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False and Fraudulent Claims

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.

2014

09-29-2014 OIG Enforcement Case
Connecticut Laboratory Settles False and Fraudulent Medicare Claims Case
Clinical Lab Partners (CLP), a laboratory in Newington, CT, that performed urine drug testing, agreed to enter into a $145,789.34 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services effective September 29, 2014. The settlement resolves allegations CLP submitted false or fraudulent claims to Medicare. Specifically, OIG contends CLP submitted claims to Medicare for high complexity urine drug tests exceeding the number of units allowed by Medicare by using a code to bypass computer programming that would have otherwise rejected such claims. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoff Hymans, collaborated to achieve this settlement.
09-19-2014
After it self-disclosed conduct to OIG, the University of California, Los Angeles (UCLA), California, agreed to pay $470,422.85 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the UCLA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-15-2014
After it self-disclosed conduct to OIG, San Miguel Hospital Corporation d/b/a Alta Vista Regional Hospital (Alta Vista), New Mexico, agreed to pay $989,955 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Alta Vista submitted claims for physical therapy services that were performed by unqualified individuals.
Arrowhead Cardiology Medical Group, Inc.
After it self-disclosed conduct to OIG, Arrowhead Cardiology Medical Group, Inc., Steven Fitzmorris, M.D., and Sunil Nowrangi, M.D. (collectively Arrowhead), California, agreed to pay $485,217 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Arrowhead billed Medicare for CPT code 93042 (Rhythm ECG, 1-2 leads; interpretation and report only) in excess of one per patient per day where there was no documented change in the patient's condition to warrant an additional service.
09-12-2014
Overland, Ordal, Thorson, and Fennell Pulmonary Consultants, P.C. (OOTFPC), Oregon, agreed to pay $79,792.33 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OOTFPC submitted claims to Medicare for Evaluation and Management services (CPT codes 99204, 99214, 99205 and 99215) and Consultation services (CPT Codes 99244 and 99245) using a higher paying CPT code than supported by the medical documentation. OIG also alleged that OOTFPC submitted claims for prolonged service code (CPT 99354) when the service did not meet Medicare guidelines.
09-10-2014 OIG Enforcement Case
Ohio Retirement Community Settles Case Involving an Excluded Nurse
Wesley Glen Retirement Community – a non-profit retirement community in Columbus, OH – entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective September 10, 2014. The $19,890 settlement resolves allegations that Wesley Glen employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that Wesley Glen employed an excluded nurse to provide items or services which were reimbursed by Federal health care programs.
09-10-2014 OIG Enforcement Case
Illinois Physician Practice Resolves Allegations of False and Fraudulent Medicare Claims
Pain Specialists of Greater Chicago (PSGC), an Illinois physician practice that performs in-office urine drug testing, entered into a $590,763.45 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective September 10, 2014. The settlement resolves allegations PSGC submitted false or fraudulent claims to Medicare. Specifically, OIG contends PSGC submitted claims to Medicare for high and low/moderate complexity urine drug tests exceeding the number of units allowed by Medicare by using a code to bypass computer programming that would have otherwise rejected such claims. The OIG also contends that PSGC submitted claims for high complexity drug tests when it performed less-expensive low or moderate complexity drug tests. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, collaborated to achieve this settlement.
09-09-2014
After it self-disclosed conduct to OIG, Rescue, Inc. (Rescue), Vermont, agreed to pay $152,593 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rescue employed an individual that it knew or should have known was excluded from participation in Federal health care programs. After it self-disclosed conduct to OIG, Amedisys, Inc. (Amedisys), South Carolina, agreed to pay $2,069,936.26 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Amedisys submitted claims for home health services that were not supported by proper medical documentation due to forgery.
09-02-2014
After it self-disclosed conduct to OIG, Norwalk Hospital Association (Norwalk), Connecticut, agreed to pay $330,967.29 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Norwalk employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-24-2014 OIG Enforcement Case
Iowa Skilled Nursing Facility Settles Case Involving Allegations of Employing an Excluded Individual
Rock Rapids Health Centre (RRHC), a skilled nursing facility located in Iowa, entered into a settlement agreement with the Office of Inspector General (OIG) for the Department of Health and Human Services, effective August 24, 2014. The settlement resolves allegations that RRHC employed an individual who was excluded from participating in any Federal health care programs. The excluded individual provided items and services to RRHC patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG in this case.
08-24-2014
After it self-disclosed conduct to OIG, the City of Baytown, Texas, agreed to pay $29,431.43 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the City of Baytown employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-22-2014
After it self-disclosed conduct to OIG, Rolling Hills H.C., Inc. and Fountain Lake Health and Rehab, Inc. (Rolling Hills and Fountain Lake), Arkansas, agreed to pay $117,748.32 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rolling Hills and Fountain Lake employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
08-15-2014
A physician and his wife agreed to be excluded from participating in Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician and his wife submitted claims to Federal health care programs for: (1) the treatment of migraines through the use of lengthy, multi-day dihydroergotamine (DHE) infusions, which were billed as chemotherapy and should have been provided through injection instead of infusion; and (2) office visits upcoded to a level 5 plus "prolonged services," which were not supported by the medical records and/or did not contain physician notes.
08-12-2014
After it self-disclosed conduct to OIG, Deerfield Valley Rescue, Inc. (Deerfield), Vermont, agreed to pay $71,503.06 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Deerfield employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Five Star Crossing LLC d/b/a The Form at the Crossing and Five Star Quality Care, Inc. (Fiver Star), Indiana, agreed to pay $121,855.01 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fiver Star submitted claims to Medicare for physical therapy services that were improperly documented by a physical therapist formerly employed by Fiver Star. OIG further alleged that the improper documentation included photocopied signed and unsigned physician certifications of plans of care that were whited-out, edited, and sometimes faxed back to physician for signature; and documentation that did not meet certain progress report requirements.
08-05-2014
After it self-disclosed conduct to OIG, Oregon Health & Science University (OHSU), Oregon, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OHSU employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Diagnostic Laboratories and Radiology (DLR), California, agreed to pay $1,983,907.51 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DLR employed four individuals that it knew or should have known were excluded from participation in Federal health care programs.
08-05-2014 OIG Enforcement Case
Florida Laboratory Settles Case Involving Allegations of False or Fraudulent Medicare Claims
Florida Family Laboratories, LLC (FFL), a Florida urine drug testing company, agreed to enter into a $197,400.09 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services effective August 5, 2014. The settlement resolves allegations FFL submitted false or fraudulent claims to Medicare. Specifically, OIG contends FFL submitted claims to Medicare for high complexity urine drug tests exceeding the number of units allowed by Medicare by using an inappropriate code to bypass computer programming that would have otherwise rejected such claims. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoff Hymans, collaborated to achieve this settlement.
07-31-2014
After it self-disclosed conduct to OIG, Integrated First Response - Great Lakes, LLC (IFR-GL), Michigan, agreed to pay $96,476.63 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that IFR-GL contracted with and employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-31-2014 OIG Enforcement Case
Missouri Health Care IT and Pharmacy Benefits Manager Settles Case Involving Allegations of Fraudulent Medicare Part D Claims
Argus Health Systems, Inc. - a health care information management services provider and pharmacy benefits manager headquartered in Kansas City, MO - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective July 31, 2014. Under the agreement, Argus agreed to pay OIG $2,029,210 to resolve allegations that the company submitted prescription drug event (PDE) data to Medicare that included sales tax from Louisiana pharmacies even though Medicare Part D drugs were not taxable under Louisiana law as of July 1, 2006. Specifically, OIG contends that from July 1, 2006 through December 31, 2009, Argus knowingly submitted or caused to be submitted PDE claims to the Centers for Medicare & Medicaid Services (CMS) that improperly claimed Louisiana sales tax costs. CMS then used those PDE claims to calculate Medicare payments to Part D sponsors with whom Argus contracted, which improperly increased reimbursement to the sponsors. Senior Counsel Christina McGarvey and Senior Counsel John O'Brien represented OIG in this case.
07-28-2014
After it self-disclosed conduct to OIG, Park West Surgical Center, LLC (Park West), Ohio, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Park West employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-28-2014 OIG Enforcement Case
Florida Doctor Settles Case Involving False Claims Allegations
Nabil Attalla Barsoum, M.D. (Barsoum), a Florida physician who performed in-office urine drug testing, agreed to enter into a $334,538.90 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services effective July 25, 2014. The settlement resolves allegations Barsoum submitted false or fraudulent claims to Medicare. Specifically, OIG contends Barsoum submitted claims to Medicare for low and moderate complexity urine drug tests exceeding the number of units allowed by Medicare by using an inappropriate code to bypass computer programming that would have otherwise rejected such claims. He also submitted claims for high complexity drug tests when he performed less-expensive low or moderate complexity drug tests. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoff Hymans, collaborated to achieve this settlement.
07-24-2014 OIG Enforcement Case
Tennessee Senior Living Community Chain Settles Case Involving Allegations of Employing Excluded Individuals
Brookdale Senior Living, Inc. and three subsidiaries (collectively, Brookdale) - a chain of senior living communities headquartered in Brentwood, TN - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective July 24, 2014. The $353,248.82 settlement resolves allegations that Brookdale employed two individuals who were excluded from participating in any Federal health care programs. After one of the individuals self-disclosed to OIG that she worked as a documentation trainer at Brookdale during her exclusion, OIG opened an investigation to determine if Brookdale had employed any additional excluded individuals. During the course of the investigation, Brookdale disclosed that it employed another excluded individual as a nurse during the period of her exclusion.
07-17-2014
After it self-disclosed conduct to OIG, Willow Springs, LLC (Willow Springs), Nevada, agreed to pay $475,423.86 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Willow Springs employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-14-2014
After it disclosed conduct to OIG pursuant to its Corporate Integrity Agreement, Omnicare, Inc. (Omnicare), headquartered in Ohio, agreed to pay $138,513.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Omnicare employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-11-2014 OIG Enforcement Case
Utah Health Care System Settles Case Involving Allegations of Employing Excluded Individuals
University of Utah (UOU) - a university-based health care system including 4 hospitals and 10 neighborhood health care centers - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective July 8, 2014. The $197,839.94 settlement resolves allegations that UOU employed three individuals who were excluded from participating in any Federal health care programs. OIG's investigation revealed that UOU employed an excluded nurse who provided items or services paid for by Federal health care programs. During the investigation, UOU disclosed that it employed two additional excluded persons.
07-11-2014 OIG Enforcement Case
Kentucky Long Term Care Organization Settles Case Involving Allegations of Employing An Excluded Individual
Bradford Heights Health & Rehab Center - a not-for-profit faith-based long-term-care organization in Hopkinsville, KY - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective July 1, 2014. The $30,121.82 settlement resolves allegations that Bradford employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that Bradford employed an excluded nurse to provide items or services that were reimbursed by Federal health care programs. Senior Counsel David M. Blank and Paralegal Specialist Jennifer McKoy represented OIG in this case.
07-08-2014
A clinical psychologist and her psychology practice 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 psychologist and her practice submitted, or caused to be submitted, claims to Medicare and Missouri Medicaid for services billed under the psychologist's NPI number for psychotherapy services that the psychologist did not personally perform. Specifically, OIG alleged that the psychologist and her practices submitted claims for psychotherapy services rendered in residential care facilities in Missouri using medical records that falsely represented her to be the "on-site supervising psychologist" for these services. OIG alleged that the psychologist typically was not on site or even available for consultation because the psychologist was treating patients in Texas. Further, OIG alleged that the services were actually performed by unsupervised licensed clinical professional counselors.
After it self-disclosed conduct to OIG, DJK Home Healthcare, LLC d/b/a Children's Home Healthcare (CHH), Texas, agreed to pay $318,598.43 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Central Maine Health Care Corporation and Central Maine Medical Center (CMMC), Maine, agreed to pay $164,841.90 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CMMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-26-2014
After it self-disclosed conduct to OIG, Americare Certified Special Services, Inc. (Americare), New York, agreed to pay $44,593.41 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Americare (1) submitted claims to Medicare for home health care services provided by an RN that were not rendered; and (2) submitted claims to Medicare for items or services provided by individuals who did not receive home health aide training or who lacked the requisite home health aide certificate.
06-24-2014
After it self-disclosed conduct to OIG, Hospicare and Palliative Care Services of Tompkins County, Inc. (HPC), New York, agreed to pay $10,726.68 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HCP employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-20-2014 OIG Enforcement Case
Pennsylvania Health Care Staffing Agency Settles Case Involving Allegations of Employing An Excluded Individual
ePeople Healthcare, Inc., a health care staffing agency in Pennsylvania, entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective June 20, 2014. The $10,204 settlement resolves allegations that ePeople employed an individual who was excluded from participating in any Federal health care programs. The excluded individual was a licensed practical nurse who provided items and services to nursing facilities that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG in this case.
06-20-2014
After it self-disclosed conduct to OIG, Hospice by the Sea, Inc. (HBTS), Florida, agreed to pay $428,935.46 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HBTS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Bennington Rescue Squad, Inc. (Bennington), Vermont, agreed to pay $94,441.35 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bennington employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-13-2014
After it self-disclosed conduct to OIG, Redlands Community Hospital (Redlands), California, agreed to pay $155,563.44 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Redlands employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-05-2014
After it self-disclosed conduct to OIG, Valeo Behavioral Health Care, Inc. (Valeo), Kansas, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Valeo submitted claims to Federal health care programs containing Evaluation & Management codes 99202 through 99205, which were for higher levels of services than those services actually provided.
06-04-2014 OIG Enforcement Case
CVS Pharmacy Enters into $1.2M Settlement with OIG on Double-Billing Claims
CVS Pharmacy, Inc. (CVS) entered into a settlement agreement for $1,216,147.19 with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective May 28, 2014. The settlement resolves allegations that CVS improperly submitted, or caused to be submitted, duplicate claims to both Medicare Part B and to Medicare Part D plan sponsors or the sponsors' agents. Specifically, CVS allegedly double-billed for immunosuppressant drugs for the same patients on the same date of service.

OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsel Geoffrey Hymans and Associate Counsel Katherine Matos, collaborated to achieve this settlement.
05-30-2014
Leer's Quality Home Health Care Services Inc. (Leer's), Texas, agreed to pay $39,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Leer's employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-29-2014 OIG Enforcement Case
Texas Health Care Center Settles with OIG on Charges of Employing an Excluded Individual
Rayburn Health Care & Rehabilitation (RHCR)- a nursing and rehabilitation center located in Jasper, TX- entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective May 15, 2014. The $110,712.60 settlement resolves allegations that RHCR employed an individual who was excluded from participating in any Federal health care programs. When the excluded individual applied to be reinstated into Federal health care programs, she reported on her application that she was employed by RHCR as a nurse for two years during her exclusion. During her employment tenure, she allegedly provided items or services reimbursed by Federal health care programs, which is prohibited for excluded individuals.
05-28-2014
After it self-disclosed conduct to OIG, Remington Family Dental, PLLC, Hardin Family Dental, PLLC, and Rubicon Dental Associates, PLLC (collectively, Remington), Montana, agreed to pay $24,579.93 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Remington employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-15-2014
After it self-disclosed conduct to OIG, Carteret Medical Group, LLC (Carteret), North Carolina, agreed to pay $29,493.21 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Carteret employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Kindred Nursing Centers West, LLC (Kindred), Colorado, agreed to pay $62,964.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kindred employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Brighton Operations, LLC (Brighton Operations), Colorado, agreed to pay $49,430.22 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bright Operations employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, California Cancer Associates for Research and Excellence (CCARE), California, agreed to pay $17,346.84 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CCARE billed Medicare for Evaluation and Management visits that were already covered within a grant funded by a pharmaceutical company and should have not been billed separately to Medicare.
05-09-2014
After it self-disclosed conduct to OIG Winterholler Dentistry, P.C. and Morrison Family Dentistry, P.C. d/b/a Winterholler Dentistry (collectively, Winterholler), Montana, agreed to pay $54,621.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Winterholler employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-06-2014
After it self-disclosed conduct to OIG, Uhrichsville Health Care Center, Inc. d/b/a Beacon Pointe Rehabilitation Center (Beacon Pointe), Ohio, agreed to pay $110,270.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Beacon Pointe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-01-2014
After it disclosed conduct to the OIG pursuant to its Corporate Integrity Agreement, Quest Diagnostics, Incorporated (Quest), New Jersey, agreed to pay $152,560.51 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Quest employed four individuals that it knew or should have known were excluded from participation in Federal health care programs.
04-24-2014
After it self-disclosed conduct to OIG, Kmart Corporation (Kmart), doing business in New York, agreed to pay $497,110.97 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kmart employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Immediate Homecare, Inc. d/b/a Immediate Homecare and Hospice (Immediate), Pennsylvania, agreed to pay $78,160.59 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Immediate employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-08-2014
In connection with the resolution of False Claims Act liability, an oncologist and his oncology practice agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the oncologist and his practice submitted, or caused to be submitted, claims to Medicare and Medicaid for chemotherapy drugs in excess of the amounts actually provided.
04-07-2014
After it self-disclosed conduct to OIG, Harvard Vanguard Medical Associates, Inc. (HVMA), Massachusetts, agreed to pay $168,687 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HVMA submitted claims to Medicare, Medicare's Atrius Health Pioneer Accountable Care Organization, and Massachusetts Medicaid using CPT codes 90805 and 90807 for services provided by a physician when the services rendered by the physician did not meet the coverage requirements for CPT codes 90805 and 90807.
03-20-2014
After it self-disclosed conduct to OIG, Mission Medical Associates, Inc. (MMA), North Carolina, agreed to pay $141,809.74 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MMA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-13-2014
In connection with the resolution of False Claims Act liability, an ophthalmologist agreed to be excluded from participating in Federal health care programs for a period of twenty years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the ophthalmologist presented or caused to be presented false or fraudulent claims for payment to Medicare and Medicaid for: (1) repeated Argon Laser Trabeculoplasties, a procedure used to treat open angle glaucoma, that were not reasonable and necessary; (2) repeated Lysis of Adhesion, a procedure used to correct a rare complication of cataract surgery, that were not reasonable and necessary; and (3) repeated Laser Peripheral Iridotomies, a procedure used to treat narrow angle glaucoma, that were not reasonable and necessary.
03-12-2014
After it self-disclosed conduct to OIG, Amedisys, Inc. (Amedisys), West Virginia, agreed to pay $1,974,812.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Amedisys, on behalf of its wholly-owned subsidiaries West Virginia, LLC, d/b/a Amedisys Hospice of Parkersburg (Amedisys-Parkersburg) and Tender Loving Care Health Care Services of West Virginia, LLC d/b/a Amedisys Hospice (Amedisys-St. Clairsville), submitted claims for hospice services for which the certification documents did not meet Federal health care program requirements. OIG contends the contracted medical directors at Amedisys-Parkersburg and Amedisys-St. Clairsville pre-signed blank medical forms, including certificates of terminal illness and face-to-face visit forms, which were later completed by Amedisys staff members.
03-11-2014
After it self-disclosed conduct to OIG, Community Memorial Healthcenter (CMH), Virginia, agreed to pay $52,332.41 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-07-2014
After it self-disclosed conduct to OIG, Brentwood Healthcare, Ltd. (Brentwood), Texas, agreed to pay $243,266.31 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Brentwood employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Little Flower Haven (LFH), Iowa, agreed to pay $61,054.64 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LFH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Centegra Health Systems and Centegra Primary Care, LLC (Centegra), Illinois, agreed to pay $398,053.31 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Centegra improperly submitted claims to Medicare and Medicaid for medical services performed by a physician based on CPT codes that resulted in greater payment than the code applicable to the services actually provided.
03-04-2014
HealthCare Partners, LLC (HCP), California, agreed to pay $341,309.93 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HCP employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
02-20-2014
PALMS Medical Transport, L.L.C. (PALMS), Georgia, agreed to pay $420,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PALMS submitted ambulance transport claims for Medicare beneficiaries using HCPCS billing code A0434 for one-way Specialty Care Transport (SCT) from a skilled nursing facility or residence to a non-hospital based End Stage Renal Disease entity. OIG contends that these transports did not qualify as SCT because: (1) non-hospitals-based dialysis facilities are not considered "facilities" for the purposes of SCT, and (2) PALMS did not provide medically necessary supplies and services at a level beyond the scope of the EMT-Paramedic.
02-18-2014
After it self-disclosed conduct to OIG, KTLA Properties LP d/b/a Alamitos West Healthcare Center (Alamitos), California, agreed to pay $27,617.37 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Alamitos employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-18-2014
After it self-disclosed conduct to OIG, Heritage Healthcare of Macon, LLC (Heritage), Georgia, agreed to pay $88,113.93 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Heritage employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-14-2014
Medicus Laboratories, LLC (Medicus), Texas, agreed to pay $5,000,000 for allegedly violating the Civil Monetary Penalties Law. OIG contends that Medicus submitted false or fraudulent claims to Medicare as follows: 1) by inappropriately using Modifier 59 to submit claims for payment for multiple units of HCPCS code G0431 when only a single unit may be billed per patient encounter; and 2) by inappropriately submitting claims for HCPCs codes 83986 (pH of body fluid), 82570 (creatinine, other sources), 81005 (urinalysis, qualitative or semi-quantitative, except immunoassays), and 81003 (urinalysis, by dip stick or table reagent) when the testing was for screening purposes and was not medically reasonable and necessary.
02-14-2014
After it self-disclosed conduct to OIG, Interim HealthCare of the Eastern Carolinas, Inc. (Interim HealthCare), North Carolina, agreed to pay $79,694 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Interim HealthCare employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-11-2013
A physiatrist in New Jersey, agreed to pay $1,500,000 for allegedly violating the Civil Monetary Penalties Law and agreed to be excluded from participation in Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physiatrist had improperly used chiropractors to provide physical therapy services "incident to" his professional services. Further, OIG alleged that the physiatrist submitted claims to Medicare for the provision or supervision of physical therapy and related services while he was not in the State where the services were allegedly performed.
02-10-2014
Altru Health System (Altru), North Dakota, agreed to pay $241,137.76 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Altru employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-04-2014
Arizona Bridge to Independent Living, Inc. (ABIL), Arizona, agreed to pay $85,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ABIL employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.
01-27-2014
After it self-disclosed conduct to OIG, Home Care United, Inc. (HCU), Wisconsin, agreed to pay $22,867.67 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HCU submitted claims to federal health care programs using Certifications of Medical necessity (CMNs) or Detailed Physician Orders (DPOs) that had been improperly altered by one of HCU's CMN Specialists. OIG alleged that these improper alterations included cutting and pasting physician signatures from other CMN or DPO forms; handwriting in a date or parts of numbers that had been cut off when the forms were faxed to HCU from the authorized physicians' offices; and using white out to change information.
01-27-2014
After it disclosed conduct to OIG pursuant to its Integrity Agreement, Decatur Vein Clinic, LLC, Decatur Vein Clinic, PC, and Decatur Vein Clinic Hobart, PC (Decatur), Indiana, agreed to pay $140,000.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Decatur billed and received reimbursement for catheter-infusion sclerotherapy procedures as well as other procedures for the care and treatment for varicose veins of the lower extremities that were not provided as claimed and were false or fraudulent.
01-13-2014
After it self-disclosed conduct to OIG, Spanish Fork Nursing and Rehabilitation Center (Spanish Fork), Utah, agreed to pay $10,000.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Spanish Fork employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-13-2014
After it self-disclosed conduct to OIG, Elim Care, Inc. (Elim), Minnesota, agreed to pay $11,477.34 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Elim employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
01-09-2014
After it self-disclosed conduct to OIG, Voices for Independence (Voices), Pennsylvania, agreed to pay $59,197.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Voices employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2013

