Houston ophthalmologists Mustapha Kibirige, 58, and Emelike Agomo, 57, have been slammed with more than $170 million in penalties for a years-long scheme to defraud Medicare through fraudulent glaucoma testing claims. The pair, who operated Outreach Diagnostic Clinic LLP in Houston, systematically overbilled the federal health program using improper codes to pocket higher reimbursements, federal prosecutors revealed.
U.S. District Judge Lynn N. Hughes found Kibirige and Agomo liable for submitting 14,450 false claims to Medicare between 2006 and 2012. Each claim used a reimbursement code that improperly inflated payments for single eye pressure measurements—routine tests in glaucoma evaluation. The fraud allowed the duo to extract significantly more money than allowed under federal guidelines.
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 was pursued under the False Claims Act, which allows whistleblowers to sue on behalf of the government.
The case was sparked by a former employee of Outreach Diagnostic Clinic LLP who filed a whistleblower lawsuit detailing the billing fraud. Under the FCA, the government is entitled to triple damages plus penalties per false claim. Judge Hughes calculated treble damages at $2,422,350 and tacked on a $11,803 penalty for each of the 14,450 false claims—totaling $170,553,350 in penalties.
The Department of Health and Human Services – Office of Inspector General led the investigation, shining a light on a scheme that exploited a critical healthcare program meant to serve the elderly and vulnerable. Deputy Civil Chief Andrew A. Bobb and former Assistant U.S. Attorney Jose Vela handled the prosecution, pushing for maximum accountability.
Though the settlement resolves the allegations, the court has not made a determination of liability. Still, the staggering penalty sends a clear message: when doctors treat Medicare like a cash register, the federal government hits back with sledgehammer force.
RELATED: Kibirige, Agomo Hit With $170M Penalty in Medicare Fraud
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Key Facts
- State: Texas
- Agency: DOJ USAO
- Category: Fraud & Financial Crimes
- Source: Official Source ↗
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