Antoine Adem, 49, a Festus physician, has been sentenced to 45 days in prison and ordered to pay $149,199 in restitution and a $55,000 fine for his part in a health care fraud scheme, the U.S. Attorney’s Office reported.
Adem’s company, Midwest Cardiovascular Inc., which is based in Festus, was placed on three years’ probation and ordered to jointly pay $149,199 in restitution and a $120,000 fine, the report said.
U.S. District Judge Audrey G. Fleissig imposed the penalties Friday (Dec. 20). Adem and his company, which also has a location in Farmington, pleaded guilty to health care fraud on Aug. 20, the U.S. Attorney’s Office reported.
From January 2014 to December 2018, Adem and his company submitted or caused to be submitted numerous false and fraudulent claims to Medicare and Medicaid. The reimbursement claims falsely stated that Adem performed two vein procedures on different days, when he actually performed the two procedures on the same day, the report said.
As a result, Adem and his company received about $2,000 more per patient than he would have received if he had correctly reported the procedure dates to Medicare and other insurers. In all, Adem and his company received $149,199 more than they were entitled to because of the fraudulent claims, according to the report.
Adem and Midwest Cardiovascular also entered into a civil settlement agreement with the United States and have paid $1.2 million, the report said.
The civil settlement resolves allegations that Adem and Midwest Cardiovascular violated the civil False Claims Act by submitting fraudulent claims to Medicare, including claims that failed to comply with Medicare regulations, claims for office visits that were upcoded and claims that falsely indicated surgical services were provided on two separate days, according to the report.
The civil settlement includes the dismissal of a complaint that was filed by whistleblower Elaine Taylor, a former employee of Midwest Cardiovascular. Under the False Claims Act, the whistleblower is entitled to a share of the civil settlement. Taylor will receive $240,000, the U.S. Attorney’s Office reported.
“Dr. Adem calculated that committing health care fraud was his path to riches. He was wrong, as he now pays the price for his crimes,” said Curt Muller, special agent in charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “We will continue working with our law enforcement partners to protect government healthcare programs and the taxpayer dollars on which they depend.”
This case was investigated by the U.S. Department of Health and Human Services Office of Inspector General, FBI and Missouri Attorney General Medicaid Fraud Control Unit.
Assistant U.S. Attorneys Dorothy McMurtry and Suzanne Moore handled the case for the U.S. Attorney’s Office.