12-30-2013
In connection with the resolution of False Claims Act liability, an individual who was the former president, CEO, and board chair of a nationwide provider of geriatric care 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 submitted, or caused to be submitted, claims to Medicare for allegedly engaging in upcoding by billing for services provided to beneficiaries in their homes when the services were instead provided in Assisted Living Facilities.
12-23-2013
After it self-disclosed conduct to OIG, Northland Retirement Community, Inc. (Northland), Wisconsin, agreed to pay $12,775.16 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Northland employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Humana Inc. (Humana), Kentucky, agreed to pay $1,814,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Humana submitted prescription drug event date (PDE claims) that included sales tax from Louisiana pharmacies to the Centers for Medicare & Medicaid Services (CMS) even though Medicare Part D drugs were not taxable under Louisiana law as of July 1, 2006. OIG further alleged that Humana knowingly submitted or caused to be submitted PDE claims to CMS that improperly claimed Louisiana sales tax costs and the CMS used Humana's PDE claims to calculate Medicare Part D payments.
12-19-2013
East Los Angeles Dialysis Center (ELADC), California, agreed to pay $56,094.23 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ELADC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-19-2013
After it self-disclosed conduct to OIG, Palm Drive Hospital (PDH), California, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law (CMPL) and provisions of the CMPL applicable to physician self-referrals and kickbacks. OIG alleged that PDH submitted claims for physician services provided by three providers to Medicare beneficiaries using the provider identification number of a physician who neither furnished the services nor personally supervised the services rendered. OIG further alleged that PDH knowingly charged facility fees and submitted claims for services provided at Palm Drive Medical Clinic (Clinic) when the Clinic failed to fully meet Medicare's regulations for Provider-Based Status, which resulted in improper billing of the claims disclosed. OIG also alleged that PDH paid remuneration to a physician in the form of payments for rent and other Clinic expenses. OIG further alleged that PDH paid remuneration to another physician in the form of payments under a service agreement and a recruitment agreement.
12-16-2013
After it self-disclosed conduct to OIG, Wyoming County Community Health System (WCCHS), New York, agreed to pay $15,000.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that WCCHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-15-2013
Ronald Goldberg, M.D. (Goldberg), and Haverhill Family Practice (HFP), Massachusetts, agreed to pay $162,676.94 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Goldberg and HFP submitted claims under Goldberg's billing number for services provided to nursing home patients that had been provided by nurse practitioners. OIG also alleged that Goldberg and HFP submitted claims for services that were not provided to patients because the patients were either hospitalized or no longer living.
12-13-2013
After it self-disclosed conduct to OIG, Laboratory Corporation of America (LabCorp), Virginia, agreed to pay $21,051 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LabCorp employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-13-2013
After it self-disclosed conduct to OIG, Pioneer Health Services of Newton, LLC (Pioneer), Mississippi, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pioneer employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-13-2013
After it self-disclosed conduct to OIG, Seton Family of Hospitals (Seton) d/b/a Towers Nursing Home (Towers), Texas, agreed to pay $1,139,789.65 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Seton billed for posthospital extended care services furnished at Towers using certifications and recertifications that did not meet applicable Medicare criteria.
12-11-2013
After it self-disclosed conduct to OIG, East River Medical Imaging, PC (East River), New York, agreed to pay $227,427.42 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that East River employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-05-2013
After it self-disclosed conduct to OIG, Fairview Health Services (Fairview), Minnesota, agreed to pay $37,823.57 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fairview employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-03-2013
A durable medical equipment (DME) company and its owner, agreed to pay $5,000, and to relinquish funds being held in suspension, for allegedly violating the Civil Monetary Penalties Law (CMPL) and provisions of the CMPL applicable to physician self-referrals and kickbacks. The DME company and its owner also agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the DME company in connection with their contract with a telemarketing company, made unsolicited telephone calls to Medicare beneficiaries to obtain orders for the furnishing of DME for which Medicare pays. OIG alleged that the DME company used the information obtained to submit claims to Medicare for the DME allegedly provided to the beneficiaries. OIG further contends that the DME company knew or should have known that they submitted false or fraudulent claims because they obtained the orders for the DME through telephone solicitations prohibited by the Social Security Act's DME Telemarketing Provisions. Those provisions prohibit suppliers of DME from making unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of a covered item, except in three circumstances. OIG alleged that the telemarketing calls made on behalf of the DME company did not fall into these exceptions. OIG contends that the DME company violated the CMPL by knowingly submitting Medicare claims that they knew or should have known were false or fraudulent for DME ordered pursuant to prohibited telephone solicitations. OIG also contends that the DME company offered or paid remuneration in the form of monetary payments to induce the telemarketing company to refer individuals for the provision of DME for which Medicare would pay or to arrange for or recommend ordering DME for which Medicare would pay.
After it self-disclosed conduct to OIG, Atlantic Gastroenterology, P.A. (Atlantic), North Carolina, agreed to pay $120,073.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Atlantic submitted claims for evaluation and management services provided by a former physician employee under CPT codes 99231, 99232, and 99233, that were not provided as claimed and were billed at levels unsupported by the record documentation.
11-19-2013
Best Choice Home Health Care Agency (Best Choice), Kansas, agreed to pay $93,990.32 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Best Choice employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-19-2013
IASIS Healthcare Corporation (IASIS), Utah, agreed to pay $318,035.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that IASIS employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.
11-14-2013
After it self-disclosed conduct to OIG, 60 Geneva Health Care, Inc., 840 Sherman Healthcare, Inc., and BCFL Holdings (Geneva), Ohio, agreed to pay $115,856.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Geneva employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-13-2013
Spectrum Private Care Services, Inc. (Spectrum), Kansas, agreed to pay $39,033.35 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Spectrum employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-29-2013
After it self-disclosed conduct to OIG, St. John's Health Care Corporation d/b/a St. John's Home (St. John's), New York, agreed to pay $42,556.29 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. John's submitted claims for occupational therapy services provided concurrently but billed as if provided individually.
10-25-2013
In connection with the resolution of False Claims Act liability, a pediatrician agreed to be excluded from participating in Federal health care programs for a period of twenty years under 42 U.S.C. § 1320a-7(b)(7). The OIG alleged that the pediatrician: (1) billed for urinalysis testing employing the CPT code 81001 for automated urinalysis with microscopy when no microscopy was performed and (2) billed CPT code 92585 for comprehensive auditory evoked response testing when the comprehensive test was not actually being performed.
10-24-2013
In connection with the resolution of False Claims Act liability, the CEO of a corporation that provides hospice services 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 CEO caused the submission of false claims to Medicare for hospice care provided to 19 patients who did not meet the eligibility requirements for the Medicare hospice benefit because each of these patients, during some, or all, of the period they received hospice care, did not have a medical prognosis of six months or less if their illnesses ran their normal course.
10-04-2013
The president/CEO of two urine drug testing facilities, agreed to be excluded from participating in Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the president/CEO knowingly submitted or caused to be submitted claims for urine drug testing that lacked an appropriate physician order, were medically unnecessary, and were fraudulently coded and for providing services that were reimbursable by Medicare in violation of the president/CEO's previous exclusion. OIG further alleged that the president/CEO knowingly submitted or caused to be submitted to Medicare: (1) claims for payment under a provider number that was obtained by knowingly submitting false information to the State of Michigan and the Medicare Administrative Contractor for the State of Michigan; (2) claims for payment for urine diagnostic tests that were not ordered by a physician; (3) separate claims for payment for urine diagnostic tests under separate CPT codes when only one CPT was allowed; and (4) claims for payment that were coded to circumvent computer edits in order to fraudulently increase payments from Medicare for services that were not ordered or provided.
10-02-2013
A physician agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician unbundled injections to the origin/insertion site of a tendon in a single office visit under CPT code 20551, when Medicare and Medicaid laws and regulations require such injections to be bundled and billed as a single claim under CPT code 20553.
07-26-2013
An employee of a durable medical equipment (DME) company agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the DME company employee caused unsolicited telephone calls to be made to Medicare beneficiaries to obtain orders for the furnishing of DME. The DME company later submitted claims to Medicare for DME allegedly provided to beneficiaries who had received the unsolicited telephone calls. OIG contends that the DME company employee knew or should have known that they were causing the submission of false or fraudulent claims because the orders for the DME were based on telephone solicitations prohibited by the Social Security Act's DME Telemarketing Provisions. OIG also contends that the DME company employee offered or paid remuneration in the form of monetary payments to telemarketing companies for the referral of individuals for the provision of DME that would be paid for by Medicare. OIG contends that the DME company employee's offering and paying for remuneration described above violated the Federal Anti-Kickback Statute.
A telemarketing company and its owner agreed to pay $347,000 for allegedly violating the Civil Monetary Penalties Law and provisions of the Civil Monetary Penalties Law applicable to physician self-referrals and kickbacks. The telemarketing company and its owner also agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the telemarketing company, in connection with their contract with a durable medical equipment (DME) company, made unsolicited telephone calls to Medicare beneficiaries to obtain orders for the furnishing of DME that Medicare would pay for. OIG alleged that the DME company in turn used the information to submit claims to Medicare for DME allegedly provided to beneficiaries. OIG contends that the telemarketing company knew or should have known that they were causing the submission of false or fraudulent claims because they obtained the orders for the DME through telephone solicitations prohibited by the Social Security Act's DME Telemarketing Provisions. OIG also contends that the telemarketing company solicited or received remuneration in the form of monetary payments in return for referring individuals for the provision of DME that would be paid for by Medicare.
10-18-2013
After it self-disclosed conduct to the OIG, Memphis Pathology Laboratory d/b/a American Esoteric Laboratories (AEL), Tennessee, agreed to pay $6,780.63 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that AEL employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-08-2013
After it self-disclosed conduct to the OIG, Conroe Healthcare (Conroe), Florida, agreed to pay $145,106.68 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Conroe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, The Guidance Center (Guidance), Michigan, agreed to pay $742,398 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Guidance made false records or statements material to improper claims for payment for multiple developmental disability services provided simultaneously to Medicaid patients when only one service was eligible for payment.
10-02-2013
After it self-disclosed conduct to the OIG, Valley View Regional Hospital (VVRH), Oklahoma, agreed to pay $44,307.15 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that VVRH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-30-2013
After it self-disclosed conduct to the OIG, Atmore Community Hospital (Atmore), Alabama, agreed to pay $10,996.20 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Atmore employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-27-2013
After it self-disclosed conduct to the OIG, Ocala Specialty Surgery Center, LLC (Ocala), Florida, agreed to pay $21,523.44 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Ocala employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, the City of El Paso, Texas (El Paso), agreed to pay $1,162,828.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that El Paso submitted claims to Medicare for emergency Advanced Life Support ambulance transportation services when, in actuality, the medically reasonable and necessary level of services was the lower cost emergency Basic Life Support ambulance transportation services.
09-26-2013
After it self-disclosed conduct to the OIG, Vital Signs Staffing, LLC (Vital Signs), Utah, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law. The OIG Alleged that Vital Signs employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-20-2013
After it self-disclosed conduct to the OIG, Osler HMA Medical Group, LLC (Osler), Florida, agreed to pay $13,836.99 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Osler employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-19-2013
Anchor Safe Healthcare, Inc. (Anchor Safe), Texas, agreed to pay $47,324 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Anchor Safe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-17-2013
After it self-disclosed conduct to the OIG, Center for Human Genetics, Inc. (CHG) and Dr. Jeffrey Milunsky (Dr. Milunsky), Massachusetts, agreed to pay $798,993 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CHG billed for single genetic tests over multiple dates of service, determined by the time span of the tests analysis. By doing so, CHG avoided "edits" built into the computerized payment systems of the government payors which would have prevented the payment of certain specific parts of Current Procedural Terminology codes on the same date of service. The OIG further alleged that Dr. Milunsky knowingly presented or caused to be presented claims for items or services that Dr. Milunsky should have known were not provided as claimed. Specifically, CHG, under Dr. Milunsky's National Provider Number, billed for services of genetic counselors "incident to" his own professional services when those genetic counselors did not provide such services under Dr. Milunsky's direct supervision because they were not located in the same office suite or at the same address.
09-09-2013
