In 2017, a hospital operator set out to build a rural health care empire with the help of a Philadelphia-area consultant.

The consultant, Jim Biden, had no experience running hospitals. But he did understand the federal government and had ties to labor unions. Perhaps more important, he was the younger brother of Joe Biden.

The final years of the Obama administration had cemented the former vice president’s towering stature in the world of health care, where he had made the fight against cancer a top federal priority and, then, a centerpiece of his legacy-building efforts.

For then 67-year-old Jim Biden, the third of four Biden siblings, his ties to his older brother made up much of his pitch as he pursued deals that could help Americore make money from drug rehab, lab testing and even cancer treatment.

“This would be a perfect platform to expose my Brothers team to [your] protocol,” Jim Biden wrote to the CEO of a Tampa-area company that controlled licensing rights to an experimental cancer treatment the hospital operator wanted to offer. “Could provide a great opportunity for some real exposure.”

The email, obtained by POLITICO from a person close to the company, documents one of the many ways in which Jim Biden invoked his brother’s name and clout in the course of his work with Americore, which has since gone bankrupt, wreaking havoc in rural communities in the process.

Jim Biden spoke of plans to give his brother equity in Americore, according to one former Americore executive, and install him on its board, according to a second. He also said that if Americore could find a winning business model for rural health care, his brother could promote the company in a future presidential campaign, a third former executive told POLITICO. All were granted anonymity to discuss a company mired in legal and political controversy

In order to fund Americore’s expansion, Jim Biden offered to secure capital from investors in the Middle East, according to the emails and executives. When the expected money did not arrive, it aggravated Americore’s preexisting financial issues. The company collapsed, leaving behind unpaid bills and neglected patients.

The management failures took a human toll as hospital staff went unpaid, services dwindled, and authorities were forced to intervene. At Americore’s hospital in southeastern Kentucky — ravaged by staff departures and dwindling medical supplies — a patient died of cardiac arrest in late 2018 after receiving substandard care, according to a Department of Health and Human Services report obtained by POLITICO.

Four years after its bankruptcy, federal investigators are still pursuing questions about what else happened at Americore.

In September, the Securities and Exchange Commission accused one of Jim Biden’s business partners of fraud related to loans to the company, allegations the business partner has denied.

Meanwhile, the Justice Department found that Americore’s hospital in Pennsylvania entered into sham service agreements and paid kickbacks as part of a scheme that billed the government for medically unnecessary lab tests the hospital shipped out to be performed elsewhere.

Those actions are at the center of a federal prosecution of a $100 million conspiracy to defraud Medicare that has netted a guilty plea from the recipient of the kickbacks, and, according to a person familiar with the case, remains ongoing.

Now, House Republicans pursuing an impeachment inquiry focused on the relationship between the president and his relatives’ business dealings have also homed in on Americore. The House Oversight Committee is set to interview Jim Biden on Feb. 21 as part of the inquiry.

As the layers of activity that occurred in and around Americore are peeled back in a federal prosecution in Pennsylvania, a bankruptcy court in Kentucky, and tense witness interviews on Capitol Hill, a POLITICO investigation renders the most detailed picture to date of the ways in which Joe Biden’s relatives leveraged his public stature to advance a private business venture.

The investigation — based on public records, court filings, dozens of interviews and hundreds of exclusively obtained internal documents — reveals that Jim Biden’s role at Americore was larger than previously reported: In some internal documents and investor materials his name is included among its top handful of leaders. He also helped the company seal regulatory approval to acquire the Pennsylvania hospital and personally fired Americore’s chief financial officer, according to the emails obtained by POLITICO.

The investigation also reveals that Joe Biden’s name and inner circle were more involved with the company than has been understood: In addition to the accounts provided by former executives, investor materials described Jim Biden as an adviser to his older brother. And on top of Joe Biden’s own previously reported encounter with the firm’s CEO, at least three of Joe Biden’s relatives did work with Americore. They include Jim Biden’s wife, Sara, and his son, Jamie. The president’s son, Hunter Biden also met with its CEO, and his personal doctor — current White House physician Kevin O’Connor — joined a meeting with Jim Biden and the president of a hospital being acquired by Americore, according to a former executive and emails obtained by POLITICO.

While the extent to which Joe Biden’s relatives have invoked their ties to him to advance their business careers has been a subject of ongoing controversy, the documents obtained by POLITICO demonstrate that Joe Biden was a central element of Jim Biden’s pitch to potential partners and investors during this period.

