The CEO of Mobile Doctors, a Chicago-based service offering house calls in six states, was arrested on charges of fraudulently overbilling Medicare. One of the company's physicians was also arrested for making false statements about health benefits.
Federal agents searched the healthcare company’s offices in Chicago, Detroit and Indianapolis and seized up to $2.6 million in fraud proceeds from various bank accounts, according to a news release Tuesday from the Justice Department’s U.S. Attorney for the Northern District of Illinois.
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Those arrested were Dike Ajiri, Mobile Doctors CEO and owner, and Banio Koroma, MD, a physician who has worked for the company, which sets up patient home visits and contracts with doctors to conduct the visits, the release said. Physicians assign their rights to bill and collect payment to Mobile Doctors, which pays the physicians directly.
According to the charges, Mobile Doctors allegedly increased or upcoded Medicare bills for in-home patient visits that the physicians falsely claimed were more complicated and longer than they actually were. Physicians also falsely certified that patients were confined to their homes so that home healthcare agencies could claim fees for additional services for patients who were not eligible for them.
A typical patient visit by Mobile Doctors lasted 10 to 30 minutes. But claims data from 2006 through early 2013 show that all established-patient visits were billed to Medicare, “using either of the two highest codes indicating the visits involved medical decision-making of moderate to high complexity, detailed or comprehensive interval histories or medical examinations, and/or visits that typically last at least 40 minutes,” the U.S. attorney’s release said.
A former manager told agents that Ajiri said that the second-highest fee code was the default code for a patient visit so that it would be worth the gas and time. The manager also reported seeing Ajiri altering billing codes and marking visits at the highest fee level on patient records submitted by physicians and assistants who accompanied them on home visits, the release noted.
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From 2006 through 2012, Mobile Doctors was paid $21.4 million on claims using the second-highest code, and $12.6 million in Medicare payments on claims using the highest fee code. “The complaint alleges that the vast majority of payments made on established-patient visit claims using the highest fee code were the result of fraudulent upcoding,” the release said.
Further, physicians working for Mobile Doctors, including Koroma, who falsely certified patients as home-bound and needing home health services, expanded the fraud. By referring patients that did not qualify to home health agencies, Mobile Doctors received more referrals from those agencies for services provided by its physicians.
From August 2010 through July 2013, 200 home health agencies submitted claims to Medicare and have been paid more than $10 million for services to patients referred by Koroma.
The fraud included a large number of patients. Between January 2006 and March 2013, Mobile Doctor physicians certified or re-certified for 60-day periods 15,598 patients as confined to their homes requiring home health services a total of 83,133 times, many of which were allegedly false. Since August 2007, Koroma was identified as the physician with the most certifications and Medicare claims of the company doctors.
Attempts to contact a Mobile Doctors spokesperson have been unsuccessful.
If convicted of healthcare fraud, Ajiri could face up to 10 years in prison and a $250,000 fine and restitution, and Koroma’s false statements count could bring up to five years in prison and a $250,000 fine, the release said.
The FBI and Department of Health and Human Services Office of Inspector General, working together as the Medicare Fraud Strike Force, and the Railroad Retirement Board Office of Inspector General and other law enforcement coordinated the efforts, which were also part of a broader investigation into allegedly illegal billing practices for medically unnecessary tests and services not performed by a physician.
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