U.S. Files Lawsuit Against Husband-And-Wife Owners of Suburban Health Care Company for Allegedly Defrauding Medicare out of Millions of Dollars
CHICAGO — The United States today filed a civil lawsuit against the husband-and-wife owners of a suburban Chicago health care company for allegedly falsely billing Medicare for millions of dollars in unnecessary or nonexistent services.
The complaint alleges that GATEWAY HEALTH SYSTEMS INC. and its owners, AJIBOLA AYENI and JOY H. TURNER-AYENI, violated the federal False Claims Act by seeking and receiving Medicare payments for home health services purportedly rendered to homebound individuals who were not actually in need of such services. The suit also alleges that DOCS AT THE DOOR P.C., a home-visiting physician company owned by Ajibola Ayeni, falsely certified the non-homebound individuals as in need of home-health services, and fraudulently “upcoded” home physician visits to the second highest billing level in order to increase compensation from Medicare.
The government’s complaint was filed today in U.S. District Court in Chicago. The government is intervening in a lawsuit that a private citizen initially filed under seal in 2013 pursuant to the qui tam, or whistleblower, provisions of the False Claims Act.
The government’s complaint was announced by Joel R. Levin, Acting United States Attorney for the Northern District of Illinois; John P. Selleck, Acting 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.
Ajibola Ayeni, 58, of Flossmoor, also faces separate criminal charges relating to his conduct while operating Docs at the Door. An eleven-count indictment returned earlier this year alleges that Ajibola Ayeni committed health care fraud from 2011 to 2015. Ayeni has pleaded not guilty to the criminal charges, and a trial date in federal court in Chicago has not yet been set.
According to the government’s suit, Docs at the Door and Gateway each claimed and were paid millions of dollars for services purportedly provided to Medicare beneficiaries. At the direction of the Ayenis, the companies created false documentation to cover up the fact they were claiming services not rendered, as well as services that were not medically necessary because the beneficiaries were not confined to the home, the suit states. The Ayenis’ fraud scheme netted them millions of dollars in federal health care funds to which they were not entitled, the suit states.
In addition to the alleged fraud scheme, the government’s suit contends that the Ayenis attempted to conceal certain assets from the government after learning of the investigation. In the summer of 2016, the Ayenis transferred several of their properties into trusts, the suit states. The transfers involved apartments in the Oakland and Edgewater neighborhoods of Chicago, a residence in Flossmoor, and two properties in Frankfort, according to the suit. The Ayenis “either intentionally transferred the properties to avoid paying a judgment to the United States for their fraud, or at a minimum, knew that they had incurred debts that they would not be able to pay,” the suit states. The suit asks the Court to void the property transfers on the basis of 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 ranging from $5,500 to $11,000 for each false claim submitted by the defendants.
The public is reminded that civil allegations are accusations only, and there has been no determination of liability. The government is represented in the civil case by Assistant U.S. Attorney Sarah J. North.
The public is reminded that the criminal charges against Ajibola Ayeni are not evidence of guilt. He is presumed innocent and entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt. If convicted, the Court must impose a reasonable sentence under federal sentencing statutes and the advisory U.S. Sentencing Guidelines. The government is represented in the criminal case by Assistant U.S. Attorney Stephen Chahn Lee.