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Civil Monetary Penalties and Affirmative Exclusions

The Office of Inspector General (OIG) has the authority to seek civil monetary penalties (CMPs), assessments, and exclusion against an individual or entity based on a wide variety of prohibited conduct. In each CMP case resolved through a settlement agreement, the settling party has contested the OIG's allegations and denied any liability. No CMP judgment or finding of liability has been made against the settling party.

OIG Enforcement Cases

The cases listed below represent recently-closed cases initiated by the OIG's Office of Counsel to the Inspector General. To view additional cases, including those resolved through the provider self-disclosure protocol, click on the specific categories to the right.

05-05-2016
Florida Podiatrist Agrees to 30 Year Exclusion
On May 5, 2016, Eugene A. Fox, D.P.M., agreed to be excluded from participation in all Federal health care programs for a period of thirty years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Dr. Fox submitted claims to Medicare for podiatric services that were not rendered or were rendered by unqualified personnel. Senior Counsel Lauren Marziani and Associate Counsel David Fuchs represented OIG.
05-05-2016
Michigan Ambulance Company Settles Case Involving False Claims
On May 5, 2016, Allied EMS Systems, Inc. (Allied), of Petoskey, Michigan, entered into a $121,722.63 settlement agreement with OIG. The settlement agreement resolves allegations that Allied submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
05-05-2016
Florida Skilled Nursing Facilities Settle Case Involving Excluded Individual
On May 5, 2016, CCRC PropCo-Cypress Village, LLC (Cypress Village), and BLC Atrium-Jacksonville, LLC (Atrium), Florida, entered into a $17,881.65 settlement agreement with OIG. The settlement agreement resolves allegations that Cypress Village and Atrium employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a speech-language pathologist, provided items or services to Cypress Village and Atrium patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG.
04-15-2016
Texas Home Health Agency Settles Case Involving Excluded Individual
On April 15, 2016, Choice Home Health Care, Inc., and its former owners Patrick Fettinger and Ann Voss (collectively "CHHC"), Texas, entered into a $89,587.82 settlement agreement with OIG. The settlement agreement resolves allegations that CHHC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a home health community liaison/marketing specialist, provided items or services to CHHC patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG.
03-11-2016
Utah Ambulance Company Settles Case Involving False Claims
On March 11, 2016, Ogden City Corporation (Ogden), of Ogden, Utah, entered into a $363,159.38 settlement agreement with OIG. The settlement agreement resolves allegations that Ogden submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate (upcoding). OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
Oregon Physical Therapy Practice and Owner Settle Case Involving False Claims
On March 11, 2016, Dan Ibarra and Northwest Physical Therapy (collectively, NPT), Oregon, entered into a $200,000 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that NPT submitted claims to Medicare for payment for direct services rendered by unlicensed employees and also submitted claims for direct, one-on-one services when these services were rendered to multiple patients at the same time. Senior Counsel Nancy Brown represented OIG.
03-04-2016
North Dakota Ambulance Provider Settles Case Involving False Claims
On March 4, 2016, Altru Health System (Altru), of Grand Forks, North Dakota, entered into a $300,974 settlement agreement with OIG. The settlement agreement resolves allegations that Altru submitted claims to Medicare for: (1) emergency Advanced Life Support ambulance transportation that should have been billed at the lower emergency Basic Life Support rate; (2) duplicate billings; (3) ambulance transportation services that were reimbursable by private insurance; and (4) emergency ambulance transportation services provided to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
03-01-2016
Oregon Mental Health Facility Settles Case Involving Excluded Individual
On March 1, 2016, Cascadia Behavioral Health, Inc. (Cascadia), Oregon, entered into a $92,052.78 settlement agreement with OIG. The settlement agreement resolves allegations that Cascadia employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a residential counselor, provided items or services to Cascadia patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Eula Taylor.
02-26-2016
Connecticut Ambulance Company Settles Case Involving False Claims
On February 26, 2016, Campion Ambulance Service, Inc. (Campion), of Waterbury, Connecticut, entered into a $100,804.74 settlement agreement with OIG. The settlement agreement resolves allegations that Campion submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
02-09-2016
Illinois Billing and Ambulance Companies Settle Case Involving False Claims
On February 9, 2016, Andres Medical Billing, Ltd. (Andres), and Kurtz Ambulance Service (Kurtz), Illinois, entered into a $77,542.72 settlement agreement with OIG. The settlement agreement resolves allegations that Andres, acting as the third-party biller for Kurtz, submitted claims to Medicare for basic life support (emergency) that did not meet Medicare requirements for emergency transport services and should have been billed at the lower non-emergency transport rate. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, collaborated to achieve this settlement.
02-05-2016
Michigan Ambulance Company Settles Case Involving False Claims
On February 5, 2016, White Lake Ambulance Authority (White Lake), Michigan, entered into a $113,635.08 settlement agreement with OIG. The settlement agreement resolves allegations that White Lake submitted claims to Medicare for basic life support (emergency) and advanced life support (emergency) ambulance transportation claims that did not meet Medicare requirements for emergency transport services. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, collaborated to achieve this settlement.
Illinois Pharmacist and Owner of a Durable Medical Equipment Supply Company Agrees to Three-Year Exclusion
On February 5, 2016, an Illinois pharmacist and owner of a durable medical equipment supply company agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the individual offered and paid kickbacks and bribes, directly or through an employee, to induce individuals representing hospitals and nursing homes to order health care items from his company for which payments were made under Medicare. Senior Counsel Henry Green represented OIG.

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