The CEO and a physician at Mobile Doctors, a Chicago-based provider of physician house-call services in six states, were arrested in connection with an alleged Medicare fraud
scheme involving upcoding for in-home visits and falsely certifying that patients were confined to their homes.
Dike Ajiri, 42, was charged with healthcare fraud and Dr. Banio Koroma, 63, was charged with making false statements related to healthcare benefits. Federal authorities are also executing warrants to seize almost $2.57 million from various bank accounts and to search the company's offices in Chicago, Detroit and Indianapolis. The company also operates in Phoenix; Flint, Mich.; San Antonio and Austin, Texas; and Kansas City and St. Louis, Mo.
A 75-page affidavit (PDF)
quotes an unidentified physician in a June 2007 memo commenting to Ajiri and company doctors that “one of the easiest ways to catch fraud crooks is that they foolishly bill everything the same.”
Mobile Doctors' physicians, patients and employees told investigators that a typical visit with an established patient took 10 to 30 minutes and was routine in nature, according to a U.S. Justice Department news release (PDF)
. But the visits were usually billed to Medicare as the highest or second-highest billing codes for a house call for which, in 2009, the local Medicare fees were $171.25 and $122.82, prosecutors said. Between 2006 and 2012, Mobile Doctors allegedly received around $21.4 million in payments for the second-highest code and $12.6 million in Medicare payments using the highest code.
Mobile Doctors physicians allegedly certified or recertified that almost 15,600 patients were confined to their homes for 60-day periods and that they required home health services more than 83,100 times. Since August 2007, more than 6,000 of these patients were certified by Koroma, according to the release, resulting in more than 17,400 patient visits charged to Medicare.
There is an additional ongoing investigation for alleged billing of medically unnecessary tests.
Two former and “several” current employees contacted authorities regarding Mobile Doctors' billing practices before being contacted by law enforcement agents. to Medicare officials before being contacted by law enforcement, and “more than seven” former and current physicians have been interviewed, according to the affidavit.
Ajiri faces a maximum penalty of 10 years in prison and a $250,000 fine with mandatory restitution. Koroma faces a five-year sentence and $250,000 fine.
In March, the Illinois Department of Financial and Professional Regulation reprimanded Koroma for “fee splitting,” (PDF)
a scheme in which a physician collects a cut of the payment in exchange for a patient referral. He was fined $2,000, according a department news release. Follow Andis Robeznieks on Twitter: @MHARobeznieks