Agbebiyi was an obstetrician/gynecologist at three different clinics. Clinic employees, who lacked any meaningful training, administered neurological tests to patients. The test involved sending an electrical current through the patients’ arms and legs. The clinics then billed Medicare for these diagnostic tests that were medically unnecessary. The patients never received any follow up treatment by neurologists.
Billing Medicare for diagnostic tests that are not medically necessary violates the False Claims Act. It can result in liability for three times the amount Medicare paid for the unnecessary tests, plus $11,000 per claim in penalties. And, as in this case, it can also result in significant prison time.
The government produced evidence that patients were not referred to Agbebiyi or the clinics by their primary care physicians or for any other legitimate purpose. Rather, they were recruited with prescriptions for controlled substances, cash payments, and fast food. It is illegal to pay kickbacks to patients covered by Medicare or Medicaid to induce them to use the services of a particular physician or clinic, even if the treatment is medically necessary.
The government has tremendous resources to track down and prosecute Medicare fraud. This case was investigated by the Federal Bureau of Investigation (FBI), the Office of the Inspector General (OIG) at the Department of Health and Human Services (HHS), and the U.S. Department of Justice acting through its local U.S. Attorney’s office. These government agencies and others frequently work together as part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) to prevent and deter fraud and enforce current anti-fraud laws around the country.
If you are facing a government investigation or criminal charges for submitting false claims to Medicare or Medicaid – or if you are aware that your employer is submitting false claims to a government healthcare program -- then you should consult with an experienced healthcare attorney immediately to protect your rights. To schedule a free and confidential consultation by telephone or in person, call my office today at (917) 652-6504 or click here to communicate with me via email.
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