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Family medicine clinic in harker heights settles false claims matter for $430,000

FOR IMMEDIATE RELEASE
March 20, 2013

United States Attorney Robert Pitman announced that in Waco, Dr. Bola Elemuren, a family practitioner d/b/a the Family Medicine Clinic (FMC) in Harker Heights, TX, along with her husband and office manager, John Ogunmuyiwa, have agreed to pay $430,000 to settle allegations of federal False Claims Act/Health Care Fraud violations involving the submission of false claims for payment to the TRICARE, Medicare and Medicaid programs.

The settlement agreement resolves allegations that, from 2003 to 2008, these defendants knowingly overcharged TRICARE for automated laboratory tests that diagnose the cause of vaginitis/bacterial vaginosis.  The automated laboratory test at issue is a single procedure that must be billed under an inclusive billing code at a pre-determined rate.  The agreement settles the claim that defendants “unbundled” and inflated their charges by separately billing the test under multiple CPT codes, at a higher total cost to the TRICARE program.  The United States asserted that the unbundled claims defendants submitted made it appear, falsely, as if they had performed more than one test and, as a result, were entitled to more than one payment from the government.

The settlement agreement also resolves allegations that, from 2008 to 2012, the defendants knowingly billed TRICARE, Medicare, and Medicaid for diagnostic x-rays performed by unqualified and improperly trained personnel.

Following the United States’ investigation, the defendants agreed to settle the case for $430,000 without litigation.  The settlement agreement is not an admission of liability by Dr. Elemuren, Ogunmuyiwa or FMC.

This matter was investigated by agents with the Department of Defense Criminal Investigative Service.  Assistant United States Attorney John LoCurto handled the matter for the Government.

TRICARE is a federally funded statutory medical benefits program for military personnel, their spouses, and their dependents.  Medicare is a federally funded program that covers the cost of medical care for individuals who are eligible based on their age, disability, or affliction with end-stage renal disease.  Medicaid covers the cost of medical care for eligible low income individuals.   The federal and state governments jointly fund the Medicaid program.

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