After it self-disclosed conduct to the OIG, Miami Behavioral Health Center, Inc. (MBHC), Florida, agreed to pay $150,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MBHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-06-2013
After it self-disclosed conduct to the OIG, Hampton Behavioral Health Center (Hampton), New Jersey, agreed to pay $30,541.49 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Hampton employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Catherine Odo Ekereuke, d/b/a Bukate Medical Supplier (Bukate), Arizona, agreed to pay $29,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bukate submitted or caused to be submitted claims to Medicare for power mobility devices and other durable medical equipment that Bukate failed to provide to beneficiaries.
08-30-2013
After it self-disclosed conduct to the OIG, Cystic Fibrosis Services, Inc. (CFS), Maryland, agreed to pay $307,877.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CFS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-12-2013
After it self-disclosed conduct to the OIG, Saint Francis Hospital and Medical Center (Saint Francis), Connecticut, agreed to pay $78,931.62 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Saint Francis employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-12-2013
Radius Specialty Hospital LLC (Radius), Massachusetts, agreed to pay $333,647.25 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Radius employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-07-2013
Two ambulance company owners agreed to be excluded from participating in Federal health care programs for ten years under 42 U.S.C. § 1320a-7(b)(7) and 42 U.S.C. § 1320a-7(b)(16). OIG alleged that the ambulance company owners (1) knowingly made or caused to be made false statements, omissions, and misrepresentations of material fact on an application to enroll as a provider of services or supplier in the Medicare program; (2) knowingly made or caused to be made false statements, omissions, and misrepresentations of a material fact in a bid to contract with a provider to furnish ambulance services and to submit claims for payment for ambulance services furnished under a Federal health care program; and (3) knowingly made or caused to be made or used a false record or statement material to a false or fraudulent claim for payment for items and services furnished under a Federal health care program.
After it self-disclosed conduct to the OIG, Dr. Susoni Health Community Services, Corp., d/b/a Dr. Cayetano Coll & Toste Regional Hospital (Cayetano), Puerto Rico, agreed to pay $381,841.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Cayetano employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-07-2013
After it self-disclosed conduct to the OIG, Hospital Doctor Susoni, Inc., d/b/a Hospital Dr. Susoni (Susoni), Puerto Rico, agreed to pay $78,229.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Susoni employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-19-2013
In connection with the resolution of False Claims Act liability, the owner of a lymphedema wound center agreed to be excluded from participating in Federal health care programs for ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the owner of the lymphedema wound center submitted claims to Medicare: (1) for physical therapy treatments that were performed by therapists who were not qualified to perform those treatments; (2) for physical therapy treatments in excess of the Medicare caps and limitations on the number of physical therapy treatments; (3) that violated the rules for "bundling" strapping/bandaging services with physical therapy treatments; and (4) for prescribing pneumatic compression pumps for Medicare beneficiaries when those pumps were not medically necessary.
07-17-2013
After it self-disclosed conduct to the OIG, North Arkansas Regional Medical Center (NARMC), Arkansas, agreed to pay $395,591.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NARMC improperly billed separately for "incident to" services that were included in its Rural Health Center payment.
07-12-2013
After it self-disclosed conduct to the OIG, Saint Luke's Health System (SLPS), Missouri, agreed to pay $142,740 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SLPS improperly billed Medicare and Medicaid for interventional radiology services furnished by a radiology practitioner assistant (RPA) in SLPS's Radiology Department. Specifically, SLPS separately and improperly billed Medicare for services furnished by an RPA even though, under Medicare rules, payment for services furnished by an RPA in a hospital setting are bundled and paid to the hospital as part of its facility payment.
07-08-2013
After it self-disclosed conduct to the OIG, Sonora Regional Medical Center (SRMC) California, agreed to pay $597,193 for allegedly violating the Civil Monetary Penalties Law. SRMC contracted with a physician to provide professional services at SRMC's medical oncology outpatient center. The OIG alleged that SRMC submitted claims containing CPT codes 99204, 99205, 99214, and 99215, that it submitted for services provided by the physician that were upcoded and that the physician engaged in a pattern or practice of coding at a higher level that he knew or should have known would result in a greater payment than the code applicable to the services he was actually providing.
07-01-2013
After it disclosed conduct to the OIG pursuant to its Corporate Integrity Agreement, Amerigroup Corporation (Amerigroup), Virginia, agreed to pay $30,754.93 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Amerigroup contracted with three individuals that it knew or should have known were excluded from participation in Federal health care programs and paid for prescriptions written by a fourth individual that it knew or should have known were excluded from participation in Federal health care programs.
06-28-2013
In connection with the resolution of False Claims Act liability, an oncology medical group practice agreed to be excluded from participating in Federal health care programs for ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the oncology medical group practice purchased drugs from a foreign drug distributor in Canada that obtained the drugs from foreign sources. OIG alleged that these drugs, sometimes with labeling in foreign languages or without dosage information, were not manufactured in establishments that were registered with the United States Food and Drug Administration (FDA). OIG alleged that the versions of the drugs that the oncology medical group practice purchased were not the subject of, and did not comply with, a new drug application, abbreviated new drug application, or biologics license application approved by the FDA for commercial marketing and, therefore, the drugs were not covered by Federal health care programs because the drugs had not received final marketing approval from the FDA.
06-19-2013
In connection with the resolution of False Claims Act liability, an oncologist and hematologist agreed to be excluded from participating in Federal health care programs for fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the oncologist and hematologist knowingly submitted false and/or fraudulent claims to Federal health care programs for: (1) quantities of drugs greater than those actually administered to patients; (2) overstating chemotherapy drug infusion times; and (3) double-billing for medications.
In connection with the resolution of False Claims Act liability, an allergist and the allergy clinic he owned agreed to be excluded from participating in Federal health care programs for a period of twenty years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the allergist through his allergy clinic submitted false claims related to Healthcare Common Procedure Codes 95004, 05165 and 99214 including: misrepresentation of services and diagnoses, overutilization of procedures, billing for unapproved hormone therapy treatments, billing for services that were not medically necessary, billing for services not rendered, and misrepresenting the provider who rendered treatment.
After it self-disclosed conduct to the OIG, Rutherford Hospital, Inc. (Rutherford), North Carolina, agreed to pay $706,090.46 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Rutherford submitted or caused to be submitted claims for physicians' services provided by a doctor to beneficiaries of Federal health care programs using the provider identification numbers of another doctor, who did not further the services. The OIG contends that Rutherford knowingly misused provider identification numbers, which resulted in improper billing of the claims identified and disclosed by Rutherford.
06-10-2013
After it self-disclosed conduct to the OIG, Mercy Clinic Oklahoma Communities, Inc. (Mercy Clinic), Oklahoma, agreed to pay $51,444.03 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mercy Clinic employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-24-2013
After it self-disclosed conduct to the OIG, Expeditive, LLC (Expeditive), New Jersey, agreed to pay $2,883.53 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Expeditive employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, SpecialtyCare Surgical Assist, LLC (SCSA), Florida, agreed to pay $247,024.19 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SCSA knowingly presented to Medicare, Medicaid, and TRICARE claims for items or services that SCSA knew or should have known were not provided as claimed and were false or fraudulent. Specifically, the OIG contends that SCSA billed the above programs for assistant-at-surgery services provided by certified surgical assistants and registered nurse first assistants, when these programs reimburse such services only if provided by physicians and/or physician assistants.
05-22-2013
Trustees of Tufts College and Tufts University School of Dental Medicine (TUSDM), Massachusetts, agreed to pay $841,120.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that TUSDM submitted claims to Medicare for various services from four of their clinics. The OIG contends that these claims were improper because the services were provided by dentists who were not credentialed by Medicare and/or the services or the code level billed were not supported by sufficient medical record documentation.
05-21-2013
Carolyn Murray-Burton, M.D. (Murray), New Jersey, agreed to pay $136,777.59 for allegedly violating the Civil Monetary Penalties Law. The OIG contends that Murray caused her employer to submit claims for reimbursement to Medicaid and Medicaid HMOs for items and services furnished by her while she did not possess a valid medical license.
After it self-disclosed conduct to the OIG, St. Peter's Hospital of the City of Albany (St. Peter's), New York, agreed to pay $16,538.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that St. Peter's employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Shahid Mansoor, M.D. doing business as Mansoor Pediatrics (Mansoor), Louisiana, agreed to pay $51,315.90 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mansoor employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-17-2013
Dr. Matthew James Britton and C.F. Health Management, Inc. d/b/a Gainesville Pain Management (Gainesville), Georgia, agreed to pay $1,577,597 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Gainesville submitted false or fraudulent claims: 1) by inappropriately using Modifiers 76 and 59, to submit claims for payment for multiple units of Healthcare Common Procedure Coding System (HCPCS) codes G0431 and G0434 when only a single unit may be billed per patient encounter; and 2) by inappropriately using Modifier QW and billing for HCPCS G0431 when the less expensive services represented by HCPCS code G0434 were actually provided.
05-10-2013
After it self-disclosed conduct to the OIG, Sutter Health Sacramento Sierra Region (SHSSR), California, agreed to pay $130,308.39 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SHSSR employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-03-2013
After it self-disclosed conduct to the OIG, Jackson Pediatric Associates, P.A. (JPA), Mississippi, agreed to pay $89,080.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that JPA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-02-2013
Visiting Nurse Association (VNA), Johnson County, Iowa, agreed to pay $33,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that VNA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-26-2013
Evergreen Oregon Healthcare Salem, LLC (Evergreen), Oregon, agreed to pay $19,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Evergreen employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-08-2013
Sergey Lugina and Executive Medical Care, P.C., (EMC), New York, agreed to pay $74,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that EMC submitted or caused to be submitted claims for medical services that were not provided as claimed and/or were false or fraudulent. The OIG alleges that these services were not provided as claimed because Sergey Lugina was on travel outside the United States during the periods when he claimed that he rendered services to beneficiaries.
04-03-2013
After it self-disclosed conduct to the OIG, RenalSouth Garden District (RSGD), Louisiana, agreed to pay $10,487.45 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that RSGD employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-11-2013
After it disclosed conduct to the OIG pursuant to its Corporate Integrity Agreement, Vanguard HealthCare, LLC (Vanguard), Tennessee, agreed to pay $159,778.00 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Vanguard employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-07-2013
In connection with the resolution of False Claims Act liability, a pharmacy owner agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the pharmacy owner submitted claims for payment for drugs that were never dispensed.
03-04-2013
After it self-disclosed conduct to the OIG, Radiology Associates, P.C. (RA) and Oregon Imaging Centers, LLC (OIC), OR, agreed to pay $189,045.28 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that OIC inappropriately billed Medicare for certain diagnostic tests provided by radiology practitioner assistants employed by RA that required personal supervision by a physician, but instead were provided under direct supervision.
02-27-2013
After it self-disclosed conduct to the OIG, Glen Haven Home, Inc. (GH), Iowa, agreed to pay $34,575.35 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that GH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-11-2013
In connection with the resolution of False Claims Act liability, a dermatologist agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the dermatologist performed medically unnecessary adjacent tissue transfers on Medicare beneficiaries and billed Medicare for evaluation and management services that were not performed.
02-08-2013
After it self-disclosed conduct to the OIG, Ability and Performance Home Care, LLC (Ability), Texas, agreed to pay $92,976.44 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Ability submitted claims to Medicare for home health care services provided to patients that included false or fraudulent documentation.
02-08-2013
After it self-disclosed conduct to the OIG, Steward Good Samaritan Medical Center, Inc. (Good Samaritan), Massachusetts, agreed to pay $15,104.13 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Good Samaritan employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-05-2013
After it self-disclosed conduct to the OIG, Swan Pointe Care Center (Swan Pointe), Ohio, agreed to pay $213,708.00 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Swan Pointe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-17-2013
After it self-disclosed conduct to the OIG, RCHP-Florence, LLC d/b/a Shoals Hospital (Shoals), Alabama, agreed to pay $45,682.02 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Shoals employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-17-2013
After it self-disclosed conduct to the OIG, Paterson Community Health Center (Paterson), New Jersey, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Paterson submitted claims for items and services furnished by an unlicensed and unregistered physician.
01-16-2013
After it self-disclosed conduct to the OIG, Bartlett Regional Hospital (Bartlett), Arkansas, agreed to pay $1,434,664.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bartlett submitted claims using incorrect physician names and NPI numbers and submitted claims for non-physician provider services that were billed under a physician's name and NPI number.

