A US District Judge has assessed penalties of $170 million on Dr. Mustapha Kibirige and Dr. Emelike Agomo in relation to fraudulently billing Medicare.
Dr. Libirige owns and operates Outreach Diagnostic Clinic, based in the midtown area of Houston. Dr. Agomo joined the clinic in 2010. The clinic examines patients for glaucoma.
Between February 2006 and December 2011, the clinic billed Medicare for the glaucoma tests performed. Devices that measure eye pressure using a portable pen or puffs of air are billed under one billing code. Imaging scans of a retina are billed under a separate code which has a higher reimbursement rate. The clinic was performing the former, but billing under the latter.
The clinic submitted 14,450 claims in this manner and received $807,450 in payments from Medicare.
An optometrist at the clinic, who started in 2005, became uncomfortable with the billing practices. In June 2012, he resigned, having failed to persuade Drs. Kibirige and Agomo to change their practices. He later blew the whistle.
The government won a summary judgment in March 2020 against the clinic. As a result, the judge assessed a penalty of
- Treble damages of $2,422,350
- A penalty of $11,803 for each claim submitted or $170,553,350.
$11,803 is the minimum penalty that could have been assessed under the statute.