Two Houston-based ophthalmologists, Mustapha Kibirige, 58, and Emelike Agomo, 57, have been slapped with more than $170 million in penalties after a federal court found they systematically defrauded Medicare through fraudulent glaucoma testing claims. The pair, who operated Outreach Diagnostic Clinic LLP in Houston — with Kibirige also practicing in Humble — exploited billing codes to inflate reimbursements, according to court documents.
U.S. District Judge Lynn N. Hughes ordered the massive penalty following a whistleblower lawsuit filed under the False Claims Act (FCA). A former employee of the clinic exposed the scheme, revealing that Kibirige and Agomo routinely billed Medicare using a higher-reimbursement code for single eye pressure tests that should have been classified under a lower-cost category. The fraud spanned from 2006 to 2012, during which the clinic submitted 14,450 false claims.
Under the FCA, the government is entitled to triple damages plus penalties per false claim. Judge Hughes calculated actual damages at $2,422,350, which were then tripled. On top of that, the court imposed a $11,803 penalty for each of the 14,450 false claims, racking up a staggering total penalty of $170,553,350. The sum reflects both the severity and duration of the fraud.
Acting U.S. Attorney Jennifer B. Lowery didn’t mince words: “Deliberately overcharging the government for medical services wastes our country’s precious health care resources,” she said. “We will not stand idly by as providers in our district attempt to abuse the system.” The case underscores federal efforts to crack down on healthcare fraud, particularly in high-volume specialties like ophthalmology.
The Department of Health and Human Services – Office of Inspector General led the investigation, which relied heavily on insider testimony. The U.S. government was represented by Deputy Civil Chief Andrew A. Bobb and former Assistant U.S. Attorney Jose Vela, who pushed the case to resolution after years of legal maneuvering.
While the settlement resolves the allegations, the court has not made a formal determination of liability. Under the FCA, the whistleblower who brought the case will be entitled to a portion of the recovery. The case serves as a stark warning to medical providers: exploit Medicare at your peril — someone might be watching.
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Key Facts
- State: Texas
- Agency: DOJ USAO
- Category: Fraud & Financial Crimes
- Source: Official Source ↗
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