Dr. Mustapha Kibirige, 58, and Dr. Emelike Agomo, 57, are ophthalmologists. They operate the Outreach Diagnostic Clinic in Houston, Texas. Both doctors are accused of fraudulently billing Medicare millions. The court assessed the charges and determined each fraudulent charge corresponds to a $11,803 penalty. As a brief aside, we’d love to know the formula used to calculate that exact sum. 

How many false claims did the doctors allegedly submit? 14,450 filed between 2006 and 2012. 

Multiply the number of false charges by the court’s financial penalty, and you get our headline. Ouch.    

A former employee of the practice filed a whistleblower lawsuit under the False Claims Act, lighting the fuse. The whistleblower accused both doctors of fraudulently billing Medicare for single eye pressure measurement tests. Ophthalmologists use these tests to treat patients suffering from glaucoma. The whistleblower claimed the doctors then used an improper reimbursement code to increase the amount of money they received via Medicare reimbursement.   

If you read our content regularly, this story might sound familiar. We recently discussed accusations against an ENT specialist practicing in North Carolina. She is accused of running a similar operation – though she (allegedly) defrauded Medicare only $46 million. In her case, the smell of money attracted the attention of federal watchdogs. That was not the case here, though the unusually large amount of money the clinic made from these tests likely lent the whistleblower’s claims extra credence. 

If convicted, it is likely both doctors will spend time behind bars – to say nothing of the $170 million in penalties.  

What can we learn? The obvious: Don’t participate in fraud.  

The less obvious lessons relate to administrative practices.  

Empower your employees to speak up if they smell something fishy. In this case, the doctors were (allegedly) doing wrong, but you can imagine a situation where a doctor burns because of an employee’s fraudulent behavior. It isn’t hard to imagine an employee (or a team of them) managing the billing/reimbursement procedures that landed these men in hot water.  

Recall the employer liability doctrine. The idea is that the employer (designated leadership body, in this case, the doctor) is held accountable for the mistakes of his practice, assuming those mistakes were by employees in their normal scope of practice. Billing and collecting would fit the description. 

If your employees are suspicious of your own business practices, they may say nothing, or assume you are complicit in fraud, delaying your opportunity to fix a problem. If they trust you and your character, they’ll likely speak up, alerting you to potential problems before it’s too late. 

Be transparent. Be honest. Don’t commit fraud. Do we really need to say this out loud? No – but we like to be thorough. 

It isn’t clear why the whistleblower was fired from the practice; he may have been fired due to reasons unrelated to the alleged scheme and filed the whistleblower lawsuit as an act of vengeance. Or he may have been terminated because he witnessed fraud and stood up to his employers. We can only speculate. And watch how this plays out. $170 million in penalties may not be a record-breaker, but it tops the charts.   

What do you think? Let us know your thoughts in the comments below.

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2021 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.