CEO of Chicago Health Care Company Pleads Guilty to Fraudulently Billing Medicare in $1.8 Million Scheme | WPN World People News

The chief executive of Chicago-based Mobile Doctors pleaded guilty to charges that he fraudulently increased Medicare bills for in-home treatment that was shorter and less complicated than the claims indicated on October 23.

DIKE AJIRI, 44, of Wilmette, admitted in a plea agreement that he personally altered patient files so that the now-defunct company could fraudulently bill several patient visits to Medicare at the highest possible level. The improper billing—known as “upcoding”—defrauded Medicare and the Railroad Retirement Board of approximately $1,854,000, according to the plea agreement.

Ajiri pleaded guilty to one count of health care fraud. He faces a maximum sentence of ten years in prison when U.S. District Judge John J. Tharp Jr. sentences him on April 19, 2016, at 2:00 p.m.

Mobile Doctors, which closed in 2013 after Ajiri was arrested, had been located at 3319 N. Elston Ave., in Chicago. The company contracted with physicians to arrange in-home visits for patients in Illinois, Michigan, Indiana and other states. For an in-home visit with an established patient to be billed properly at the highest level, the visit must involve at least two of the following components as defined by the American Medical Association: a comprehensive interval history, a comprehensive examination, and/or medical decision-making process of moderate to high complexity. According to the AMA, such a visit usually involves problems of moderate to high severity, with the physician typically spending 60 minutes face-to-face with the patient and/or the patient’s family.

According to the plea agreement, Ajiri personally altered Mobile Doctors’ billing forms—and instructed Mobile Doctors’ personnel to do the same—so that many of the in-home visits were fraudulently billed to Medicare and the Railroad Retirement Board at the highest level. Ajiri knew that these visits did not qualify for the maximum payment, and that it was unlawful for him to submit the false claims.

The investigation also resulted in charges against BANIO KOROMA, a Mobile Doctors physician. The indictment against Koroma charges that he falsely certified patients as confined to their homes when they were not actually home-bound and did not require specialized care. Koroma, of Tinley Park, is scheduled to proceed to trial on Dec. 7, 2015, before Judge Tharp.

Ajiri’s guilty plea was announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Michael J. Anderson, Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation; and Lamont Pugh III, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General.

Source : U.S. Attorney’s Office