2012

12-21-2012
In connection with the resolution of False Claims Act liability, a physician agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician submitted claims to Medicare and Medicaid for a more comprehensive and complex evaluation and management service than he actually provided.
After it self-disclosed conduct to the OIG, CaroMont Medical Group, Inc. (CaroMont), North Carolina, agreed to pay $205,685.27 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CaroMont presented to the United States claims for items or services that CaroMont knew or should have known were not provided as claimed and were false or fraudulent. The OIG alleged that CaroMont purchased drugs and devices from foreign sources and provided those drugs to Federal health care program patients and billed Federal healthcare programs for those products for their biochemical equivalents sold in the United States.
11-13-2012
After it self-disclosed conduct to the OIG, Community General Hospital (CGH), NY, agreed to pay $248,362.78 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CGH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-17-2012
In connection with the resolution of False Claims Act liability, a chiropractic medical group and its four owners agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the chiropractic medical group and its four owners knowingly submitted claims to Medicare for multiple units of therapeutic activities (CPT Code 95730) for treatment sessions that did not reflect the actual time that patients were treated.
10-05-2012
After it self-disclosed conduct to the OIG, Essex Valley Healthcare, Inc., East Orange General Hospital, and Essex Valley Medical Transportation Services, Inc. (Respondents), New Jersey, agreed to pay $61,570.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the respondents employed two individuals that they knew or should have known were excluded from participation in Federal health care programs.
11-16-2012
After it disclosed conduct to the OIG pursuant to its Corporate Integrity Agreement, Touro Infirmary (Touro), Louisiana, agreed to pay $427,561.59 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Touro employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-13-2012
After it self-disclosed conduct to the OIG, Community General Hospital (CGH), NY, agreed to pay $248,362.78 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CGH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Safeway, Inc., Wyoming, agreed to pay $56,994 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Safeway, Inc. submitted claims to Medicare Part D for the branded drug Protonix when it dispensed the authorized Protonix generic drug known as pantoprazole.
10-25-2012
After it self-disclosed conduct to the OIG, Colorado Retina Associates, P.C. and Douglas Holmes, M.D. (CRA and Dr. Holmes), Colorado, agreed to pay $71,867.58 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CRA and Dr. Holmes submitted to Federal healthcare programs claims for evaluation and management services that were not provided as claimed and were false or fraudulent.
10-12-2012
After he disclosed conduct to the OIG pursuant to his Integrity Agreement, Dr. Akram Abraham d/b/a Abraham Medical Clinic (Dr. Abraham), Massachusetts, agreed to pay $43,014.80 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Abraham employed an individual that he knew or should have known was excluded from participation in Federal health care programs.
10-07-2012
After it self-disclosed conduct to the OIG, ABQ Health Partners, LLC (ABQ), New Mexico, agreed to pay $1,096,112 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ABQ submitted claims to Federal health care programs for services performed by pharmacy clinicians during new and established patient visits based on E&M codes that ABQ knew or should have known were not reimbursable.
After it self-disclosed conduct to the OIG, Home Healthcare Connection, Inc. (HHCI), Kansas, agreed to pay $81,102.06 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HHCI employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Auburn Community Hospital (ACH), New York, agreed to pay $150,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ACH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-05-2012
After it self-disclosed conduct to the OIG, Essex Valley Healthcare, Inc., East Orange General Hospital, and Essex Valley Medical Transportation Services, Inc. (Respondents), New Jersey, agreed to pay $61,570.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the respondents employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
10-04-2012
After it self-disclosed conduct to the OIG, Duke University Health System, Inc., d/b/a Duke University Hospital (Duke), North Carolina, agreed to pay $6,395.54 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Duke employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-26-2012
After it self-disclosed conduct to the OIG, North Canton Medical Foundation (NCMF), Ohio, agreed to pay $1,018,877 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NCMF submitted claims to the Federal health care programs for podiatry services which were not supported by medical documentation.
After it self-disclosed conduct to the OIG, Salida Hospital District d/b/a Heart of the Rockies Regional Medical Center (HRRMC), Colorado, agreed to pay $120,580.25 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HRRMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-25-2012
After they self-disclosed conduct to the OIG, Discovery House LT, Inc., Discovery House UC, Inc., Discovery House TV, Inc., and Discovery House Utah, Inc. (collectively, Discovery House), Utah, agreed to pay $105,794.24 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Discovery House employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-21-2012
After it disclosed conduct to the OIG pursuant to its Corporate Integrity Agreement, Decatur Vein Clinic (Decatur), Indiana, agreed to pay $41,898.94 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Decatur employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-19-2012
After it self-disclosed conduct to the OIG, East Boston Neighborhood Health Center (EBNHC), Massachusetts, agreed to pay $103,485.79 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that EBNHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Down East Community Hospital (Down East), Maine, agreed to pay $417,440.78 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Down East employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-22-2012
After it self-disclosed conduct to the OIG, Mercy Hospitals East Communities (Mercy), Missouri, agreed to pay $138,452 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mercy employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-22-2012
After it self-disclosed conduct to the OIG, House Psychiatric Clinic, Inc. and Matthew House, D.O. (collectively House), California, agreed to pay $34,849.89 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that House billed Federal health care programs for items or services that were not provided as claimed and were false or fraudulent. Specifically, House: 1) submitted claims for services provided by four unlicensed employees as if the services were provided by Dr. House; and 2) submitted claims for services provided by a Nurse Practitioner as if those services were provided by Dr. House.
08-15-2012
After it self-disclosed conduct to the OIG, Colorado Surgical Services, PC (CSS), Colorado, agreed to pay $13,616.57 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CSS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-07-2012
After it self-disclosed conduct to the OIG, Supervalu, Inc., and its subsidiaries, FF Acquisitions, LLC, Foodarama, Inc., New Albertsons, Inc., SUPERVALU Pharmacies, Inc., and Shoppers Food Warehouse Corporation (collectively Supervalu), Minnesota, agreed to pay $184,464.03 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Supervalu submitted claims to Federal health care programs for a branded drug when it dispensed the authorized generic drug.
08-07-2012
After it self-disclosed conduct to the OIG, Mental Health Center of East Central Kansas (MHCECK), Kansas, agreed to pay $35,840 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MHCECK improperly billed the Kansas Medicaid program for psychological services provided by a psychological testing assistant (PTA). Specifically, the PTA, who was not licensed to provide or bill for psychological evaluations, was instructed by one of MHCECK's licensed clinical psychologists (clinician) to perform psychological testing and write test interpretations and evaluation reports without the clinician ever having interviewed or seen the patients. MHCECK billed the services to Medicaid under the clinician's provider number.
08-02-2012
After it self-disclosed conduct to the OIG, Albany Memorial Hospital (AMH), New York, agreed to pay $206,669.53 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that AMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-01-2012
After it self-disclosed conduct to the OIG, Laurence Rosenfield, M.D., P.A., and Spinal Diagnostics & Interventional Pain Medicine (SDIPM), Texas, agreed to pay $110,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Rosenfield and SDIPM, through a contracted company, improperly billed Federal health care programs for services provided by a physician that did not have a Medicare provider number. The services were billed using Dr. Rosenfield's provider number.
07-24-2012
After it self-disclosed conduct to the OIG, Billings Clinic (Billings), Montana, agreed to pay $284,098.55 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Billings employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-25-2012
Stephan P. Babirak, Ph.D. M.D. (Babirak) and Metabolic Leader, LLC, PA (Metabolic Leader), Maine, agreed to pay $17,087.58 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Babirak and his medical practice, Metabolic Leader, improperly billed Medicare for: (1) new patient Evaluation & Management (E&M) office visits for pre-existing patients; (2) upcoded E&M office visits; and (3) services provided by nurse practitioners that were billed under Babirak's provider number when he was not in the office.
07-24-2012
After it self-disclosed conduct to the OIG, Dartmouth-Hitchcock, Vermont, agreed to pay $65,934.00 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dartmouth-Hitchcock submitted claims to Medicare and Medicaid for outpatient ambulatory clinic visits provided by a physician that were not supported by medical record documentation.
07-13-2012
After it self-disclosed conduct to the OIG, The Village of Wilkes (Wilkes), North Carolina, agreed to pay $207,440.19 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Wilkes employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-11-2012
Dr. Jorge Zamora-Quezada, Texas, agreed to pay $83,481.22 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Jorge Zamora-Quezada employed an individual that he knew or should have known was excluded from participation in Federal health care programs.
07-06-2012
After it self-disclosed conduct to the OIG, the Treatment and Learning Centers, Inc. (TLC), Maryland, agreed to pay $28,214.16 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that TLC knowingly presented claims for items or services that TLC knew or should have known were not provided as claimed and were false or fraudulent. The OIG alleged that TLC improperly submitted claims to Medicare for services rendered by two audiologists, using the Medicare enrollment information and National Provider Identifier of a third audiologist employed by TLC.
07-05-2012
After it self-disclosed conduct to the OIG, Seasons Hospice and Palliative Care of Southern Florida, Inc. (Seasons), Florida, agreed to pay $73,428.48 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Seasons employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-27-2012
Cooperative Home Care (Cooperative), Missouri, agreed to pay $121,010 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Cooperative employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, The Memorial Hospital at North Conway, New Hampshire (TMH) agreed to pay $20,479.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that TMH submitted upcoded claims to Medicare and Medicaid for Evaluation & Management services provided by one of TMH's physicians.
06-19-2012
In connection with the resolution of False Claims Act liability, a physician agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician submitted or caused to be submitted claims to Medicaid: (1) by issuing prescriptions for Tramadol to patients that were without legitimate medical purpose or not in the usual course of professional treatment; and (2) for office visits with patients that were for services that were not medically necessary and/or not adequately supported by medical record documentation.
Hy-Vee, Inc., Iowa, agreed to pay $831,871.61 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Hy-Vee, Inc. employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-15-2012
After it self-disclosed conduct to the OIG, Robert Jacobson Pharmacy (RJP), New York, agreed to pay $164,842.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that RJP employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-07-2012
Jennings Healthcare Center (Jennings), Indiana, agreed to pay $81,704.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Jennings employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, University Eye Surgeons, P.C. (University), Tennessee, agreed to pay $19,429 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that University employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-06-2012
On With Life, Iowa, agreed to pay $77,586 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that On With Life employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-05-2012
The owner of a company that supplies durable medical equipment (DME) agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the DME supply company owner knowingly submitted or caused to be submitted false or fraudulent claims to the Medicare program. Specifically, OIG alleged that the DME supply company owner: (1) billed for an item of durable medical equipment that was never provided to the beneficiary; (2) billed for 13 motorized wheelchairs when less expensive power scooters were actually provided to beneficiaries; and (3) billed for items of durable medical equipment before the items were actually provided to the beneficiaries.
05-31-2012
After it self-disclosed conduct to the OIG, HCM Management, Inc. (HCM), Iowa agreed to pay $200,812.31 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HCM employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, HCM Management, Inc. (HCM), Iowa, agreed to pay $200,812.31 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HCM employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
05-25-2012
In connection with the resolution of False Claims Act liability, the owner of a company that supplies durable medical equipment (DME) agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the DME supply company owner knowingly submitted or caused to be submitted claims when he was not approved by Medicare and was ineligible to receive Medicare and TRICARE reimbursements.
In connection with the resolution of False Claims Act liability, two co-owners of a hospice agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the hospice co-owners submitted claims for payment to Medicare for some patients who were either completely or partially hospice ineligible or were provided a higher level of hospice care than was necessary or allowable.
05-10-2012
After it self-disclosed conduct to the OIG, Animas Corporation (Animas), Pennsylvania, agreed to pay $1,683,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Animas submitted reimbursement to Medicare and Medicaid for infusion pumps and supplies that were based upon documentation that included signed written orders received from physicians which had been altered without the physician's approval.
05-09-2012
Halls Physicians Services (HPS), Tennessee, agreed to pay $51,972.20 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HPS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-27-2012
Bloomington Podiatry Center (BPC), Indiana, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BPC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-16-2012
Baypointe Nursing Home, Inc. d/b/a Baypointe Rehabilitation & Skilled Care Center (Baypointe), Massachusetts, agreed to pay $351,255.44 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Baypointe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-03-2012
After it self-disclosed conduct to the OIG, Transitional Services for New York, Inc. (TSNYI), New York, agreed to pay $141,275 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that TSNYI submitted to Medicare upcoded claims for reimbursement for outpatient psychotherapy and psychiatric services.
04-02-2012
The manager of a medical group practice agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the medical group practice manager caused the submission of claims to Medicare for medically unnecessary diagnostic tests that were not ordered by a physician.
03-26-2012
After it self-disclosed conduct to the OIG, Southern Maine Medical Center (SMMC), Maine, agreed to pay $76,529.81 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SMMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-20-2012
Ronald V. Myers, Sr., M.D. (Myers), Mississippi, agreed to pay $25,500 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Myers caused improper claims to be submitted to Medicare from Select Care, Inc. and Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Myers did not personally render or did not directly supervise.
03-01-2012
In connection with the resolution of False Claims Act liability, a physician agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician improperly billed Medicare for medically unnecessary pain injections that were administered by an unlicensed medical assistant. As part of the False Claims Act settlement, the physician admitted that he allowed his unlicensed medical assistant to administer at least 80% of the pain injections.
02-20-2012
In connection with the resolution of False Claims Act liability, the marketing director of a mobile ultrasound company agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the mobile ultrasound company marketing director knowingly caused the submission of false claims for ultrasound services that were never ordered or performed.
02-13-2012
After it self-disclosed conduct to the OIG, Reid Hospital & Health Care Services, Inc. (Reid), Indiana, agreed to pay $96,645.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Reid made and used false records to secure payment of false and fraudulent claims for items and services furnished under Medicare.
01-25-2012
A radiation oncologist agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the radiation oncologist knowingly submitted or caused the submission of false or fraudulent claims to Medicare, under various CPT codes, by: (1) excessively billing; (2) lacking documentation justifying the level of services billed; (3) billing for professional components of tests when only technical components were provided; and (4) billing under more complex CPT codes when less complex procedures were actually performed.
01-20-2012
After it self-disclosed conduct to the OIG, Senior Select Home Health Services (Senior Select), Texas, agreed to pay $41,125.51 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Senior Select knowingly presented claims for items or services that Senior Select knew or should have known were not provided as claimed and were false or fraudulent.
01-19-2012
LP Lexington Pimlico, LLC d/b/a Bluegrass Care and Rehabilitation Center (Bluegrass), Kentucky, agreed to pay $11,994.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bluegrass employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-17-2012
Buchanan County Health Center (BCHC), Iowa, agreed to pay $406,030 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BCHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-10-2012
After it self-disclosed conduct to the OIG, Superior Medical Supply, Inc. (SMSI), Tennessee, agreed to pay $20,649.81 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SMSI employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-06-2012
Nathaniel Brown, M.D. (Brown), Mississippi, agreed to pay $108,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Brown caused improper claims to be submitted to Medicare from Mississippi Care Partners, Inc., for physical therapy and related health care items or services that Brown did not personally render or did not directly supervise.

