Skip to main content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Civil Monetary Penalties and Affirmative Exclusions

2020

12-22-2020
Aeon Global Health Agreed to Pay $75,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Non-Covered Services
On December 22, 2020, Peachstate Health Management, LLC d/b/a Aeon Global Health (Aeon Global health), headquartered in Gainesville, Georgia, entered into a $75,000 settlement agreement with OIG. The settlement agreement resolves allegations that Aeon Global Health submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
12-21-2020
Frye Regional Medical Center Agreed to Pay $100,000 for Allegedly Violating Patient Dumping Statute by Failing to Provide an Appropriate Medical Screening Examination and Stabilizing Treatment
On December 21, 2020, Frye Regional Medical Center (FRMC), Hickory, North Carolina, entered into a $100,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, FRMC violated the Emergency Medical Treatment and Labor Act (EMTALA), when it failed to provide an appropriate medical screening examination and stabilizing treatment to a 53-year-old individual. Specifically, the individual presented to FRMC's Emergency Department (ED) at 7:37 a.m. on January 10, 2016, complaining of chest pain. The individual was immediately given an electrocardiogram (EKG) that was read by a physician two minutes later. The EKG was normal. The triage nurse documented the individual's chief complaint as "chest pain since last night, also nausea, vomiting, and diarrhea." The individual was sent to the waiting room without drawing any labs. The individual's spouse subsequently repeatedly asked for medical assistance because the individual was lying on the floor due to worsening chest pain. When a nurse finally responded, she told the spouse that they would have to wait. No reassessment of the individual was performed. At 11:21 a.m., the medical record noted that the individual left without treatment. The individual presented to a second hospital at 11:25 a.m. where the individual received an emergency heart catheterization and was diagnosed with triple vessel disease. The individual needed an urgent coronary bypass and was sent back to FRMC where the individual underwent a triple coronary bypass the next day. Senior Counsel Sandra Sands represented OIG.
12-17-2020
Steven Yohay Agreed to Be Excluded for 15 Years for Inducing Medicaid Beneficiaries for Enrolling Medicaid Patients in Substance Abuse Treatment Through Kickbacks
On December 17, 2020, in connection with the resolution of his False Claims Act liability, Steven Yohay, Oak Beach, New York, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for 15 years. The investigation revealed and OIG alleged that Yohay, as the majority owner, President, and former CEO of A.R.E.B.A.-CASRIEL, Inc. d/b/a Addiction Care Interventions Chemical Dependency Treatment Centers (ACI), engaged in an illegal kickback scheme involving the use of employed drivers to solicit and recruit Medicaid beneficiaries for admission to ACI's treatment programs, which resulted in false claims for payment to Medicaid. OIG further alleged that Yohay employed and paid an individual-purportedly for translation services-in order to induce that individual to refer patients to ACI, which resulted in false claims for payment to Medicaid. OIG also alleged that Yohay knew ACI admitted Medicaid patients into its inpatient treatment program who were not evaluated by a qualified health care professional as required by applicable state law and fabricated documentation with false signatures, but failed to return funds obtained using the false documentation to Medicaid. Senior Counsel Andrea Treese Berlin and David Fuchs represented OIG.
12-14-2020
Dr. Milan Chakrabarty and Hemet Endoscopy Center Agreed to Pay $66,000 for Allegedly Violating the Civil Monetary Penalties Law by Failing to Return and Falsely Certifying their Eligibility to Receive CARES Act Provider Relief Funds.
On December 14, 2020, Milan S. Chakrabarty, M.D. (Dr. Chakrabarty), and the Hemet Endoscopy Center (Hemet Endoscopy), Hemet, California, entered into a $66,715.47 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Chakrabarty and Hemet Endoscopy knowingly made, used, or caused to be made a false statement in a document that is required to be submitted in order to directly or indirectly receive or retain funds provided in whole or in part by the Secretary of HHS. Specifically, OIG contends that on April 17, 2020, Hemet Endoscopy, an ambulatory surgery center owned by Dr. Chakrabarty, received a Provider Relief Fund payment pursuant to the CARES Act. On April 27, 2020, an employee of Dr. Chakrabarty's attested in the HHS Provider Relief Fund Portal that Hemet Endoscopy was eligible to receive this payment because, among other things, it treated patients after January 31, 2020, and its Medicare billing privileges had not been revoked. However, Hemet Endoscopy did not treat patients after January 31, 2020, and HHS had revoked its Medicare billing privileges on November 22, 2019. Hemet Endoscopy subsequently retained its April 17, 2020 Provider Relief Fund payment and a later May 26, 2020 Provider Relief Fund payment despite being ineligible to retain those payments. Senior Counsel Michael Torrisi, assisted by Chief Investigator Amber Mahmood, represented OIG.
