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DOJ Intervenes in Whistleblower’s Suit Alleging Health Care Company Defrauded Medicare

Posted  October 18, 2017

By the C|C Whistleblower Lawyer Team

The Justice Department announced a lawsuit Tuesday against the husband-and-wife owners of a health care company outside Chicago, alleging they violated the False Claims Act by falsely billing Medicare for millions of dollars in unnecessary or nonexistent home healthcare services. According to the lawsuit, the couple netted millions of dollars through the scheme.

The government’s complaint alleges that Gateway Health Systems Inc. and its owners, Ajibola Ayeni and Joy Turner-Ayeni, falsely billed Medicare for home health services purportedly provided to homebound patients who did not actually need the services. It also alleges that Docs at the Door, another company owned by Ajibola Ayeni, overbilled Medicare by “upcoding” physician home visits, or claiming the doctors were providing longer and more in-depth services than they actually were. Docs at the Door also falsely certified non-homebound individuals as in need of home health services, the suit claims.

To conceal the scheme, the companies allegedly falsified documents, and after the Ayenis learned of the government’s investigation, they attempted to hide their assets from the government by transferring properties into trusts, according to the suit.

A whistleblower filed the lawsuit under seal in 2013, pursuant to the qui tam provisions of the False Claims Act. The Act allows private citizens to file alert the government to fraud by filing a lawsuit under seal, and provides that the whistleblower may share in any recovery.

Tagged in: FCA Federal, Government Decision, Home Health and Hospice, Medical Billing Fraud, Whistleblower Case,