Antoine Adem, M.D., 49, of Festus, and his company, Midwest Cardiovascular, Inc., were sentenced Friday.
Dr. Adem was sentenced to a prison term of 45 days and ordered to pay restitution of $149,199 and a fine of $55,000 for his involvement in a healthcare fraud scheme.
Midwest Cardiovascular was sentenced to a term of probation of 3 years and ordered to jointly pay restitution with Dr. Adem of $149,199 and a fine of $120,000.
Midwest Cardiovascular has offices in Festus and Farmington. Dr. Adem and Midwest Cardiovascular appeared Friday in federal court before U.S. District Judge Audrey G. Fleissig. Both previously entered guilty pleas on Aug. 20.
According to court documents, from January 2014 to December 2018, Dr. Adem and Midwest Cardiovascular submitted or caused to be submitted numerous false and fraudulent claims to Medicare and Missouri Medicaid. The reimbursement claims falsely indicated that Dr. Adem performed two vein procedures, known as vascular embolization and occlusions, on patients on two different days, when he actually performed the two procedures on the same day.
As a result, Dr. Adem and Midwest Cardiovascular received approximately $2,000 more per patient than they would have received if they had informed Medicare and other insurers that the two procedures were performed on the same day. As a result of these fraudulent claims, Medicare and Missouri Medicaid paid Dr. Adem and Midwest Cardiovascular $149,199 more than they were entitled to receive.
Dr. Adem and Midwest Cardiovascular also entered into a civil settlement agreement with the United States and have paid $1.2 million. The civil settlement resolves allegations that Dr. 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 that surgical services for vascular embolization and occlusion were provided on two separate days.
The civil settlement includes the dismissal of a qui tam complaint that was filed by whistleblower Elaine Taylor, a former employee of Midwest Cardiovascular. United States of America, ex rel., Elaine Taylor v. Antoine M. Adem, M.D. and Midwest Cardiovascular, Inc., et al, Case No. 4:17CV858-PLC (E.D. Mo.). Under the False Claims Act, the whistleblower, also known as a Relator, is entitled to a share of the civil settlement. Taylor will receive $240,000.
“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, the Federal Bureau of Investigation, and the Missouri Attorney General Medicaid Fraud Control Unit. Assistant U.S. Attorneys Dorothy McMurtry and Suzanne Moore are handling the case for the U.S. Attorney’s Office.
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