Former Railroad Employee Sentenced to Two and a Half Years in Federal Prison for Fraudulently Obtaining Disability Benefits
CHICAGO — The chief executive of Chicago-based Mobile Doctors pleaded guilty today to charges that he fraudulently increased Medicare bills for in-home treatment that was shorter and less complicated than the claims indicated.
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 was carried out by the Medicare Fraud Strike Force, which consists of agents from the Federal Bureau of Investigation and the U.S. Department of Health and Human Services, and prosecutors from the U.S. Attorney’s Office and the Justice Department’s Fraud Section. The strike force is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and HHS to prevent fraud and to enforce anti-fraud laws around the country.
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. The Railroad Retirement Board Office of Inspector General is also participating in the case.
The government is represented by Assistant United States Attorneys Stephen Chahn Lee and Eric Pruitt.
To report health care fraud or to learn more about the Health Care Fraud Prevention & Enforcement Action Team (HEAT), logon to: StopMedicareFraud.gov.