Healthcare theft continues to embarrass an otherwise noble profession, and the litany of criminal physicians, pharmaceutical suppliers and CEOs found guilty of stealing from insurance providers and patients, is never-ending.
Consider this: just last year alone. successful government prosecutions recovered just under $6,000,000,000 in stolen money – $2,000,000,000 more than the previous year. Here’s an example of how they steal:
The former chief executive of an organized crime scam in the Chicago-area called Mobile Doctors has confessed in court that, well, he kinda’ did cheat insurance providers in the matter of home-care visits. Thousands of times, actually. And he was aided and abetted by at least one doctor, because doctors have a way of making things appear . . . you know . . . legit.
Dike Ajiri of Wilmette, and one of the physicians he employed, Doctor Banio Koroma, age 63, conspired to steal just under $2,000,000 by submitting fraudulent bills to both Medicare and the Railroad Retirement Board of Chicago.
“Ajiri told doctors that they could earn more money if they ordered more tests such as electrocardiograms. He was part owner of the company that performed the tests – In Home Diagnostics.” (U.S Attorney press release)
Ajiri was originally arrested in August, 2013, charged when federal agents had raided Mobile Doctors offices in numerous cities in several states. Investigators had learned that Mobile Doctors would routinely dispatch physicians to perform abbreviated patient care sessions lasting 10-20 minutes. The company would then bill insurance providers for a more comprehensive 40-minute treatment.
In his confession before U.S. District Judge John Tharp, Ajiri, age 42, admitted to faking medical records to ensure they indicated more serious disease care – which of course required longer treatment times – than in truth existed. This crime – which in the halls of healthcare is off-the-chart common – has its very own official-sounding name. Neither hospitals nor nurses nor physicians call it theft. That would make them look like common criminals. No, in the Twilight Zone of medicine we call it, “Upcoding.”
Mobile Doctors would hire MDs under contract to perform in-home visits for patients in 5 states, including Indiana, Illinois as well as Michigan. Since their scam was discovered Mobile Doctors has been shut down.
Medical Miscreant Ajiri could be sentenced to a 10-year prison term at his sentencing hearing in April.
And Doctor Banio Koroma? Well, he has been charged with falsely claiming patients were home-bound when they were not. His trial is scheduled to begin in December, and he faces a 5-year sentence.
Here is another view of this case: