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Selected Provider Self-disclosure Protocol Settlements

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.

False and Fraudulent Claims

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.
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.
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.

Kickback and Physician Self-Referral

05-11-2011
After it self-disclosed conduct to the OIG, Pacifica Hospital of the Valley (Pacifica), California, agreed to pay $764,250 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Pacifica paid indirect improper remuneration to a physician in the form of payments to a marketing firm for marketing services that were never rendered under joint marketing agreements. The remuneration created a financial relationship between Pacifica and the physician that caused Pacifica to present claims for health services that resulted from prohibited referrals in violation of the Stark law.
03-24-2011
After it self-disclosed conduct to the OIG, Fairview Northland Regional Health Care (FNRHC), Minnesota, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that FNRHC entered into an unwritten lease agreement with a physician practice.
12-03-2010
After it self-disclosed conduct to the OIG, Wayne County Hospital (WCH), Kentucky, agreed to pay $110,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that WCH: 1) paid remuneration to a physician by failing to charge processing fees for payroll services rendered to his practice; 2) paid remuneration to a physician and failed to demand or collect payroll processing fees and payments due for personnel and practice management support services rendered to her practice; and 3) paid remuneration to two physicians by failing to demand repayment of wages and benefits paid to the physicians and their staff and failed to charge processing fees for payroll services rendered to the practice.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201