Physician Convicted of Medicare Fraud Okayed Unneeded Tests

May 14, 2012

May 14, 2012 — An obstetrician-gynecologist in suburban Detroit, Michigan, was found guilty by a federal jury on May 11 of Medicare fraud in a $6.7 million scheme involving medically unnecessary neurological tests.

Jonathan Agbebiyi, MD, 62, from Highland, Michigan, was convicted of 6 counts of committing healthcare fraud and 1 count of conspiracy to commit healthcare fraud.

Federal prosecutors and the Department of Health and Human Services have zeroed in on Detroit as 1 of 9 major hotspots for Medicare fraud. Since March 2007, the government's Medicare Fraud Strike Force has charged roughly 1330 individuals nationwide with falsely billing Medicare for more than $4 billion. In terms of dollar value, Dr. Agbebiyi's case is smaller than many others prosecuted by the government, but it nevertheless illustrates the parody of medicine characteristic of Medicare fraud.

As in other cases, the physician in the fraud scheme was not the ringleader but, instead, a well-paid accomplice of nonphysicians who called the shots. According to prosecutors, Dr. Agbebiyi was a staff physician at 3 clinics in Livonia, Michigan, a suburb of Detroit, between 2007 and 2010 that were owned and operated by several nonphysicians from Miami, another city rife with Medicare fraud.

The owners, who have already pled guilty to fraud charges, built their practices by recruiting indigent Medicare patients from Detroit with cash, fast food, and prescriptions for controlled substances. Dr. Agbebiyi ordered medically unnecessary tests for them that included sensory nerve and motor nerve conduction studies, transcranial Doppler studies, and intracranial studies. Clinic employees "who lacked any meaningful training" administered the tests. Nerve conduction studies were confined to those in which electrodes are placed on a patient's skin, according to prosecutors. The 3 clinics did not bill Medicare for more invasive needle nerve conduction tests.

Paid $100 per hour without tax deductions, Dr. Agbebiyi earned $183,000 between April 2008 and January 2010 for his time at the clinics. It was money that supplemented his income from Sinai-Grace Hospital in Detroit, where he worked in its obstetrics triage unit during that period, according to prosecutors.

"This doctor exposed patients to neurological testing solely to generate money for himself at the expense of the Medicare program," said Barbara McQuade, US Attorney for the Eastern District of Michigan, in a press release. "We are grateful for the hard work that uncovered this betrayal of medical ethics and theft of taxpayer funds."

Dr. Agbebiyi is scheduled to be sentenced on August 13. Each count of healthcare fraud, as well as conspiracy to commit it, carries a maximum penalty of 10 years in prison and a $250,000 fine.

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