Co-Owner of Atlanta-Based Medical Clinic Chain and Hospital CEO Pleaded Guilty to Illegal Pay-for-Patient Conspiracy
A CEO of an Atlanta-area hospital and the co-owner and chief operating
officer of an Atlanta-based medical clinic chain pleaded guilty in connection
with the payment of illegal kickbacks to clinics in exchange for Medicaid
patient referrals to hospitals in the Atlanta area and on Hilton Head
Island, South Carolina.
Principal Deputy Assistant Attorney General Marshall L. Miller of the
Justice Department's Criminal Division, U.S. Attorney Sally Quillian
Yates of the Northern District of Georgia, Special Agent in Charge Derrick
Jackson of the Atlanta Region of the Department of Health and Human Services
Office of Inspector General (HHS-OIG) and Assistant Director in Charge
J. Britt Johnson of the FBI's Atlanta Field Office made the announcement.
The guilty pleas were entered by U.S. District Judge Amy Totenberg of
the Northern District of Georgia.
"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."
"Our federal health care programs depend on providers exercising
independent judgment in the best interests of patients," said U.S.
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."
"It is outrageous 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,"
said Special Agent in Charge Jackson. "Our agency is dedicated to
unearthing such corrosive and illegal kickback schemes, which undermine
the public's trust in the medical profession,"
"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," said Special Agent
in Charge Johnson. "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."
Tracey Cota, 50, pleaded guilty on Aug. 6, 2014, and Gary Lang, 58, pleaded
guilty on Aug. 7, 2014. Both 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.
According to the charges and other information presented in court, Lang
was the Chief Executive Officer of an Atlanta-area hospital that was enrolled
as a provider in the Georgia Medicaid program. Cota was the co-owner and
chief operating officer of Hispanic Medical Management, Inc. dba Clinica
de la Mama (Clinica), a Georgia corporation that operated several medical
clinics in the Atlanta area and on Hilton Head Island. These clinics specialized
in providing prenatal care services to primarily undocumented Hispanic
women. The women typically did not have medical insurance, and they were
ineligible for Medicaid because of their immigration status. Georgia and
South Carolina Medicaid, however, covered and paid certain costs associated
with the women's 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.
Between July 2000 and July 2012, Cota conspired with Lang and other executives
from Atlanta-area hospitals and from a hospital on Hilton Head Island
to pay kickbacks to Clinica for the referral of Clinica's patients
to the hospitals. The hospitals disguised the kickbacks using contracts
with Clinica to provide certain services, including translation services
and Medicaid eligibility determination services, but the true purpose
of the arrangements was to pay Clinica for patient referrals. These referrals
ultimately resulted in Medicaid reimbursements of over $100 million to
the hospitals.
Cota and Lang were charged in separate criminal informations on June 28,
2014. Both are scheduled for sentencing on Jan. 15, 2015.
This case is being investigated by the FBI and HHS-OIG. The case was prosecuted
by Assistant Chiefs Benton Curtis and Robert Zink of the Criminal Division's
Fraud Section and Assistant U.S. Attorney Sally B. Molloy of the Northern
District of Georgia.