Registered nurse James Ademiju, who operates Illinois-based agencies Adonis Inc. and BestMed-Care Services Ltd., was arrested Tuesday in connection with a home care-related scam that allegedly bilked Medicare for $5 million over a three-year period.
The two nursing agencies allegedly obtained many patients from a marketing company that claimed to offer “free” nursing services to Medicare beneficiaries. Adonis and BestMed-Care Services, both located in Dolton, paid hundreds of dollars per patient to the marketing company, which would refer people to the agencies, according to the office of the U.S. Attorney for the Northern District of Illinois.
A criminal complaint alleges Ademiju was involved in a scheme to defraud Medicare by billing for unnecessary nursing services that were provided to patients who were were obtained via illegal payments for patient referrals and were not confined to the home, the U.S. Attorney’s office stated in a press release.
For more than three years, a total of approximately $5 million was paid to Adonis and BestMed-Care Services by Medicare for services rendered to patients deemed to be homebound—but who the federal authorities believe were not. Between February 2011 and December 2014, Medicare paid Adonis approximately $1.9 million and BestMed-Care Services approximately $3.1 million for these skilled nursing services.
According to a 56-page affidavit in support of the arrest, the charge against Ademiju arises from the investigation of Suburban Home Physicians, a Schaumburg, Ill., 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, Adonis and BestMed-Care Services referred many patients to physicians at Suburban Home Physicians, even when patients had primary care doctors and continued to see those doctors. Physicians at Suburban Home then allegedly certified the patients for skilled nursing services, even when patients did not qualify for skilled nursing services that were covered by Medicare.
Additionally, nursing assessments signed by Ademiju contained false information about patients, according to complaints.
For example, Ademiju allegedly signed nursing assessments falsely stating that patients were homebound and that that patients needed assistance with activities of daily living, such as dressing and bathing themselves, even when they did not.
Adonis and BestMed-Care Services then allegedly billed Medicare for long periods in part by periodically discharging patients, claiming the patients no longer needed services, and then readmitting the same patients a short time later without notifying them.
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, 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, according to the legal complaint in the matter.
She said she was not confined to the home during the time that she received nursing services, and that the nursing visits were “worthless.” Medicare paid Adonis and BestMed-Care Services more than $11,000 for the nursing services provided to this patient.
Another patient told law enforcement that he realized the nursing visits were unnecessary and eventually stopped them. He 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 this patient.
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.
Written by Emily Study