2011

12-22-2011
The owner of a pain clinic agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the pain clinic owner improperly billed or caused to be billed claims using CPT Code 97032 rather than G0329 for the provision of Microvas treatment. OIG alleged that Microvas and other electrical stimulation/electromagnetic therapy (ES/ET) devices are only covered for treatment of chronic Stage III or Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that have not healed within 30 days after occurrence following appropriate standard wound therapy. OIG alleged that Medicare was billed for treatment of patients with neuropathy, rather than with ulcer/wound conditions contained in the National Coverage Determination. Further, OIG alleged that ES/ET is covered by Medicare, if performed by a physician, physical therapist, or incident to a physician service. OIG alleged that many of the Microvas procedures billed to Medicare were performed by the pain clinic owner or other unlicensed office staff.
11-30-2011
After it self-disclosed conduct to the OIG, Evergreen Health Center, P.C. (Evergreen), Missouri, agreed to pay $83,012.58 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that one of Evergreen's independent contracting psychologists submitted claims for services not provided.
11-22-2011
After it self-disclosed conduct to the OIG, Waukesha Memorial Hospital, Inc. and ProHealth Care Medical Associates, Inc. (collectively, Waukesha), Wisconsin, agreed to pay $38,375.37 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Waukesha employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-03-2011
In connection with the resolution of False Claims Act liability, the chief operating officer (COO) of an ambulance company agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the ambulance company COO caused to be submitted for payment claims falsely representing to Medicare and Medicaid that Advanced Life Support (ALS) services were appropriate and furnished by ambulance personnel when in fact no ALS-service was rendered and/or the patient did not require an ALS transport.
09-15-2011
In connection with the resolution of False Claims Act liability, the biller for a clinic specializing in obstetrics and gynecology (OB/GYN) agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the biller for the OB/GYN clinic unbundled services or billed for different services than actually provided.
08-29-2011
Mainstream Living, Inc. (Mainstream), Iowa, agreed to pay $132,925.49 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mainstream employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-18-2011
In connection with the resolution of False Claims Act liability, a medical group practice agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that a physician at the medical group practice represented in patient medical records and reimbursement claims to Medicare and Medicaid that he examined and evaluated numerous patients using CPT Code 99214, although the requirements set forth in CPT Code 99214 were not met. OIG also alleged that the physician did not write prescriptions that authorized routine refills, which resulted in unnecessary and or upcoded office visits.
06-24-2011
An anesthesiologist agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the anesthesiologist billed for a consultation every time he performed a catheterization for another physician and that the consultations were not ordered by the other physician, as required by Medicare, or performed by the anesthesiologist.
06-23-2011
In connection with the resolution of False Claims Act liability, a psychotherapy practice and its two owners, a social worker and a psychologist, 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 psychotherapy practice and its two owners submitted claims for payment to Medicare for social worker consultation services that were falsely represented to have taken place face to face.
05-31-2011
In connection with the resolution of False Claims Act liability, a physician and his practice agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician and his practice submitted, or caused to be submitted, improper claims to Medicare and Medicaid for: (1) nursing facility care services allegedly performed on patients located in nursing homes when, in fact, those patients were not present in the nursing homes but were instead hospital inpatients; and (2) hospital care services in which the medical note in the patient's chart reflected that the services in question were performed by hospital residents or Advanced Practice Registered Nurses, and the physician merely countersigned the note and did not include his own note to reflect any services he allegedly performed as the attending physician.
03-31-2011
In connection with the resolution of False Claims Act liability, the owner of a company that sold diabetic shoe inserts agreed to be excluded from participating in Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that diabetic shoe insert company owner: (1) sold custom diabetic shoe inserts that were not, in fact, custom as defined by Medicare because they were not created with a unique image of each foot; and (2) sold heat moldable diabetic shoe inserts that did not comply with the Medicare requirements for those inserts and did not conform to the heat moldable diabetic inserts that were submitted to Medicare for coding verification.
03-22-2011
After it self-disclosed conduct to the OIG, Mary Imogene Bassett Hospital d-b-a Bassett Medical Center (Bassett), New York, agreed to pay $18,084 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bassett submitted claims to Medicare and Medicaid for a multiple view non-invasive physiologic vascular study and instead delivered a single view non-invasive physiologic vascular study.
03-21-2011
Betty J. Feir, PhD, Texas, agreed to pay $61,270 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Feir submitted claims to Medicare for initial diagnostic services performed by auxiliary personnel instead of her and for services performed by auxiliary personnel while she was not present and did not provide direct supervision.
11-17-2011
After it self-disclosed conduct to the OIG, Pitt County Memorial Hospital (PCMH), North Carolina, agreed to pay $68,479.04 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PCMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-14-2011
After it self-disclosed conduct to the OIG, Providence Hospital, Alabama, agreed to pay $5,938.54 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Providence Hospital employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-12-2011
In connection with the resolution of False Claims Act liability, an individual who was the owner, president and CEO of an intra-operative neurophysiology testing service 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 submitted, or caused to be submitted, claims to Medicare for intraoperative neurophysiology testing services, billed pursuant to CPT code 99920, that contained an excessive number of units/hours and/or were provided by the same monitoring physician to multiple patients simultaneously, contrary to the relevant Medicare policy.
11-02-2011
After it self-disclosed conduct to the OIG, Sonoma Healthcare Center (SHC), California, agreed to pay $106,650.11 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-01-2011
Phillip L. Barnes, D.O. (Barnes), Mississippi, agreed to pay $49,419 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Barnes caused improper claims to be submitted to Medicare from Select Care, Inc. and Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Barnes did not personally render or did not directly supervise.
Reginald W. Stewart, (Stewart), Mississippi, agreed to pay $88,810 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Stewart caused improper claims to be submitted to Medicare from Mississippi Care Partners, Inc. and Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Stewart did not personally render or did not directly supervise.
10-26-2011
After it self-disclosed conduct to the OIG, New York City Health and Hospital Corporation (HHC), New York, agreed to pay $442,909.35 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HHC employed eight individuals that it knew or should have known were excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Conestoga View Nursing, L.P. d/b/a Conestoga View, Pennsylvania, agreed to pay $264,879.84 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Conestoga View employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-12-2011
In connection with the resolution of False Claims Act liability, a physician agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician caused the submission of claims to Medicare and Medicaid for his office visits that were false or fraudulent because they did not accurately reflect the level of professional service that he provided to the beneficiaries.
10-06-2011
After it self-disclosed conduct to the OIG, Blue Hill Memorial Hospital (BHMH), Maine, agreed to pay $40,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BHMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-20-2011
After it self-disclosed conduct to the OIG, Maine Coast Memorial Hospital (MCMH), Maine, agreed to pay $186,398.71 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MCMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-15-2011
Jenq-Sheng Liu, Jenq-Sheng Liu, M.D., P.S.C. d/b/a Blue Grass Women's Clinic, and Su-Mei Liu, (defendants), Kentucky, agreed to pay $58,952.57 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the defendants fraudulently billed Medicaid for six different Current Procedural Terminology codes. Su-Mei Liu agreed to a five-year period of exclusion from all Federal health care programs.
09-06-2011
After it self-disclosed conduct to the OIG, Cape Cod Hospital (CCH) a subsidiary of Cape Cod Healthcare, Inc., Massachusetts, agreed to pay $115,605.36 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CCH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-06-2011
After it self-disclosed conduct to the OIG, Visiting Nurse Association of Cape Cod (VNA) a subsidiary of Cape Cod Healthcare, Inc., Massachusetts, agreed to pay $278,169.84 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that VNA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-30-2011
After it self-disclosed conduct to the OIG, St. Joseph Health Services of Rhode Island (St. Joseph), Rhode Island, agreed to pay $123,032 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that St. Joseph employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-23-2011
Savient Pharmaceuticals, Inc. (Savient), New Jersey, agreed to pay $100,000 to resolve Civil Monetary Penalties liability under the Medicaid Drug Rebate Program. Savient failed to submit pricing information and to pay a rebate to state Medicaid programs for covered drugs that the state Medicaid programs reimburse.
08-19-2011
After it self-disclosed conduct to the OIG, Hospice of the Finger Lakes (HFL), New York, agreed to pay $35,831.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HFL employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-09-2011
After it self-disclosed conduct to the OIG, Kmart Corporation (Kmart), Indiana, agreed to pay $945,021.19 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Kmart employed four individuals that it knew or should have known were excluded from participation in Federal health care programs.
08-09-2011
After it self-disclosed conduct to the OIG, North American Partners in Anesthesia (NAPA), New York, agreed to pay $506,231 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that five physicians formerly associated with NAPA had furnished services at a gastroenterologist's office that inaccurately reflected procedures as having been done on two separate days when they were actually done on a single day. The false statements resulted in higher charges and caused NAPA to submit false claims in connection with those services.
07-25-2011
After it self-disclosed conduct to the OIG, Trustees of Indiana University (IU), Indiana, agreed to pay $603,522 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that IU improperly claimed services provided by third and fourth year students in its professional optometry degree program under the physician fee schedule. The services could not be properly claimed under the physician fee schedule because the students were not in a graduate medical education program and the services were not provided in a teaching hospital or teaching setting.
07-22-2011
After it self-disclosed conduct to the OIG, Health Management Services, Inc. (HMS), Louisiana, agreed to pay $6,545.61 for allegedly violating the Civil Monetary Penalties Law. Specifically, HMS disclosed the alteration of continuous positive airway pressure downloads for patients by two individuals at HMS in order to obtain Federal health care program reimbursement.
07-22-2011
After it self-disclosed conduct to the OIG, Margaret R. Pardee Memorial Hospital (Pardee), North Carolina, agreed to pay $94,729 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Pardee employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-18-2011
After it self-disclosed conduct to the OIG, Premier Health Care Services (PHCS), Ohio, agreed to pay $39,039 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PHCS's wholly owned subsidiary, Lucas County Emergency Physicians (LCEP), submitted false claims to Medicare and Medicaid. Specifically, while employed by LCEP, a physician provided physician services at two hospitals where he improperly billed Medicare and Medicaid under the physician fee schedule for services which were performed by residents only.
07-18-2011
After it self-disclosed conduct to the OIG, Mercy Health Partners (MHP), Ohio, agreed to pay $82,855 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that two of MHP's hospitals, St. Vincent Mercy Medical Center and St. Charles Mercy Hospital, submitted false claims to Medicare and Medicaid. Specifically, a physician improperly billed under the physician fee schedule for physician services which were performed by residents only.
06-10-2011
After it self-disclosed conduct to the OIG, Valley Obstetrics and Gynecology (VOG), Washington, agreed to pay $72,439.62 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that VOG employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-22-2011
After it self-disclosed conduct to the OIG, University of Nevada School of Medicine (UNSOM), Nevada, agreed to pay $138,321.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that UNSOM submitted or caused to be submitted claims for physicians' services provided by two physicians to beneficiaries of Federal health care programs using the provider identification numbers of two physicians who did not furnish the services.
06-21-2011
Daniel Herrington, the owner of One Source Medical Services a durable medical equipment (DME) company, Florida, agreed to pay $124,141.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Herrington, through the DME company, billed Medicare for custom molded diabetic shoe inserts when in fact only prefabricated inserts were provided to beneficiaries.
06-10-2011
After it self-disclosed conduct to the OIG, WellStar Cobb Hospital (WCH), Georgia, agreed to pay $9,216.73 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that WCH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-06-2011
After it self-disclosed conduct to the OIG, University of North Texas Health Science Center at Fort Worth (UNTHSC), Texas, agreed to pay $859,500 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that UNTHSC submitted claims for physicians' services provided to beneficiaries of Federal health care programs using the provider identification numbers of 103 physicians who neither furnished the service nor personally supervised the services rendered.
05-13-2011
After it self-disclosed conduct to the OIG, Internal Medicine Associates (IMA), Indiana, agreed to pay $58,573.55 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that IMA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-12-2011
Beth Israel Deaconess Medical Center in Boston, Massachusetts (BIDMC) agreed to pay $233,932.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BIDMC improperly billed Medicare for Lupron drug injections to male patients under HCPCS Code J1950 when BIDMC should have known that the proper code for these claims was the lower reimbursed HCPC Code J9217.
05-12-2011
Beth Israel Deaconess Hospital in Needham, Massachusetts (BIDH-N) agreed to pay $59,701.60 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BIDH-N improperly billed Medicare for Lupron drug injections to male patients under HCPCS Code J1950 when BIDH-N should have known that the proper code for these claims was the lower reimbursed HCPCS Code J9217.
05-10-2011
After it self-disclosed conduct to the OIG, Colorado-Fayette Medical Center (CFMC), Texas, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CFMC presented claims for items or services that it knew or should have known were not provided as claimed and were false or fraudulent.
04-29-2011
Gary Sinopoli, Jr., M.D. (Sinopoli), Mississippi, agreed to pay $133,333.16 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Sinopoli caused improper claims to be submitted to Medicare from Progressive Physical Medicine, Inc., for physical therapy and related health care items or services that Sinopoli did not personally render or did not directly supervise.
Fort Smith Regional Healthcare Foundation (Foundation), Arkansas, agreed to pay $233,000 to resolve Sparks Health System's (Sparks) liability for allegedly violating the Civil Monetary Penalties Law. The Foundation was created from the sale of Sparks and bears liability for this settlement. Sparks self-disclosed conduct to the OIG and the OIG alleged that Sparks presented claims for items that it knew or should have know were false or fraudulent.
04-06-2011
After it self-disclosed conduct to the OIG, Calvin Community, Iowa, agreed to pay $56,663 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Calvin Community employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-21-2011
Betty J. Feir, PhD, Texas, agreed to pay $61,270 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Feir billed Federal health care programs for services provided by auxiliary personnel instead of her and for services performed by the auxiliary personnel while she was not present.
03-11-2011
Deaconess Hospital (Deaconess), Indiana, agreed to pay $76,592.52 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Deaconess employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-09-2011
Herman T. Palmer, M.D. (Palmer), Mississippi, agreed to pay $29,200 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Palmer caused improper claims to be submitted to Medicare from Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Palmer did not personally render or did not directly supervise.
02-07-2011
Logan Emergency Ambulance Service Authority (Logan), West Virginia, agreed to pay $79,176 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Logan employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2010

