Local doc pleads guilty to health care fraud

A local doctor enters a guilty plea in U.S. District Court to one count of health care fraud after prosecutors say Dr. Antoine Adem and his company, Midwest Cardiovascular Inc., filed false insurance claims regarding medical procedures resulting in over payments to the company for services. 

A local doctor pleaded guilty this week in U.S. District Court to one count of Health Care Fraud.

Dr. Antoine Adem, of Midwest Cardiovascular Inc. located in Festus and Farmington, appeared before District Judge Audrey G. Fleissig Tuesday morning where he entered a guilty plea on the federal count.

The U.S. Attorney’s Office filed the charge against Midwest Cardiovascular and Adem, the company’s owner and president since its inception in 2008, claiming that from January 2014 to December 2018, Adem and his company submitted numerous false and fraudulent claims to Medicare and Medicaid. As a result of these fraudulent claims, Medicare paid Adem and his practice $149,199, more than they were entitled to receive.

The court documents outline the method or scheme that the doctor and his company used to submit the Medicaid and Medicare claims.

According to court documents, Medicare does not pay for the treatment of varicose veins for purely cosmetic purposes. However, Medicare will pay for the treatment of varicose veins, when medically necessary. Surgical intervention, such as vascular embolization and occlusion ("vein procedures"), may be covered when conservative measures such as exercise, periodic leg elevation, weight loss, compressive therapy, and avoidance of prolonged immobility prove unsuccessful.

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Adem performed and billed for vascular embolization and occlusion on certain patients, without any prior conservative treatment for their varicose veins and this was one part of the scheme to defraud, according to the court records.

Documents state further part of the scheme to defraud was the fact that Adem personally directed his employees to schedule two vein procedures to be performed on certain patients in one day. Adem's nurse, who was also his assistant during the surgery, used an office planner to note that both surgeries were to be performed on the same day. Nonetheless, Adem made hand-written notes that indicated that he had performed the vein procedures on two different dates. He then gave these notes to his nurse/assistant, who had been present in the room during the surgery. The assistant then scanned Adem's hand-written notes into the electronic medical record (EMR), thus incorporating the false and fraudulent notes into the patients' permanent medical records.

The charge further states that Midwest Cardiovascular, acting through its president and agent Adem, caused false and fraudulent reimbursement claims, reflecting vein procedures performed on two different days, to be submitted to Medicare and other insurers. As a result, Midwest Cardiovascular and Adem received about $2,000 more than would have received if they had informed Medicare and the other insurers that the two vein procedures were performed on the same day.

Lastly, the count states that on or about Dec. 31, 2015, Adem knowingly and willfully executed, and attempted to execute, the scheme to defraud a health care benefit program, when he submitted a reimbursement claim to the Medicare Program which falsely and fraudulently stated that he had performed a vascular embolization and occlusion procedure on a patient on Dec. 29, 2015, when Adem knew no service had been provided.

Adem withdraw his former plea of not guilty in Tuesday’s court appearance and entered a plea of guilty to health care fraud. Sentencing in this case has been scheduled for Nov. 19, where Adem could face a fine and/or a term of imprisonment for no more than 10 years.

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