None of these Biden family members would answer specific questions related to Ameriore. The White House did not respond to detailed requests for comment.

Jim Biden has not been accused of criminal wrongdoing. His attorney, Paul Fishman, said in a statement that he “conducted himself ethically and honorably in all his business dealings.” A spokesman for Jim Biden declined to answer detailed follow-up questions, writing, “We are not able to participate in this story at this time.”

POLITICO’s investigation did not find that Joe Biden involved himself in the firm or took actions on its behalf. However, Joe Biden did benefit indirectly from his brother’s work with the firm. On the same day Jim Biden received a $200,000 payment from Americore, he made out a check for his brother Joe. The White House has said the check was for repayment of a loan, but did not respond to questions about the circumstances of the loan, including whether Joe Biden was aware of his brother’s income from Americore.

Otherwise, Joe Biden remained on the sidelines as his name and relatives became intertwined with a company that was pitched as a vehicle for his legacy, but stands accused of defrauding taxpayers instead.

“I was sold that Americore was going to be the salvation of rural hospitals,” said one of the former executives. “The whole thing was a scam, and it didn't take that long to figure it out.”

Mississippi Roots

Jim Biden’s involvement with Americore traces back to his family’s decades-long ties to a circle of Mississippi attorneys that supported Joe Biden’s national political ambitions when he served in the Senate.

Since serving as finance chairman of his brother’s first Senate campaign in his early 20s, Jim Biden had regularly struck up business relationships with Joe Biden’s political backers, including the Mississippians.

The circle orbited around tort lawyer Dickie Scruggs, a brother-in-law of former Republican Senate Majority Leader Trent Lott, who achieved fame and fortune in the 1990s through his scorched-earth legal fights against big tobacco companies.

One of Scruggs’ associates had worked for Joe Biden’s 1988 presidential campaign, and when Scruggs needed congressional support for a large tobacco settlement, he hired Jim Biden as a consultant.

Then, in 2007, Scruggs became an early supporter of Joe Biden’s Democratic presidential primary bid, but the high-flying tort lawyer’s star soon came crashing down when he was caught trying to bribe a judge in a dispute over attorney’s fees.

Scruggs’ downfall also dealt a blow to Jim Biden: As his big brother wielded the gavel of the Senate Foreign Relations Committee and pursued his second presidential run, he was preparing to launch an international lobbying firm with two Scruggs associates. When both of the men were implicated in the bribery scheme and convicted along with Scruggs, the lobbying business was abandoned.

Jim Biden’s dealings went much further with Joey Langston, another lawyer convicted for trying to bribe a judge for Scruggs. When Langston got out of prison, he went into the health care field, and Jim Biden joined him.

Like the Bidens, Langston’s family is a close-knit clan. Just as Jim Biden regularly involved his nephew Hunter in his ventures, Joey Langston sometimes did business with his son, Keaton Langston. A former business partner of the Langstons recalled being struck in a business meeting when Keaton Langston referred to his father as “daddy.”

Some details of the Jim Biden-Joey Langston relationship have emerged from the impeachment inquiry in recent months.

According to a person familiar with Joey Langston’s congressional interview earlier this month, he told investigators that he has lent Jim Biden $800,000, that he has received only $400,000 in repayment, and that he has no documentation of the loans.

According to a second person familiar with the interview transcript, Joey Langston said he has not spoken to Joe Biden in more than a decade and did not know of Joe Biden having any involvement in his brother’s dealings.

Many details of the relationship between Jim Biden and Joey Langston remain sketchy. Sometime around 2015, the two men became involved in a business called Trina Health, in which Jim Biden at one point described himself as a partner.

Trina championed a controversial method for treating diabetes that some insurers balked at paying for. Trina’s founder, G. Ford Gilbert, lobbied the state’s legislature to force insurers to pay for his product. But he was caught bribing the majority leader of Alabama’s House of Representatives, Republican Micky Hammon, leading to Gilbert’s conviction.

Jim Biden and Joey Langston, who were not implicated in the scheme, moved on from Trina, but maintained an interest in the business of health care.

The Biden Brand

In early 2017, Joe Biden was in legacy-building mode.

His son Beau Biden’s battle with brain cancer had inspired the Cancer Moonshot, a federal push to cure the disease, and closely linked the Biden name with health care in the public imagination.

In the waning days of the Obama administration, the outgoing vice president announced he would continue the cancer fight with a nonprofit, the Biden Cancer Initiative. In June, the nonprofit officially launched.

At the time, Jim Biden was in empire-building mode. Like his older brother, his plans included........

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