Suit: Suburban couple defrauded millions from Medicare

The federal government has filed a lawsuit accusing a south suburban couple of defrauding Medicare out of millions of dollars through false claims by their medical companies.

The suit, filed Tuesday in U.S. District Court, accuses Gateway Health Systems Inc. and its owners – 58-year-old Ajibola Ayeni and his wife, Joy H. Turner-Ayeni – of violating the federal False Claims Act by seeking and accepting Medicare payments for fraudulent services, according to a statement from the U.S. attorney’s office.

Ayeni also owned Docs at the Door P.C., a home-visiting physician company, prosecutors said. The suit claims the company falsely certified non-homebound patients as needing home-health services and fraudulently “upcoded” home doctor visits to the second-highest billing level in order to increase payments from Medicare.

Both Gateway and Docs at the Door were paid millions of dollars for services they claimed to provide for Medicare beneficiaries, prosecutors said. Ayeni and Turner-Ayeni directed the companies to create false documentation to cover up services that were not rendered or that were not medically necessary.

After they learned of the investigation into their scheme, Ayeni and Turner-Ayeni tried to conceal assets from the government by transferring them into trusts, the U.S. attorney’s office said. The property transferred included apartments in the Oakland and Edgewater neighborhoods, a home in south suburban Flossmoor and two properties in southwest suburban Frankfort.

They “either intentionally transferred the properties to avoid paying a judgment to the United States for their fraud, or at a minimum, knew that they had incurred debts that they would not be able to pay,” according to the suit.

The lawsuit seeks to recover three times the damages from the fraud, plus civil penalties between $5,500 and $11,000 for each false Medicare claim submitted.

In addition to the allegations in the lawsuit, Ayeni, of Flossmoor, is facing separate federal criminal charges for health care fraud committed between 2011 and 2015 while operating Docs at the Door, prosecutors said. He has pleaded not guilty to the charges and a trial date has not yet been set.