over $100 million to the hospitals.
Cota, 50, of Dunwoody, Ga., and Lang, 58, also of Atlanta, Ga., were each charged in separate Criminal Informations on June 28, 2014, with one count of conspiracy to pay and receive remuneration in exchange for Medicaid patient referrals. Sentencing has not yet been scheduled.
This case is being investigated by the Federal Bureau of Investigation and the U.S. Department of Health and Human Services, Office of the Inspector General.
Assistant United States Attorney Sally B. Molloy and Assistant Chiefs Ben Curtis and Rob Zink with DOJ Criminal Division’s Fraud Section are prosecuting the case.
For further information please contact the U.S. Attorney’s Public Affairs Office at USAGAN.PressEmails@usdoj.gov or (404) 581-6016. The Internet address for the home page for the U.S. Attorney’s Office for the Northern District of Georgia Atlanta Division is http://www.justice.gov/usao/gan/.