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Civil Monetary Penalties and Affirmative Exclusions

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

OIG Enforcement Cases

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

03-11-2016
Utah Ambulance Company Settles Case Involving False Claims
On March 11, 2016, Ogden City Corporation (Ogden), of Ogden, Utah, entered into a $363,159.38 settlement agreement with OIG. The settlement agreement resolves allegations that Ogden submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate (upcoding). OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
Oregon Physical Therapy Practice and Owner Settle Case Involving False Claims
On March 11, 2016, Dan Ibarra and Northwest Physical Therapy (collectively, NPT), Oregon, entered into a $200,000 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that NPT submitted claims to Medicare for payment for direct services rendered by unlicensed employees and also submitted claims for direct, one-on-one services when these services were rendered to multiple patients at the same time. Senior Counsel Nancy Brown represented OIG.
03-04-2016
North Dakota Ambulance Provider Settles Case Involving False Claims
On March 4, 2016, Altru Health System (Altru), of Grand Forks, North Dakota, entered into a $300,974 settlement agreement with OIG. The settlement agreement resolves allegations that Altru submitted claims to Medicare for: (1) emergency Advanced Life Support ambulance transportation that should have been billed at the lower emergency Basic Life Support rate; (2) duplicate billings; (3) ambulance transportation services that were reimbursable by private insurance; and (4) emergency ambulance transportation services provided to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
03-01-2016
Oregon Mental Health Facility Settles Case Involving Excluded Individual
On March 1, 2016, Cascadia Behavioral Health, Inc. (Cascadia), Oregon, entered into a $92,052.78 settlement agreement with OIG. The settlement agreement resolves allegations that Cascadia employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a residential counselor, provided items or services to Cascadia patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Eula Taylor.
02-26-2016
Connecticut Ambulance Company Settles Case Involving False Claims
On February 26, 2016, Campion Ambulance Service, Inc. (Campion), of Waterbury, Connecticut, entered into a $100,804.74 settlement agreement with OIG. The settlement agreement resolves allegations that Campion submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
02-09-2016
Illinois Billing and Ambulance Companies Settle Case Involving False Claims
On February 9, 2016, Andres Medical Billing, Ltd. (Andres), and Kurtz Ambulance Service (Kurtz), Illinois, entered into a $77,542.72 settlement agreement with OIG. The settlement agreement resolves allegations that Andres, acting as the third-party biller for Kurtz, submitted claims to Medicare for basic life support (emergency) that did not meet Medicare requirements for emergency transport services and should have been billed at the lower non-emergency transport rate. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, collaborated to achieve this settlement.
02-05-2016
Michigan Ambulance Company Settles Case Involving False Claims
On February 5, 2016, White Lake Ambulance Authority (White Lake), Michigan, entered into a $113,635.08 settlement agreement with OIG. The settlement agreement resolves allegations that White Lake submitted claims to Medicare for basic life support (emergency) and advanced life support (emergency) ambulance transportation claims that did not meet Medicare requirements for emergency transport services. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, collaborated to achieve this settlement.
Illinois Pharmacist and Owner of a Durable Medical Equipment Supply Company Agrees to Three-Year Exclusion
On February 5, 2016, an Illinois pharmacist and owner of a durable medical equipment supply company agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the individual offered and paid kickbacks and bribes, directly or through an employee, to induce individuals representing hospitals and nursing homes to order health care items from his company for which payments were made under Medicare. Senior Counsel Henry Green represented OIG.
01-27-2016
Massachusetts Ambulance Company Settles Case Involving False Claims
On January 27, 2016, LifeLine Ambulance Service, LLC (LifeLine), of Woburn, Massachusetts, entered into a $74,414.66 settlement agreement with OIG. The settlement agreement resolves allegations that LifeLine submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
01-07-2016
Illinois Cardiology Practices Settle Case Involving Excluded Individual
On January 7, 2016, CardioSpecialists Group, Ltd. (CSG), Illinois, entered into a $274,721.40 settlement agreement with OIG. The settlement agreement resolves allegations that CSG employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a medical biller, provided items or services to CSG patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Eula Taylor.
01-06-2016
University of Mississippi Medical Center Settles Case Involving a Patient Dumping Allegation
On January 6, 2016, The University of Mississippi Medical Center (UMMC), in Jackson, Mississippi, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that UMMC failed to accept the appropriate transfer of a 64-year-old women who needed specialized capabilities of UMMC's hospital to stabilize her emergency medical condition. OIG's investigation revealed that the operator at UMMC refused the request to transfer the patient because of a UMMC policy that it would not accept the transfer of Louisiana residents. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
Floyd Medical Center in Georgia Settles Case Involving a Patient Dumping Allegation
On January 6, 2016, Floyd Medical Center (FMC), in Rome, Georgia, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that FMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to evaluate and treat a mentally ill patient who was transferred from another hospital to FMC for involuntary inpatient psychiatric care. OIG's investigation revealed the following. The patient was aggressive and combative upon his arrival to FMC's emergency department. Three security personnel, including an off-duty police officer working for FMC, attempted to restrain the patient while a nurse went to retrieve medication to calm him down. When the security personnel entered the room, the patient attempted to strike one of them. In response, a security officer hit the patient in the head and pushed him until he fell on the bed. The security officers then wrestled the patient to the ground and handcuffed him, causing injury to the patient. When the nurse returned, the security personnel informed her that the patient's behavior was beyond what FMC could safely control. Without psychiatric evaluation or appropriate medical treatment, the emergency department physician medically cleared the patient and he was taken to jail. Despite having an on-call psychiatrist and capabilities to treat the patient, at no point was he evaluated or treated by a mental health professional. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.

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