12-08-2020
Teresita Alquero Agreed to Be Excluded for 5 Years for Paying Remuneration in the Form of Medical Directorship Compensation in Excess of Fair Market Value in Exchange for Referrals and Submitted Claims that Misidentified the Attending Physician
Effective December 8, 2020, in connection with the resolution of her False Claims Act liability, Teresita Lumanas Alquero (Alquero), Sugar Land, Texas, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for 5 years. The investigation revealed and OIG alleged that Alquero knowingly and willfully paid improper remuneration in the form of medical directorship compensation that exceeded fair market value to a physician to induce his referrals of Medicare patients to home health and hospice companies formerly owned by Alquero and submitted claims to Medicare associated with those referrals. OIG also alleged that Alquero submitted claims for payment identifying another physician as the attending physician, when in fact, the physician did not provide services to patients because he was incarcerated in federal prison, and his medical license was suspended. Senior Counsel Ellen Slavin represented OIG.
12-07-2020
James Carpenter and Solace Advancement Agreed to Be Excluded for 20 Years for Causing the Submission of False Claims for Neuro-Stimulators
On December 7, 2020, in connection with the resolution of their False Claims Act liability, James Carpenter (Carpenter), Rockledge, Florida, and Solace Advancement, LLC (Solace), Michigan, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for twenty years. The investigation revealed and OIG alleged that Carpenter and Solace promoted and sold the P-Stim and Stivax devices by engaging in a scheme to falsely represent to medical providers that Medicare reimbursed for the Stivax and P-Stim devices and provider services related to the devices. As part of the scheme, Carpenter, Solace, and others falsely represented and communicated to health care providers throughout the United States that it was appropriate to submit claims to Medicare for reimbursement for: (a) the Stivax device by submitting Healthcare Common Procedure Coding System ("HCPCS") codes, including L8679; and (b) for the medical provider's services applying the Stivax device by submitting a variety of Current Procedural Terminology ("CPT") codes. However, these codes were at all times intended to reimburse for materials and services related to surgically implanted neuro-stimulators that are implanted under the skin by a surgeon in a surgical setting. The P-Stim and Stivax devices are not implantable neurostimulators and are instead electro-acupuncture devices that are applied to patients' ears without anesthesia in a medical office setting. Medicare does not reimburse for electro-acupuncture devices and related services. Senior Counsel Katie Fink represented OIG.
12-04-2020
Barry McLeod-Hughes Agreed to Be Excluded for 7 Years for Submitting False Claims for Physical Therapy Services
On December 4, 2020, in connection with the resolution of his False Claims Act liability, Barry McLeod-Hughes (McLeod-Hughes), Byron, Georgia, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for 7 years. The investigation revealed and OIG alleged that McLeod-Hughes and his practice, McLeod-Hughes and Associates Physical Therapy and Rehabilitation Clinic, d/b/a McLeod-Hughes and Associates Inc., submitted claims to Medicare and TRICARE for physical therapy services purportedly provided by McLeod-Hughes to Medicare and TRICARE beneficiaries when, in fact, athletic trainers and other unlicensed or uncredentialed individuals actually furnished the physical therapy services. Senior Counsel Matthew Westbrook represented OIG.
12-02-2020
New Horizons Medical, Inc. Agreed to Pay $84,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Non-Covered Services
On December 2, 2020, New Horizons Medical, Inc. (New Horizons), Framingham, Massachusetts, entered into a $84,393.68 settlement agreement with OIG. The settlement agreement resolves allegations that New Horizons submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
11-17-2020
Mathias Berry, DC and Katherine Ross, DC Agreed to Be Excluded for Causing False Claims for Medically Unnecessary Knee Braces That Were Tainted by Kickbacks
Effective November 17, 2020, in connection with the resolution of their False Claims Act liability, Mathias Berry, DC (Berry), Puyallup, Washington, and Katherine Ross, DC (Ross), Kirkland, Washington, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7). Berry agreed to be excluded for 8 years and Ross agreed to be excluded for 5 years. The investigation revealed and OIG alleged that Berry and Ross knowingly submitted, or caused to be submitted by Osteo Relief Institutes clinics, false claims to Medicare for medically unnecessary viscosupplementation and medically unnecessary knee braces that were also tainted by kickbacks solicited and received by Berry and a related entity known as Results Laboratories, LLC. Senior Counsel Keshia Thompson represented OIG.
