WASHINGTON, D.C. – Attorney General Karl A. Racine today announced a lawsuit against Oji Fit World, a fitness training company, for filing false Medicaid claims and defrauding the District.
In the lawsuit, the Office of the Attorney General (OAG) alleges that Oji Fit World and its owner, Amaka Oji, engaged in a scheme to profit by overbilling Medicaid – and as a result, District taxpayers – for fitness services provided to individuals with intellectual and developmental disabilities. OAG also alleges that the company fraudulently billed for services that were not provided at all. The District is seeking to recover damages, civil penalties, and the costs of the District’s litigation.
“Medicaid is a lifeline program that enables individuals with disabilities to get care and services they need to be healthy—and Oji Fit World stole from this much-needed program,” said AG Racine. “The Office of the Attorney General will bring suit against those who illegally profit at the expense of vulnerable residents and taxpayers, and companies should understand that if they defraud the District and our residents, they will be held accountable.”
The District’s Medicaid program reimburses certain wellness services, including fitness training, for certain Medicaid beneficiaries who have intellectual and developmental disabilities. These services help individuals with disabilities stay healthy and are intended to help increase their independence and well-being. For a Medicaid beneficiary to qualify for fitness training, a doctor must order the services. Trainers must tailor services to a person’s specific needs, goals, and abilities and keep careful records of each session. Medicaid requires fitness training to be billed in 15-minute increments, and during the time Oji Fit World was operating, Medicaid reimbursed training at a rate of $18.75 for every 15 minutes ($75 per hour).
In this lawsuit, OAG alleges that Oji Fit World unjustly enriched itself from 2012 through 2015 by submitting false claims to the District’s Medicaid program. Specifically, Oji Fit World violated District law by:
- Charging the District for services that were never provided: Oji Fit World routinely scheduled one-hour training sessions regardless of the needs or capabilities of the individuals they were training. According to the company’s own records, sessions were often cut short or not held at all. Oji paid employees only for the amount of time they reported actually training Medicaid beneficiaries, but, in nearly every one of over 22,000 claims she filed, Oji billed Medicaid for the full hour of service.
- Falsifying records: On multiple occasions, trainers recorded exercise routines that a client could not actually accomplish. One trainer claimed on numerous occasions that a client walked between 1.5 and 2 miles, including one instance in which she walked 1.5 miles in 20 minutes. However, that client uses a wheelchair and cannot walk long distances. Some trainers documented providing services using equipment, like treadmills or ellipticals, that was not available at the facility where they were training. And though Oji Fit World was required to keep detailed records of every training session, hundreds of records were blank, lacked signatures, or were obvious duplicates with only the date changed.
- Failing to supervise trainers: Amaka Oji was approved to provide fitness training services to Medicaid beneficiaries, but under the program’s rules, any assistants or aides were supposed to be closely supervised. Instead of providing the services herself, Oji continued to work a full-time job as an engineer and hired employees to provide services to people with disabilities with little to no supervision.
With this lawsuit, OAG is seeking to recover the thousands of dollars in Medicaid funds it paid to Oji Fit World because of the company’s fraudulent claims, as well as treble damages, penalties, interest, and costs the District incurred by bringing this case. OAG appreciates the cooperation and support provided by the Office of the Inspector General and Inspector General Lucas in the investigation of this matter.
A copy of the legal complaint against Oji Fit World is available here.
Report Medicaid Fraud in the District
Individuals or health care company employees who suspect fraud against the District’s Medicaid program can make an anonymous report to www.dhcf.dc.gov/page/reporting-fraud-waste-and-abuse-01 or by calling (877) 632-2873.