Former MetroHealth COO, interim CEO convicted in elaborate maze of kickback, fraud schemes

MetroHealth dental clinic/urgent care in Cleveland. Credit: Google Street View

The former chief operating officer for Ohio's MetroHealth Hospital System and three dentists who worked in the system were convicted for their roles in a fraud conspiracy involving hundreds of thousands of dollars in bribes and kickbacks related to the hospital's dental program, the Department of Justice announced.

Edward R. Hills, Sari Alqsous, Yazan B. Al-Madani and Tariq Sayegh were all convicted on criminal charges and will be sentenced November 27.

Hills worked as MetroHealth's chief operating officer and director of MetroHealth Dental as well as as interim president and chief executive officer of the system from December 2012 through July 2013. Alqsous, Al-Madani and Sayegh were dentists who worked for MetroHealth.

Citing court documents, testimony and documents presented at trial, the DOJ said Hills, Alqsous and Al-Madani ran series of conspiracies from 2008 through 2016 that included bribery, kickbacks, witness tampering and other crimes. Hills took bribes in the form of cash, checks, a $3,879 Louis Vuitton briefcase, a 55-inch television, airline flights and use of a downtown Cleveland apartment from Alqsous, Al-Madani and others. For his part, Hills reciprocated through various means including allowing them to work at their private dental clinics while they were paid full-time salaries from MetroHealth.

Evidence included text messages and meetings at expensive restaurants, which resulted in cash being deposited into Hills' bank accounts. In one instance, Alqsous texted Al-Madani and another person in 2013 saying, "With 22nd of October approaching we ll be celebrating Dr hills bday earlier this year…1,000 dollars each is the gift from the 3 sons their father." Later that same day, $3,000 was deposited into Hills' bank account, the DOJ said.

As director of MetroHealth Dental, Hills was responsible for determining monthly bonuses for dentists who produced receipts in excess of their monthly salary and benefits. The typical bonus received was 25 percent of the revenue generated for excess receipts. Hills often inflated the bonuses for Alqsous, Al-Madani and others, by a total of approximately $92,829, according to the DOJ. He also allowed Alqsous, Al-Madani and others to retain full-time salaries and benefits at MetroHealth without them working full-time hours, giving them time to operate private dental clinics. 

Another scheme involved dental residents within the MetroHealth system. Hills provided MetroHealth dental residents to practice at those private clinics during regular business hours, but neither Alqsous nor Al-Madani paid them wages or salaries.

Normally, the MetroHealth Dental residency took four to six candidates program from a pool of 40 to 60 applicants annually. Hills had final authority over who was selected for the residency program. Alqsous and Sayegh pinpointed candidates from Jordan or who trained at a Jordanian dental school, and told them they would have to pay a "donation" to MetroHealth to be considered.

"Alqsous and Sayegh directed the candidates to pay the "donation" directly to them, and in some cases, told the candidates a portion of the money would go to Hills. Alqsous, Sayegh and Al-Madani solicited at least $75,000 in bribes from resident dentist candidates between 2008 and 2014," the DOJ said.

Al-Madani and Alqsous also paid bribes to Hills for him to refer Medicaid recipients to private dental clinics they owned instead of MetroHealth facilities. 

Hills, Alqsous and Al-Madani subsequently conspired to obstruct justice when they instructed people not to cooperate with law enforcement when they learned of the federal investigation in 2014.

This has been a big year so far when it comes to bringing down fraud operations. Earlier this month, roughly 600 defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, were charged in what's being called the biggest healthcare fraud take-down in history. 

The alleged schemes involved more than $2 billion in false billings and almost a third of the defendants were charged for their roles in prescribing and distributing opioids and other "dangerous narcotics."

The last year has also seen 2,700 individuals banned from Medicare, Medicaid, and all other federal healthcare programs, including 587 providers excluded for conduct related to opioid diversion and abuse, according to the Department of Health and Human Services.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com