11-13-2020
Israel Weber and Pharmex Pharmacy Were Excluded for Defaulting on Payment Obligations
On November 13, 2020, OIG excluded Israel Weber and Pharmex Pharmacy, LLC (collectively, "Pharmex"), Lakewood, New Jersey, for defaulting on payment obligations under a settlement agreement with OIG, wherein OIG alleged that Pharmex Pharmacy employed an individual who was excluded from participating in any Federal health care program. Pharmex's exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates Pharmex's participation in Federal health care programs. Senior Counsels Srishti Sheffner and Geoffrey Hymans represented OIG.
11-09-2020
Dr. Anthony Cruse Agreed to Be Excluded for 10 Years for Receiving Improper Remuneration
Effective November 9, 2020, Anthony L. Cruse, D.O., Oklahoma City, Oklahoma, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for 10 years. The investigation revealed and OIG alleged that Dr. Cruse knowingly received, or caused other physicians in Southwest Orthopaedic Specialists, PLLC (SOS) to receive, improper remuneration from Orthopaedic & Multispecialty Surgery, LLC (OCOM) in exchange for referrals, in violation of the anti-kickback statute, in the form of: (1) free or below-fair market value office space, employees, and supplies; (2) compensation in excess of fair market value for the services furnished by SOS and Cruse; (3) buyback provisions and payments for Dr. Cruse and other SOS physicians in their OCOM equity that were above fair market value; and (4) preferential investment opportunities in connection with the provision of anesthesia services at OCOM by Anesthesia Partners of Oklahoma, LLC. OIG also alleged that Dr. Cruse engaged in conduct that did not satisfy the requirements of an applicable exception to the physician self-referral law, because Dr. Cruse and SOS were: (1) compensated by OCOM in the form of below fair market value office space, employees, and supplies; and (2) compensated by OCOM above fair market value for services furnished by SOS and Dr. Cruse. Dr. Cruse and SOS made referrals to OCOM for designated health services, resulting in OCOM's submission of claims to Medicare for payment for such designated health services. Senior Counsel Karen Glassman represented OIG.
10-13-2020
William Rosellini and His Companies Agreed to Pay $50,000 and Be Excluded for 5 Years for Allegedly Violating the Civil Monetary Penalties Law by Inappropriately Drawing Down Funds from NIH Small Business Innovation Research Grants
On October 13, 2020, William Rosellini, Nexeon Medsystems, Inc., Pulsus Medical, LLC, , and Nexeon Medsystems Puerto Rico Operating Company, Inc. (collectively, "Nexeon"), entered into a settlement agreement with OIG in which they agreed to pay $50,000 and be excluded from participation in all Federal health care programs for five years under 42 U.S.C. 1320a-7a and 42 U.S.C. 1320a-7(b)(7). The settlement agreement resolves allegations that Nexeon drew down funds from the HHS Payment Management System from National Institutes of Health (NIH) Small Business Innovation Research (SBIR) awards that were: (1) sent to an overseas affiliate without NIH approval, in violation of NIH SBIR requirements; (2) based upon quotes and other potential costs that were never incurred; (3) comingled among various affiliates and used for unallowable costs unrelated to the NIH SBIR awards; and (4) not supported by adequate documentation to ensure that the funds were used for allowable costs in accordance with the terms and conditions of the awards. Senior Counsels Michael Torrisi and David Traskey, assisted by Chief Investigator Amber Mahmood, represented OIG.
