Illinois Medicare fraud case results in $25M fine for healthcare exec

The U.S. attorney’s office filed its own complaint against Ayeni and his wife, Joy Turner-Ayeni, 61, of Flossmoor, and their companies, including Docs At The Door, alleging they knowingly submitted claims for Medicare payments for services not rendered, services that were not medically necessary and services that were “upcoded” to a higher-level reimbursement, the statement said.

The complaint alleged Ayeni and Docs At The Door had submitted thousands of claims for a Medicare service called care plan oversight that they knew had not been provided. Medicare oversight claims involve a doctor’s time performing functions reviewing a home health patient’s care that are not related to the certification itself or a face-to-face visit with the patient, which are separately billed, the statement said.     

Neither Ayeni nor Docs At The Door could be reached for comment this morning. A lawyer previously listed as defending Ayeni did not reply to requests for comment.

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On March 24, Chief U.S. District Judge Rebecca Pallmeyer granted summary judgment regarding the care plan oversight false claims in the federal civil case, holding that Ayeni and Docs At The Door are liable based on Ayeni’s earlier guilty plea in a related 2017 criminal case, and his admissions within that plea agreement, the statement said. On Tuesday, the court entered judgment against Ayeni and Docs At The Door for $25.6 million, made up of $1.6 million in treble damages and $24 million in civil penalties, the statement said.

Ayeni pleaded guilty in the related criminal case in August 2019 to one count of theft or embezzlement in connection with a healthcare benefit program. 

“In his plea, Ayeni specifically admitted that the Medicare program paid Docs At The Door approximately $523,600 from 2011 through June 2015 as the result of 4,367 false claims for the care plan oversight service that he, as the owner and authorized official of the business, knowingly caused to be submitted, although he knew that care plan oversight service had not been rendered,” the statement said. “He also admitted that he instructed others to create false documentation to support those false claims for care plan oversight.”

This story first appeared in Crain’s Chicago Business.