$25 million False Claims Act Judgment

Long awaited victory on a qui tam False Claims Act case filed in 2013. Great job by the AUSA in getting a criminal conviction and civil judgment of $25,589,300.

CHICAGO — A former owner of a home visiting physician company in suburban Chicago, who was previously convicted of theft from the Medicare program, has been ordered by a federal judge to pay more than $25 million in damages and penalties as the result of more than 4,000 violations of the False Claims Act.

AJIBOLA AYENI, 63, of Flossmoor, formerly operated DOCS AT THE DOOR, P.C., a home visiting physician company in Matteson, Illinois. In 2017, the government intervened in a sealed whistleblower lawsuit that had been brought against him and other defendants in 2013. The United States filed its own complaint-in-intervention against Ayeni and his wife, JOY H. TURNER-AYENI, 61, of Flossmoor, and their companies, including Docs at the Door, alleging that they had violated the federal False Claims Act by 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. The allegations included that Ayeni and Docs at the Door had submitted thousands of claims for a Medicare service called care plan oversight, which they knew had not been provided. Care plan oversight is a covered Medicare service, where a physician who has certified a plan of care for a home health patient spends an additional 30 minutes in a calendar month performing certain oversight functions that are not related to the certification itself or a face-to-face visit with the patient, which are separately billed.

Also in 2017, Ayeni was charged in a related criminal case alleging care plan oversight fraud. That case resolved in a guilty plea on August 22, 2019, when Ayeni pleaded guilty to one count of theft or embezzlement in connection with a health care benefit program. In his plea, Ayeni specifically admitted that the Medicare program paid Docs at the Door approximately $523,600 from 2011 through June 2015 as the result of 4,367 false claims for the care plan oversight service that he, as the owner and authorized official of the business, knowingly caused to be submitted although he knew that care plan oversight service had not been rendered. He also admitted that he instructed others to create false documentation to support those false claims for care plan oversight.

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, holding that Ayeni and Docs at the Door are liable under the False Claims Act for those false care plan oversight claims to Medicare based upon Ayeni’s earlier guilty plea and his admissions within the plea agreement. On March 28, 2023, the court entered judgment against Ayeni and Docs at the Door in the amount of $25,589,300, made up of $1,570,800 in treble damages and $24,018,500 in civil penalties.

The ruling is 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 government is represented in its civil fraud case by Assistant U.S. Attorney Sarah North. The government was represented in the criminal case against Ayeni by Assistant U.S. Attorneys Jeremy Daniel and Sarah North.

To combat fraud, the False Claims Act permits private individuals to sue for false claims on behalf of the government and to share in any recovery. The Act also allows the government to intervene or take over the lawsuit, as it has done in this case, and to recover three times damages plus civil penalties, that ranged from $5,500 to $11,000 for each false claim submitted by the defendants during the fraud scheme in this case.

Source: https://www.justice.gov/usao-ndil/pr/suburban-chicago-health-care-company-and-its-owner-ordered-pay-false-claims-act (All information above taken from here)