Advanced Pain Management Specialists Agreed to Pay $24,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Non-Covered Services
On October 13, 2020, Advanced Pain Management Specialists, P.A., (Advanced Pain), Fort Myers, Florida, entered into a $24,921.96 settlement agreement with OIG. The settlement agreement resolves allegations that Advanced Pain submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
09-30-2020
Dr. Joseph Rizzo and Center for Preventative and Regenerative Medicine Agreed to Be Excluded for 7 Years for Receiving Improper Remuneration in the Form of Purported Research Grants
On September 30, 2020, in connection with the resolution of their False Claims Act liability, Joseph Rizzo, M.D. (Dr. Rizzo) and the Center for Preventative and Regenerative Medicine, P.A. (CPRM), Lubbock, Texas, each agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for 7 years. The investigation revealed and OIG alleged that Dr. Rizzo and CPRM received remuneration from a marketing company and two laboratories in the form of purported research grants in exchange for Dr. Rizzo ordering clinical laboratory services from the laboratories. Pursuant to this financial arrangement, the laboratories performed the clinical laboratory services ordered by Dr. Rizzo and submitted claims to the Medicare program for payment in violation of the Anti-Kickback Statute. Senior Counsel Karen Glassman represented OIG.
09-11-2020
Dr. Hy Ngo Agreed to Pay $85,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual
On September 11, 2020, Hy Ngo, MD (Dr. Ngo), Los Angeles, California, entered into an $85,318.98 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Ngo employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a physician, provided items or services that were billed to Federal health care programs. Associate Counsel Jonathan Culpepper represented OIG.
08-04-2020
Northern Lighthouse Agreed to Pay $29,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual
On August 4, 2020, Northern Lighthouse, with multiple locations in Maine, entered into a $29,971.36 settlement agreement with OIG. The settlement agreement resolves allegations that Northern Lighthouse employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a direct support professional, provided items or services that were billed to Federal health care programs.
07-20-2020
Texas Company and Owner Agree to Voluntary Exclusion
On July 20, 2020, in connection with the resolution of their False Claims Act liability, Jason Bourque (Bourque) and Allen Research Corporation (Allen Research), Frisco, Texas, each agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for 10 years. The investigation revealed and OIG alleged that Bourque and Allen Research: recruited physicians to be part of a purported "research study" for transdermal pain cream; directed certain recruited physicians who participated in the purported "research study" to send prescriptions for pain creams to a pharmacy in Allen, Texas; together with the pharmacy, had an agreement pursuant to which the pharmacy agreed to pay Bourque and Allen Research a percentage of its insurance reimbursements, which included amounts paid by TRICARE, for pain cream prescriptions Bourque and Allen Research arranged to be filled by the pharmacy; and then paid certain physicians who had written the prescriptions a percentage of the amount received from the pharmacy. OIG alleged that the arrangement among Bourque, Allen Research, the pharmacy, and the physicians violated the Anti-Kickback Statute. Senior Counsel Karen Glassman represented OIG.
07-14-2020
New York Federally Qualified Health Center Settles Case Involving False Grant Claims and Misrepresentations
On July 14, 2020, Brooklyn Plaza Medical Center (BPMC), a federally qualified health center in Brooklyn, New York, entered into a $100,000 settlement agreement and a 5-year recipient compliance agreement with OIG. The settlement agreement resolves allegations that BPMC made false specified claims in the form of drawdowns from the HHS Payment Management System for Health Resources and Services Administration grant funds that were not supported by adequate documentation, timesheets, and a financial management and control system that ensured that HHS grant funds were used solely for authorized purposes in accordance with federal statutes, regulations, and the terms and conditions of BPMC's federal awards. The OIG further alleged that on various occasions during the same timeframe, BPMC falsely represented to HHS in funding applications that it had in place: (1) safeguards to prohibit employees from using their positions for personal gain; and (2) a financial management and control system that ensured that HHS grant funds were used solely for authorized purposes in accordance with federal statutes, regulations, and the terms and conditions of BPMC's federal awards. OIG's Office of Investigations and Office of Counsel to the Inspector General, represented by Senior Counsels Michael Torrisi and David Traskey, collaborated to achieve this settlement.
07-10-2020
Texas Skilled Nursing Facility Settles Case Involving Excluded Individual
On July 10, 2020, RJ Meridian Care Alta Vista, LLC d/b/a Meridian Care Monte Vista (Meridian Care), San Antonio, Texas, entered into a $143,630.83 settlement agreement with OIG. The settlement agreement resolves allegations that Meridian Care employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an admission director, provided items or services that were billed to Federal health care programs.
