Chicago Healthcare CEO Pleads Guilty to $1.8 Million Billing Scheme
CHICAGO — The chief executive of Chicago-based Mobile Doctors pleaded guilty today to charges that he fraudulently increased Medicare bills for in-home treatments that were shorter and less complicated than the claims indicated.
DIKE AJIRI, 44, of Wilmette, admitted in a plea agreement that he altered patient files so the now-defunct company could fraudulently bill several patient visits to Medicare at the highest possible level. According to the plea agreement, the improper billing – known as “upcoding” – defrauded Medicare and the Railroad Retirement Board of approximately $1,854,000.
Ajiri pleaded guilty to one count of healthcare 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 appropriately billed 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 false claims.
The Medicare Fraud Strike Force conducted the investigation, consisting 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 enforce anti-fraud laws nationwide.
The investigation also resulted in charges against BANIO KOROMA, a mobile doctor’s physician. The indictment against Koroma charges that he falsely certified patients as confined to their homes when they were not homebound and did not require specialized care. Koroma, of Tinley Park, is scheduled to proceed to trial on Dec. 7, 2015, before Judge Tharp.
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 announced Ajiri's guilty plea. The Railroad Retirement Board Office of Inspector General also participates in the case.
Assistant United States Attorneys Stephen Chahn Lee and Eric Pruitt represented the government.
To report healthcare fraud or to learn more about the Health Care Fraud Prevention & Enforcement Action Team (HEAT), log on to StopMedicareFraud.gov.
About Stephen Lee Law
At the heart of every press release from the Law Offices of Stephen Chahn Lee lies a diverse and illustrious career that traverses the realms of journalism, law, and medicine with precision. From a pre-med student to a respected journalist, a lawyer at a premier New York firm, and an influential federal prosecutor, Stephen Lee's unique journey underpins the profound insights and captivating storytelling that define the firm's communications. Since founding his solo practice in 2022, Lee has tackled complex, high-stakes legal matters with the enthusiasm that marked his tenure at Debevoise & Plimpton LLP and his decisive victories as an Assistant United States Attorney. His firm's press releases are more than just news; they are narratives enriched by his comprehensive legal expertise, commitment to justice, and active community engagement. In Chicago, where he practices, writes, and volunteers, Lee strives for a positive impact beyond the courtroom.
For further insights into Stephen’s background as a U.S. Assistant Attorney or for legal guidance with healthcare fraud defense, please contact Stephen Lee Law.
