Tenet Medicaid kickback scheme draws new charges
- The U.S. Department of Justice has charged two more individuals with complicity in the case of a Medicaid fraud scheme that allegedly directed pregnant women to Tenet hospitals, Reuters reported.
- William Moore, former CEO of Atlanta Medical Center, and Edmundo Cota, ex-head of a prenatal care clinic operator, were charged in the U.S. District Court for the Northern District of Atlanta. They — along with former Tenet senior vice president John Holland — are charged with conspiracy and wire fraud, among other crimes.
- According to the indictment, the trio colluded to cause Tenet to pay more than $12 million in bribes to Clinica de la Mama, which ran clinics in Georgia and South Carolina. In return, Clinica personnel referred expectant mothers to Tenet hospitals for childbirth services.
The defendants and others created pre-textual contracts between the Tenet hospitals and the clinics to explain away the inducements, Reuters reported. The majority of Clinica patients were undocumented Hispanic women.
The charges are the latest in a whistleblower lawsuit that accused the Dallas-based hospital chain and four of its hospitals of conspiring to violate federal anti-kickback statutes. DOJ jointed the lawsuit in 2014.
In October of last year, Tenet and two of the hospitals — Atlanta Medical Center and North Fulton Hospital in Atlanta — agreed to pay the government $514 million. Tenet sold both of the hospitals in March 2016.
Charges against Holland were brought in February.
The new indictment shows the federal government continues to be serious about cracking down on healthcare fraud. During fiscal year 2016, the government reclaimed more than $3.3 billion in fraudulent healthcare claims, for a return on investment of $5 for every dollar expended. The funds were reclaimed under the Health Care Fraud and Abuse Control Program, a joint effort of DOJ and HHS.
The Medicare Fraud Strike Force also sent 290 defendants to prison during the year, with sentences averages more than 48 months.
Government officials warned the industry last year that more must be done to reduce wasteful spending.