06-29-2020
Florida Practice Settles Case Involving False Claims
On June 29, 2020, Florida Pain and Rehabilitation Center (FPRC), Lake City, Florida entered into a $94,658.76 settlement agreement with OIG. The settlement agreement resolves allegations that FPRC submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
Florida Laboratory Settles Case Involving False Claims
On June 29, 2020, River Crossing Labs, LLC (RCL), Tampa, Florida, entered into a $68,253.44 settlement agreement with OIG. The settlement agreement resolves allegations that RCL submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
06-05-2020
Florida Laboratory Settles Case Involving False Claims
On June 5, 2020, Complete Biosolutions, Inc. (CBI), Hialeah, Florida, entered into a $126,793.56 settlement agreement with OIG. The settlement agreement resolves allegations that CBI submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
06-01-2020
Mark Kaiser and Doc Solutions Agreed to Be Excluded for 20 Years for Causing the Submission of False Claims for Neuro-Stimulators
On June 1, 2020, in connection with the resolution of their False Claims Act liability, Mark Kaiser (Kaiser), Bradenton, Florida and Doc Solutions LLC (Doc Solutions), Indiana, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for twenty years. The government alleged that Kaiser and Doc Solutions falsely represented to health care providers that it was appropriate to submit claims to Medicare for reimbursement: (a) for the Stivax device by submitting Healthcare Common Procedure Coding System (HCPCS) codes, including L8679; and (b) for the medical practitioner's services applying the Stivax device by submitting a variety of Current Procedural Terminology (CPT) codes. However, the HCPCS and CPT codes that Kaiser and Doc Solutions promoted were at all times intended to reimburse for materials and services related to surgically implanted neuro-stimulators that are implanted under the skin by a surgeon in a surgical setting. The Stivax device is not an implantable neurostimulator and is instead an electro-acupuncture device that is applied to patients' ears without anesthesia in a medical office setting. Medicare does not reimburse for electro-acupuncture devices and related services. Senior Counsel Katie Fink represented OIG.
05-27-2020
Florida Practice Settles Case Involving False Claims
On May 27, 2020, Stages of Life Medical Institute, Inc. (SLMI), Longwood, Florida, entered into a $54,746.52 settlement agreement with OIG. The settlement agreement resolves allegations that SLMI submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
05-21-2020
Texas Pharmaceutical Company Settles Case Involving Drug Price Reporting
On May 21, 2020, Method Pharmaceuticals, LLC (Method), Fort Worth, Texas, entered into a $45,000 settlement agreement with OIG. The settlement agreement resolves allegations that Method failed to submit timely certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2015, 2016, 2017, and 2018. The Medicaid Drug Rebate Program requires manufacturers to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the manufacturer's covered outpatient drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Mary Riordan represented OIG with the assistance of Program Analyst Mariel Filtz.
05-14-2020
South Carolina Ambulance Company Settles Case Involving False Claims
On May 14, 2020, Vital Care EMS, Inc. (Vital Care), an ambulance provider servicing Sumter, Columbia, and Greenville, South Carolina, entered into a $2,213,516.71 settlement agreement with OIG. The settlement agreement resolves allegations that Vital Care presented claims to Medicare Part B for ambulance transportation to and from skilled nursing facilities (SNFs) where such transportation was covered by the SNF consolidated billing payment under Medicare Part A. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Srishti Sheffner and Geoffrey Hymans with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
05-08-2020
Illinois Diagnostic Service Provider and Owner Settle Case Involving False Claims
On May 8, 2020, Hussain Ghalib and U.S. Diagnostics, Inc. (collectively, "US Diagnostics"), Chicago, Illinois, entered into a $147,302.35 settlement agreement with OIG. The settlement agreement resolves allegations that US Diagnostics submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which US Diagnostics submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
04-22-2020
Texas Physician Agrees to Voluntary Exclusion
On April 22, 2020, in connection with the resolution of his False Claims Act liability, Maaz Abbasi, M.D., Houston, Texas, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for three years. The investigation revealed that in exchange for illegal remuneration: (1) Dr. Abbasi signed Medicare Home Health Certifications and Plans of Care certifying patient eligibility for home health services without any knowledge of the patients' medical condition or homebound status; and (2) Dr. Abbasi signed another physician's signature on Medicare Home Health Certifications and Plans of Care certifying patient eligibility for home health services without the physician's authorization, permission, or knowledge, and without any knowledge of the patients' medical condition or homebound status. Senior Counsel Ellen Slavin represented OIG.
