HOUSTON – Two ophthalmologists and their eye clinic must pay millions of dollars for fraudulently billing Medicare in relation to the evaluation and treatment of glaucoma, announced Acting U.S. Attorney Jennifer B. Lowery.
“Deliberately overcharging the government for medical services wastes our country’s precious health care resources,” said Lowery. “We will not stand idly by as providers in our district attempt to abuse the system.”
U.S. District Judge Lynn N. Hughes assessed the amounts against Dr. Mustapha Kibirige, 58, and Dr. Emelike Agomo, 57, and the eye clinic they operated in Houston – Outreach Diagnostic Clinic LLP. Kibirige also practices in Humble.
The action is a result of a whistleblower lawsuit a former employee of Outreach had filed under the False Claims Act (FCA). It alleged the two ophthalmologists were fraudulently billing the Medicare Program for single eye pressure measurement tests used to assess and treat glaucoma. Kibirige and Agomo allegedly billed the federal health care program using an improper reimbursement code that provided a higher reimbursement than what was allowed.
Under the FCA, the government is entitled to treble damages and a penalty on each false claim. Judge Hughes determined those damages amounted to $2,422,350. The court further found the practice had submitted 14,450 false claims to the Medicare Program between 2006 and 2012. Judge Hughes assessed a penalty of $11,803 for each of those false claims, resulting in a total of $170,553,350 in penalties.
Under the FCA, a private party can file an action on behalf of the United States and receive a share of the recovery.
The Department of Health and Human Services - Office of Inspector General conducted the investigation. Deputy Civil Chief Andrew A. Bobb and former Assistant U.S. Attorney Jose Vela handled that matter.
The claims resolved by the settlement are allegations only and there has been no determination of liability.
Department of Justice
Office of the U.S. Attorney
Southern District of Texas