Health Law Daily Wrap Up, ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: Maryland physician receives 12-year exclusion from federal health programs for fraudulent medical orders, (Oct 31, 2025)

By Wendy Biddle, J.D.

The decision hinged on three aggravating factors, including nearly $400,000 in restitution and a two-year pattern of fraudulent conduct.

The Department of Health and Human Services Departmental Appeals Board has upheld a 12-year exclusion from federal health care programs for a Maryland physician who admitted to signing thousands of fraudulent medical orders for durable medical equipment and genetic testing without establishing doctor-patient relationships or assessing medical necessity. The 12 year exclusion, up from the five-year minimum, was based on three aggravating factors, which the ALJ affirmed as reasonable (Yerokun, DAB No. CR6516, Doc. No. C-24-375 (July 31, 2024)).

Dr. Oluwatobi Alabi Yerokun entered a guilty plea on September 21, 2022, to one count of conspiracy to make false statements regarding health care matters, in violation of 18 U.S.C. §§ 371 and 1035. According to his plea agreement with the United States Attorney's Office for the Western District of Missouri, Yerokun acknowledged that he knowingly and willfully signed orders for durable medical equipment and genetic testing for Medicare and Medicaid beneficiaries despite having no prior doctor-patient relationship with them and lacking adequate information to assess medical necessity.

The scheme proved financially lucrative for Yerokun, who received approximately $20 for each order he signed. Between March 2019 and April 2021, he earned a total of $44,860 through these fraudulent orders. The financial impact on federal health care programs was substantially larger. Medicare paid $3,094,181 for the durable medical equipment claims, while Medicare and Medicaid paid $371,302 and $524,734, respectively, for laboratory claims.

On March 13, 2023, a federal court sentenced Yerokun to five years of probation and ordered him to pay $399,021 in restitution to the Medicare and Missouri Medicaid programs. According to a motion filed by the United States requesting a downward departure from advisory Sentencing Guidelines, the restitution amount represented 10 percent of the total amounts paid by Medicare and Medicaid and reflected Yerokun's estimated culpability compared to others involved in the scheme who were more involved and received the majority of ill-gotten profits.

Following his criminal conviction, the Maryland State Board of Physicians suspended Yerokun's medical license on February 2, 2023. Additionally, on June 6, 2023, the Maryland Medicaid program terminated his enrollment, citing his guilty plea to Medicare and Medicaid program-related crimes in federal court.

The Inspector General of the Department of Health and Human Services subsequently excluded Yerokun from participation in Medicare, Medicaid, and all federal health care programs on January 31, 2024, for a minimum period of 12 years, effective February 20, 2024. The exclusion was mandated under section 1128(a)(1) of the Social Security Act, which requires exclusion of any individual convicted of a criminal offense related to the delivery of an item or service under Medicare or any state health care program.

While the statute mandates a minimum exclusion period of five years, the IG extended the exclusion to 12 years based on three aggravating factors enumerated in federal regulations. The Administrative Law Judge (ALJ) affirmed both the basis for exclusion and the 12-year duration in a decision issued July 31, 2024.

The first aggravating factor considered was the financial loss to government programs. The restitution amount of $399,021 was approximately eight times the $50,000 threshold that triggers consideration of this aggravating factor under 42 C.F.R. § 1001.102(b)(1). The ALJ noted that the Inspector General had a reasonable basis to lengthen the exclusion based on this substantial loss.

The second aggravating factor involved the duration of Yerokun's criminal conduct. The conspiracy spanned from approximately February 2019 through April 2021, far exceeding the one-year threshold established in the regulations. The ALJ emphasized that Yerokun's actions were not a one-time lapse in judgment but rather involved thousands of improper orders over more than two years. The decision quoted precedent establishing that this aggravating factor serves to distinguish petitioners whose lapse in integrity is short-lived from those who evidence a lack of integrity over a longer period.

The third aggravating factor centered on other adverse actions taken against Yerokun based on the same circumstances underlying his conviction. Both the suspension of his Maryland medical license and the termination of his Maryland Medicaid enrollment qualified as adverse actions under 42 C.F.R. § 1001.102(b)(9). The ALJ rejected Yerokun's argument that his continued licensure in New York and Delaware should weigh against this factor, explaining that whether other entities declined to take action or have not yet taken action is irrelevant to the Inspector General's consideration of this aggravating factor.

Yerokun attempted to establish mitigation based on his cooperation with authorities, submitting evidence that the United States had requested a downward departure from Sentencing Guidelines. However, the ALJ found that the motion did not reference any enumerated mitigating factors set forth in federal regulations, such as cooperation that resulted in others being convicted or excluded, additional cases being investigated, or the imposition of civil monetary penalties. Without evidence supporting an enumerated mitigating factor, the Inspector General lacked any basis to apply mitigation.

The ALJ concluded that the 12-year exclusion period was not unreasonable given the three significant aggravating factors and the absence of any mitigating factors. The decision cited precedent upholding a 12-year exclusion based on two aggravating factors involving a similar program loss and a 20-month duration of criminal conduct.

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