04-20-2020
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On April 20, 2020, DeKalb Medical Center, Inc. (DeKalb), Decatur, Georgia, entered into a $260,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, DeKalb violated the Emergency Medical Treatment and Labor Act (EMTALA), when it failed to provide an adequate screening examination and stabilizing treatment for twenty-one individuals. The following are examples of such incidents.

Patient N.R.A., a 25-year-old female, presented to DeKalb's Emergency Department (ED) on January 18, 2015, with complaints of acute gastric pain, nausea, and vomiting. The medical records also listed possible pregnancy as her chief complaint. N.R.A. had a prior history of peptic ulcer disease and gastric ulcers. The medical records indicated that N.R.A. was seen by a registered nurse and was triaged using an emergency severity level index at level 4 (indicating a non-urgent patient). The triage nurse recorded N.R.A.'s vital signs and marked "no" next to nine questions on a non-patient specific checklist. Within six minutes of the nurse starting the triage process, N.R.A. was discharged from DeKalb's ED.

Patient B.B. a 29-year-old male, was brought to DeKalb's ED by an ambulance on February 2, 2015, with complaints of neck pain after suffering from a motor vehicle accident one hour prior to his arrival. B.B. rated his pain at a level 5 on a scale of 1 to 10 (with 10 being the worst). The medical records indicate that B.B. was seen by a registered nurse, who triaged him using the emergency severity level index at level 4 (indicating a non-urgent patient). The triage nurse recorded B.B.'s vital signs and marked "no" next to nine questions on a non-patient specific checklist. B.B. was then discharged from DeKalb's ED.

In each of the incidents described above, DeKalb's ED was capable of providing an appropriate medical screening examination to determine whether the patients had an emergency medical condition and providing stabilizing treatments in the event patients had such conditions, but OIG contends that DeKalb failed to do so. Similar incidents occurred for the following 19 individuals who presented to DeKalb's ED: C.R.B. (1/24/2015); B.N.C. (1/30/2015); D.M.A. (2/2/2015); T.R. (2/3/2015); D.M. (2/6/2015); D.C.W. (2/10/2015); T.D. (2/11/2015); T.M.M. (2/24/2015); A.A.H. (3/1/2015); M.C.B. (3/2/2015); R.S.M. (3/3/2015); W.P.H. (3/6/2015); F.D.R. (3/7/2015); K.D. (4/5/2015); T.M.C. (4/9/2015); T.K. (4/9/2015); R.L.M. (4/9/2015); T.B. (4/10/2015); and L.D.C. (9/1/2015). In each of these cases, OIG determined that DeKalb failed to provide an appropriate medical screening examination or stabilizing treatment to these individuals within the capability of its ED. Senior Counsel Srishti Sheffner represented OIG.
04-06-2020
New Mexico Physician and Practice Settle Case Involving False Claims
On April 6, 2020, Gopal Reddy, M.D. and Gopal Reddy M.D., P.C. (collectively, "Dr. Reddy"), Albuquerque, New Mexico, entered into a $199,705.36 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Reddy submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Reddy submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
03-30-2020
North Carolina Ambulance Company Settles Case Involving False Claims
On March 30, 2020, Bertie Ambulance Service, Inc. (Bertie), Windsor, North Carolina, entered into a $342,208.22 settlement agreement with OIG. The settlement agreement resolves allegations that Bertie presented claims to Medicare Part B for ambulance transportation to and from skilled nursing facilities (SNFs) where such transportation was covered by the SNF consolidated billing payment under Medicare Part A. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
03-23-2020
Massachusetts Ambulance Company Settles Case Involving False Claims
On March 23, 2020, STAT Ambulance Service of New England, Inc. (STAT), New Bedford, Massachusetts, entered into a $75,228.16 settlement agreement with OIG. The settlement agreement resolves allegations that STAT presented claims to Medicare Part B for ambulance transportation to and from skilled nursing facilities (SNFs) where such transportation was already covered by the SNF consolidated billing payment under Medicare Part A. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
03-12-2020
Arkansas Assisted Living Facility Excluded for Default
On March 12, 2020, OIG excluded Whispering Knoll, Pine Bluff, Arkansas, for defaulting on payment obligations under a settlement agreement with OIG wherein OIG alleged that Whispering Knoll employed an individual who was excluded from participating in any Federal health care program. Whispering Knoll's exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates Whispering Knoll's participation in Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
03-12-2020
Colorado Physicians and Practice Settles Case Involving Kickbacks
On March 12, 2020, Chad E. