Nurse Charged with Health Care Fraud Scheme for Billing Medicare for Unnecessary Services
CHICAGO—A registered nurse was arrested today on a federal health care fraud charges. The nurse defendant, JAMES ADEMIJU, who operates two nursing agencies, Adonis Inc. and BestMed-Care Services Ltd., was arrested this morning and charged with health care fraud in a criminal complaint. The complaint alleges a scheme to defraud Medicare by billing for unnecessary nursing services that were provided to patients who were not confined to the home and who were obtained via illegal payments for patient referrals. For over three years, beginning in 2011, a total of approximately $5 million was paid to the two agencies by Medicare for services rendered to patients deemed to be homebound.
Ademiju, 41, of Matteson, a licensed registered nurse in Illinois since 2006, is scheduled to appear at 3:00 p.m. today before U.S. Magistrate Judge Mary M. Rowland in U.S. District Court.
Simultaneous with Ademiju’s arrest, agents from the FBI, the U.S. Department of Health and Human Services Office of Inspector General, and other law enforcement agencies executed search warrants at the offices of Adonis Inc., and BestMed-Care Services Ltd., both located in Dolton. Warrants were also executed to seize alleged fraud proceeds maintained in bank accounts maintained by Adonis Inc. and BestMed-Care Services Ltd.
The arrests and charges were announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Robert J. Holley, 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 Regional Office of the HHS-OIG. The Railroad Retirement Board Office of Inspector General is also participating in the investigation.
According to a 56-page affidavit in support of the arrest, search and seizure warrants, the charge against Ademiju arises from the investigation of Suburban Home Physicians, a Schaumburg company that did business as Doctor At Home. In a related case, an indictment was returned last month against a doctor, Alan Newman, and a nurse, Diana Jocelyn, at Suburban Home Physicians. According to the affidavit unsealed today, Ademiju works at two nursing agencies, Adonis, as the office manager, and BestMed-Care Services, as the administrator. Between February 2011 and December 2014, Medicare paid Adonis approximately $1.9 million and BestMed-Care Services approximately $3.1 million for skilled-nursing services.
Adonis and BestMed-Care Services allegedly obtained many patients from a marketing company which claimed to offer “free” nursing services to Medicare beneficiaries. Adonis and BestMed-Care Services paid hundreds of dollars per patient to a marketing company which would refer patients to Adonis and BestMed-Care Services.
According to the affidavit, Adonis and BestMed-Care Services referred many patients to physicians at Suburban Home Physicians, even when patients had primary-care physicians and continued to see those primary-care physicians. Physicians at Suburban Home Physicians then certified the patients for skilled-nursing services, even when patients did not qualify for skillednursing services that were covered by Medicare.
Also described in the complaint, nursing assessments signed by Ademiju contained false information about patients. For example, Ademiju signed nursing assessments that falsely stated that patients were homebound and that falsely stated that patients needed assistance with activities of daily living such as dressing and bathing themselves. Adonis and BestMed-Care Services then billed Medicare for long periods in part by periodically discharging patients, claiming the patients no longer needed services, and then re-admitting the same patients a short time later without telling the patients that they had been discharged or re-admitted. In some instances, a patient was discharged from one agency and then admitted at the other agency in less than a week, and sometimes even on the same day.
One patient, Patient LD, who received nursing services from Adonis and BestMed-Care Services and was certified for such services by a physician at Suburban Home Physicians, told law enforcement that she began receiving nursing services after getting a call out of the blue and being told that a physician and nurse would come visit her. Patient LD said that she was not confined to the home during the time that she received nursing services, and said that the nursing visits were “worthless.” Medicare paid Adonis and BestMed-Care Services more than $11,000 for the nursing services provided to Patient LD.
Another patient described in the complaint, Patient JS, who received services from Adonis and BestMed-Care Services and was certified for such services by a physician at Suburban Home Physicians, told law enforcement that he realized that the nursing visits were unnecessary and eventually stopped them. Patient JS told law enforcement that he felt bad for having allowed the visits to go on as long as he had even when he knew they were unnecessary. Medicare paid Adonis and BestMed-Care Services more than $13,000 for the nursing services provided to Patient JS.
The government is being represented by Assistant U.S. Attorney Stephen Chahn Lee.
Ademiju was charged with one count of health care fraud and faces a maximum penalty of 10 years in prison and a $250,000 fine or a fine totaling twice the gain or loss, whichever is greater, and restitution is mandatory. If convicted, the Court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The public is reminded that a complaint and an indictment are not evidence of guilt. The defendant is presumed innocent and is entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.
The Medicare Fraud Strike Force began operating in Chicago in February 2011, and consists of agents from the FBI and HHS-OIG, working together with 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 announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Scores of defendants have been charged locally in health care fraud cases since the strike force began operating in Chicago.
To report health care fraud to learn more about the Health Care Fraud Prevention & Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.