12-21-2010
Edward D. Henderson, Jr., M.D. (Henderson), Mississippi, agreed to pay $68,100 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Henderson caused improper claims to be submitted to Medicare from Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Henderson did not personally render or did not directly supervise.
12-21-2010
Chadley T. Vega, M.D. (Vega), Mississippi, agreed to pay $46,200 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Vega caused improper claims to be submitted to Medicare from Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Vega did not personally render or did not directly supervise.
11-24-2010
After it self-disclosed conduct to the OIG, Miami County Medical Center (MCMC), Kansas, agreed to pay $403,935.30 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MCMC billed Medicare for physical therapy services that lacked sufficient documentation.
11-22-2010
Long Term Care, Inc. (LTC), North Carolina, agreed to pay $170,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that LTC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-20-2010
After it self-disclosed conduct to the OIG, Alliance Nursing, Inc. (Alliance), Washington, agreed to pay $14,907.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Alliance employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-18-2010
Signature Healthcare, LLC (Signature), California, agreed to pay $104,747.06 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Signature employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-30-2010
After it self-disclosed conduct to the OIG, Northeast Georgia Physicians Group, Inc. (NEGPG), Georgia, agreed to pay $64,494.92 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NEGPG billed Federal health care programs for services provided by physicians, but billed the services under the names of physicians who did not provide the services.
After it self-disclosed conduct to the OIG, Pocahontas Community Hospital (PCH), Iowa, agreed to pay $6,001.15 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PCH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-09-2010
After it self-disclosed conduct to the OIG, Mercy Medical Center and St. Alexius Medical Center (collectively the Centers), North Dakota, agreed to pay $88,331.63 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Centers' employed the same individual that they knew or should have known was excluded from participation in Federal health care programs.
09-02-2010
After it self-disclosed conduct to the OIG, Elmhurst Outpatient Surgery Center, LLC (Elmhurst), Illinois, agreed to pay $126,525 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Elmhurst submitted false claims to Medicare for services that were not provided as claimed.
08-30-2010
After it self-disclosed conduct to the OIG, Catholic Healthcare West, Bakersfield Memorial Hospital, and Community Hospital of San Bernardino (collectively CHW), CA, agreed to pay $243,819.28 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CHW employed five individuals that it knew or should have known were excluded from participation in Federal health care programs.
08-19-2010
Hackley Professional Pharmacy, Inc. (Hackley), Michigan, agreed to pay $158,565.97 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Hackley employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-18-2010
After it self-disclosed conduct to the OIG, Beaches Open MRI of Tamarac, LLC (Beaches MRI), Florida, agreed to pay $48,384.10 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Beaches MRI employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-10-2010
After it self-disclosed conduct to the OIG, Five Star Quality Care, Inc. (Five Star), Massachusetts, agreed to pay $677,210 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Five Star employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.
08-03-2010
After it self-disclosed conduct to the OIG, Middle Tennessee Medical Center, Inc. (MTMC), Tennessee, agreed to pay $19,830.94 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MTMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-26-2010
After it self-disclosed conduct to the OIG, Mt. Tam Orthopedics, Inc. (Mt. Tam), California, agreed to pay $106,649.06 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mt. Tam employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-09-2010
Beechwood Rehabilitation and Nursing Center (BRNC), Connecticut, agreed to pay $42,203 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BRNC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-29-2010
After it self-disclosed conduct to the OIG, New Vista Health Services (NVHS), California, agreed to pay $86,967 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NVHS submitted false claims to the United States for blood glucose monitoring and wound care products.
06-28-1020
After it self-disclosed conduct to the OIG, Adventist Health System d/b/a Huguley Memorial Medical Center (Adventist), Texas, agreed to pay $68,831.82 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Adventist employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-25-2010
After it self-disclosed conduct to the OIG, South Pasadena Convalescent Hospital (SPCH), California, agreed to pay $142,731.56 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SPCH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Highland Park Skilled Nursing & Wellness Centre (Highland), California, agreed to pay $10,640.81 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Highland employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-22-2010
After it self-disclosed conduct to the OIG, East Boston Neighborhood Health Center (EBNHC), Massachusetts, agreed to pay $200,962 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that EBNHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, San Juan Regional Medical Center (SJRMC), New Mexico, agreed to pay $197,098.07 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SJRMC employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
06-14-2010
Lake Region Lutheran Home d/b/a Heartland Care Center (Heartland), North Dakota, agreed to pay $133,973.28 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Heartland employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-11-2010
After it self-disclosed conduct to the OIG, AdCare Hospital of Worcester (AHW), Massachusetts, agreed to pay $254,820 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that AHW employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-10-2010
After it self-disclosed conduct to the OIG, University of Arkansas for Medical Sciences (UAMS), Arkansas, agreed to pay $201,689.98 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that UAMS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-04-2010
After it self-disclosed conduct to the OIG, Providence Health System - Southern California (PHS) agreed to pay $105,219.49 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-03-2010
After it self-disclosed conduct to the OIG, New York Downtown Hospital (NYDH) agreed to pay $220,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NYDH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-26-2010
After it self-disclosed conduct to the OIG, Beth Israel Deaconess Medical Center (BIDMC), Massachusetts, agreed to pay $99,787.75 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BIDMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-25-2010
After it self-disclosed conduct to the OIG, South Lincoln Hospital District d/b/a South Lincoln Medical Center (SLMC), Wyoming, agreed to pay $37,736.72 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SLMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-20-2010
Elder Service Plan of the North Shore (ESPNS) agreed to pay $308,709.00 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ESPNS contracted with a dentist that ESPNS should have known was excluded from participation in Federal health care programs. ESPNS participates in the Program of All-Inclusive Care for the Elderly (PACE), which receives funding from the Medicare and Medicaid programs.
05-18-2010
After it self-disclosed conduct to the OIG, Tenet Healthcare Corporation and Tenet HealthSystem KNC, Inc., (collectively Tenet), California, agreed to pay $1.9 million for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Tenet submitted claims to the Federal health care programs for clinical research-related items or services rendered at a hospital that were billed to or reimbursed by the Federal health care programs, including: 1) items or services that were paid for by clinical research sponsors or grants under which the clinical research was conducted; 2) items or services that were indicated as free of charge in the research informed consent; 3) items or services that were for research purposes only and not for the clinical management of the patient; and/or 4) items or services that were otherwise not covered under the Centers for Medicare and Medicaid Services Clinical Trial Policy.
05-17-2010
After it self-disclosed conduct to the OIG, State University of New York Upstate Medical University Hospital (SUNY), New York, agreed to pay $11,799.29 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SUNY employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-11-2010
After it self-disclosed conduct to the OIG, PolyMedica Corporation (PolyMedica), Florida, agreed to pay $151,963.40 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PolyMedica employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-29-2010
After it self-disclosed conduct to the OIG, LRG Healthcare d/b/a Lakes Region General Hospital (LRGH), New Hampshire, agreed to pay $42,900.75 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that LRGH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-14-2010
After it self-disclosed conduct to the OIG, Kinney Drugs (Kinney), New York, agreed to pay $8,002.95 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that a Kinney pharmacist filled unauthorized telephone prescriptions and submitted claims for those prescriptions to Medicare.
After it self-disclosed conduct to the OIG, Alpine Health Clinic (Alpine), California, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Alpine submitted false claims for services that were never provided.
04-01-2010
After it self-disclosed conduct to the OIG, La Videa Llena, Inc. (LVL) New Mexico, agreed to pay $250,078.11 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that LVL submitted false claims to the United States for oxygen services.
Robert J. Kramer and Kramer Physical Therapy Associates, Inc. (KPTA), Massachusetts, agreed to pay $122,474 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Kramer and KPTA improperly billed Medicare for physical therapy services that were not properly supervised by a licensed physical therapist.
01-13-2010
After they self-disclosed conduct to the OIG, Bel Pre Leasing Co, LLC, Liberty Leasing Co, LLC, Marlboro Leasing Co, LLC, Fayette Leasing Co, LLC, RMNH EMP, LLC, CHSI EMP, LLC, Communicare of Columbus, Inc., Prime Care Four, LLC, Regency Leasing Co, LLC, and Resident Care Consulting, LLC, Ohio, agreed to pay $135,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the entities employed two individuals that they knew or should have known were excluded from participation in Federal health care programs.

