In a recent ruling, a federal judge has ordered a suburban Chicago health care company and its owner to pay a False Claims Act judgment of more than $25 million. The former owner of the home visiting physician company, AJIBOLA AYENI, has been convicted of theft from the Medicare program and was found liable for over 4,000 violations of the False Claims Act. The company, DOCS AT THE DOOR, P.C., was accused of knowingly submitting claims for Medicare payments for services not rendered, services that were not medically necessary, and services that were incorrectly reimbursed. The judgment includes treble damages and civil penalties, emphasizing the consequences of fraudulent activities in the health care industry.
Suburban Chicago Health Care Company Ordered To Pay False Claims Act Judgment of More Than $25 Million
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Background
In a recent ruling, a suburban Chicago health care company has been ordered to pay a false claims act judgment of more than $25 million. The case involves AJIBOLA AYENI, the former owner of DOCS AT THE DOOR, P.C., a home visiting physician company in Matteson, Illinois. The government intervened in a sealed whistleblower lawsuit in 2013, alleging that Ayeni and his wife, JOY H. TURNER-AYENI, along with their companies, violated the federal False Claims Act. The allegations include knowingly submitting claims for Medicare payments for services not rendered, services that were not medically necessary, and services that were “upcoded” to a higher level reimbursement than was appropriate or provided.
Details of the Case
The government’s complaint-in-intervention against Ayeni and Docs at the Door specifically mentions the submission of thousands of claims for a Medicare service called care plan oversight, which Ayeni and his company knew had not been provided. Care plan oversight is a covered Medicare service where a physician spends an additional 30 minutes in a calendar month performing certain oversight functions for a home health patient. However, Ayeni and Docs at the Door allegedly billed Medicare for this service even though it had not been rendered. The case also involved the creation of false documentation to support these false claims.
Criminal Charges and Guilty Plea
In addition to the civil case, Ayeni was charged in a related criminal case for care plan oversight fraud. He pleaded guilty on August 22, 2019, to one count of theft or embezzlement in connection with a health care benefit program. Ayeni admitted that he caused Docs at the Door to submit 4,367 false claims for the care plan oversight service, resulting in approximately $523,600 in payments from Medicare. He also admitted to instructing others to create false documentation to support these claims.
Summary Judgment and Court Decision
On March 24, 2023, Chief U.S. District Judge Rebecca R. Pallmeyer granted summary judgment to the United States regarding the care plan oversight false claims in its civil case. The judge held Ayeni and Docs at the Door liable under the False Claims Act based on Ayeni’s earlier guilty plea and admissions within the plea agreement. Four days later, on March 28, 2023, the court entered a judgment against Ayeni and Docs at the Door in the amount of $25,589,300, which includes treble damages and civil penalties.
The Judgment
The judgment against Ayeni and Docs at the Door consists of $1,570,800 in treble damages and $24,018,500 in civil penalties. This significant amount reflects the severity of the false claims and the impact on the Medicare program. The false claims not only defrauded the government but also put patients at risk by providing unnecessary or non-existent medical services.
Announcement of the Ruling
The ruling and judgment were announced by Morris Pasqual, Acting United States Attorney for the Northern District of Illinois, Robert W. Wheeler, Jr., Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation, and Mario Pinto, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General. The announcement highlights the successful prosecution of false claims and the commitment to combating fraud in the healthcare industry.
Representatives Involved
In the civil fraud case, the government was represented by Assistant U.S. Attorney Sarah North. In the criminal case against Ayeni, the government was represented by Assistant U.S. Attorneys Jeremy Daniel and Sarah North. These representatives worked diligently to gather evidence, pursue the case, and ensure that justice was served.
False Claims Act and Private Individuals
The False Claims Act plays a crucial role in combating fraud in government programs such as Medicare. One of its key provisions allows private individuals to sue for false claims on behalf of the government. This provision incentivizes whistleblowers to come forward and expose fraudulent activities. In this case, it was a sealed whistleblower lawsuit that initiated the government’s intervention and ultimately led to the judgment against Ayeni and Docs at the Door.
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Importance of Combating Fraud
Combating fraud is of utmost importance in the health care industry. False claims not only defraud the government but also drain valuable resources that could be used to provide necessary medical services to those in need. This case serves as a reminder that fraud will not be tolerated, and perpetrators will be held accountable for their actions. The significant judgment against Ayeni and Docs at the Door sends a strong message that fraudulent activities will be met with severe consequences.
Related Content
For more information on health care fraud cases and efforts to combat fraud, please visit the official website of the U.S. Department of Justice. The website provides guidance documents, forms, publications, and other resources to educate individuals and organizations about the importance of compliance with the law. Additionally, the website offers information for victims in large cases and opportunities for employment within the Department of Justice.
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