2009

12-16-2009
After it self-disclosed conduct to the OIG, The Neurological Institute, P.A., f/k/a Neurology Consultants of the Carolinas, P.A. (Institute), North Carolina, agreed to pay $181,851 for allegedly violating the Civil Monetary Penalty Law. The OIG alleged that the Institute improperly submitted claims to Medicare and Medicaid for (1) a physician's services (or an item or service incident to a physician's service) when the individual who furnished the service was not a physician; (2) services provided by a physician, when the services were not actually provided by that physician; and (3) services provided based on codes that the Institute knew or should have known would result in greater payments to the Institute than the codes applicable to the services actually provided.
11-30-2009
After it self-disclosed conduct to the OIG, Fundamental Administrative Services, LLC, THI of Kansas at Indian Creek, LLC, and Mulberry Manor, LLC, Maryland, agreed to pay $15,313.80 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that each employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-10-2009
After it self-disclosed conduct to the OIG, Heartland Surgical Specialty Hospital (Heartland), Kansas, agreed to pay $33,187 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Heartland employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-31-2009
After it self-disclosed conduct to the OIG, Winslow House, LLC (Winslow), Iowa, agreed to pay $9,500.51 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Winslow employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-22-2009
After it self-disclosed conduct to the OIG, University Pediatricians, Michigan, agreed to pay $91,782.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that a former physician employee of University Pediatricians failed to follow policies and procedures for claims submitted to Medicare and Medicaid for services provided by Pediatric Gastroenterology Fellows under her supervision. Specifically, the physician employee occasionally instructed Fellows to use pre-printed forms indicating that she accompanied the Fellows during patient visits. The physician employee used these forms at times when she was present during patient visits, as well as at times when she was not present.
10-16-2009
After it self-disclosed conduct to the OIG, Coram, Inc., New York, agreed to pay $72,500 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Coram, Inc. employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-15-2009
After it self-disclosed conduct to the OIG, ABCM Corporation, Iowa, agreed to pay $40,137 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ABCM Corporation employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Margaretville Memorial Hospital and Margaretville Nursing Home, Inc., New York, agreed to pay $80,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Margaretville inappropriately billed Medicare Part D and State health care plans for drugs provided by Margaretville Hospital to Margaretville Nursing Home residents when the residents were covered by Medicare Part A.
09-08-2009
After it self-disclosed conduct to the OIG, Pocahontas Manor Care Center (PMCC), Iowa, agreed to pay $106,862 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PMCC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-11-2009
After it self-disclosed conduct to the OIG, Medicalodge of Butler (Medicalodge), Missouri, agreed to pay $67,715.26 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Medicalodge employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-12-2009
After it self-disclosed conduct to the OIG, Saint Vincent Medical Education and Research Institute, Inc. d/b/a Saint Vincent Medical Group (SVMG), Pennsylvania, agreed to pay $23,436.12 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SVMG employed an individual that SVMG knew or should have known was excluded from participation in Federal health care programs.
07-17-2009
After it self-disclosed conduct to the OIG, SJH Cardiac Catheterization (SJH), New York, agreed to pay $15,133 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SJH employed an individual that SJH knew or should have known was excluded from participation in Federal health care programs.
06-29-2009
Clifford Koon, Jeffrey Cowan, and William Dorvall (respondents), Florida, former owners and officers of Matrix, Diabetics, Inc. (a durable medical equipment (DME) company), agreed to pay $260,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the respondents caused Matrix to pay telemarketing firms to make unsolicited telephone calls to Medicare beneficiaries to market DME on behalf of the company. The DME company in turn submitted claims for these items for Medicare reimbursement. Section 1834(a)(17) of the Social Security Act prohibits DME suppliers from making unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of a covered item, except in certain situations that were not present in this case. Section 1834(a)(17)(B) of the Act prohibits payment to a supplier who knowingly submits a claim generated pursuant to prohibited telemarketing calls.
06-17-2009
Alexander Zeuli and Physical Therapy Health Services (Respondents), Massachusetts, agreed to pay $18,532 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents improperly billed Medicare under certain CPT codes for physical therapy services when lower reimbursed codes and/or fewer units of these codes should have been billed.
06-02-2009
Ravenwood Nursing Home, Inc. (RNH), Maryland, agreed to pay $28,252.95 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that RNH employed an individual that RNH knew or should have known was excluded from participation in Federal health care programs.
05-29-2009
After it self-disclosed conduct to the OIG, National Medicare Recovery Services, Inc. (NMRS), California, agreed to pay $500,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NMRS presented or caused to be presented improper claims to Medicare for Part B wound care supplies.
05-27-2009
Claxton-Hepburn Medical Center (CHMC), New York, agreed to pay $168,597 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CHMC employed two individuals that CHMC knew or should have known were excluded from participation in Federal health care programs.
05-20-2009
Wayne Wittenberg, M.D. and his medical practice, Nature Coast Neurosurgery (Respondents), Florida, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
05-14-2009
After it self-disclosed conduct to the OIG, Colquitt Regional Medical Center (Colquitt), Georgia, agreed to pay $151,004.65 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Colquitt billed Medicare and Tricare for services provided by physician-assistants as if they were provided by the actual physicians.
04-21-2009
After it self-disclosed conduct to the OIG, National Medicare Recovery Services, Inc. (NMRS), California, agreed to pay $500,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NMRS presented or caused to be presented claims for Medicare Part B wound care supplies that NMRS knew or should have known would result in greater payment to NMRS's nursing home clients than the code applicable to the items actually provided.
04-02-2009
After it self-disclosed conduct to the OIG, Marquis Healthcare, Inc. (MHI), Ohio, agreed to pay $7,714.68 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MHI employed an individual that MHI knew or should have known was excluded from participation in Federal health care programs.
03-25-2009
After it self-disclosed conduct to the OIG, St. Mary Medical Center (SMMC), Pennsylvania, agreed to pay $172,617.10 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SMMC employed an individual that SMMC knew or should have known was excluded from participation in Federal health care programs.
03-16-2009
Ediberto Soto-Cora, M.D., Texas, agreed to pay $534,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Soto-Cora submitted false or fraudulent claims by using CPT codes that would generate a higher reimbursement than justified by the medical documentation or that he submitted claims without any supporting medical documentation.
03-13-2009
West Valley Imaging Limited Partnership and two physicians (West Valley), Nevada, agreed to pay $2 million and to enter into a 5-year integrity agreement for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that West Valley performed radiology tests and exams that were not ordered by Medicare beneficiaries' treating physicians.
03-11-2009
After it self-disclosed conduct to the OIG, Walgreen Louisiana Co. (Walgreen), Louisiana, agreed to pay $1,053,774.82 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Walgreen employed an individual that Walgreen knew or should have known was excluded from participation in Federal health care programs.
03-03-2009
After it self-disclosed conduct to the OIG, ShopKo Stores, Inc. (ShopKo), Utah, agreed to pay $669,824.74 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ShopKo employed an individual that ShopKo knew or should have known was excluded from participation in Federal health care programs.
02-25-2009
After it self-disclosed conduct to the OIG, HealthWorks Rehab & Fitness, (HealthWorks), West Virginia, agreed to pay $8,132.16 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HealthWorks inappropriately billed Medicare for the performance of iontophoresis services, which is not a covered service under Medicare because it is deemed experimental.
01-06-09
Methodist Health Care-Memphis Hospitals (Methodist), Tennessee, agreed to pay $136,627 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Methodist employed an individual that Methodist knew or should have known was excluded from participation in Federal health care programs.

2008

12-29-2008
Haven Nursing Home, Inc. (Haven), Maryland, agreed to pay $90,921.06 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Haven employed an individual that Haven knew or should have known was excluded from participation in Federal health care programs.
12-12-2008
After it self-disclosed conduct to the OIG, Ellsworth Municipal Hospital (Ellsworth), Iowa, agreed to pay $46,165.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Ellsworth employed an individual that Ellsworth knew or should have known was excluded from participation in Federal health care programs.
11-18-2008
After it self-disclosed conduct to the OIG, City of Chicago, Illinois, agreed to pay $6.9 million for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the City of Chicago submitted claims to Medicare for ambulance services that were not medically necessary, billed at the wrong level of service, and submitted claims without the patient's or other appropriate person's signature as required by CMS regulations.
09-30-2008
After it self-disclosed conduct to the OIG, Skilled Healthcare LLC (Skilled), California, agreed to pay $190,746 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that eight skilled nursing facilities and one rehabilitation services contract provider for which Skilled provided administrative services, including compliance services, employed individuals that Skilled and the nine providers knew or should have known were excluded from participation in Federal health care programs. Skilled paid $190,746 on behalf of the following nine providers: Briarcliff Nursing and Rehabilitation Center LP (Texas), Pacific Healthcare and Rehabilitation Center, LLC (California), Rossville Healthcare and Rehabilitation Center, LLC (Kansas), Town & Country Manor LP (Texas), St. Elizabeth Healthcare and Rehabilitation, LLC (California), Hallmark Rehabilitation GP, LLC (California), Royalwood Care Center, LLC (California), Eureka Healthcare and Rehabilitation Center, LLC (California), and Grenada Healthcare and Rehabilitation Center, LLC (California).
09-18-2008
After it self-disclosed conduct to the OIG, Courtyard Manor of Farmington Hills (Courtyard Manor), Michigan, agreed to pay $1.7 million for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Courtyard Manor received federal health care program funds while the entity was excluded. Courtyard Manor also agreed to be excluded from Medicare, Medicaid, and all other Federal health care programs for two years in addition to its original 10-year period of exclusion.
07-26-2008
After it self-disclosed conduct to the OIG, FutureCare Irvington, LLC (FutureCare), Maryland, agreed to pay $36,290.79 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that FutureCare employed an individual that FutureCare knew or should have known was excluded from participation in Federal health care programs.
07-24-2008
Whole Health Pharmacy (WHP), Colorado, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that WHP employed an individual that WHP knew or should have known was excluded from participation in Federal health care programs.
07-16-2008
St. Barnabas Hospital, New York, agreed to pay $132,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the hospital employed three individuals that the hospital knew or should have known were excluded from participation in Federal health care programs.
07-02-2008
Southern Illinois Healthcare Foundation (SIHF), Illinois, agreed to pay $562,021 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SIHF employed an individual that SIHF knew or should have known was excluded from participation in Federal health care programs.
06-16-2008
After it self-disclosed conduct to the OIG, Sparks Health System, Sparks Medical Foundation, and Sparks Regional Medical Center (collectively, Respondents), Arkansas, agreed to pay $1,142,973 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents billed Medicare for medically unnecessary hospital services.
05-09-2008
After it self-disclosed conduct to the OIG, Sabine County Hospital District, Texas, agreed to pay $82,341, for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Sabine fraudulently included a physician recruiting fee on its cost report as a reimbursable expense.
04-15-2008
After it self-disclosed conduct to the OIG, Biotronic West, LLC, NeuralWatch, LLC, and The Regents of the University of California, for its University of California Davis Medical Center (collectively, Respondents), agreed to pay $41,488.24 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents employed an individual that the Respondents knew or should have known had been excluded from participation in Federal health care programs.
04-03-2008
After it self-disclosed conduct to the OIG, Caritas Christi, Massachusetts, agreed to pay $250,060 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Caritas Christi employed or contracted with five individuals that Caritas Christi knew or should have known were excluded from participation in Federal health care programs.
02-01-2008
Newton Memorial Hospital (NMH), New Jersey, agreed to pay $89,279.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NMH employed an individual that NMH knew or should have known was excluded from participation in Federal health care programs.
01-04-2008
After it self-disclosed conduct to the OIG, Shands at Alachua General Hospital (Shands), Florida, agreed to pay $119,838 and to enter into a 3-year certification of compliance agreement for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Shands employed an individual that Shands knew or should have known had been excluded from participation in Federal health care programs.

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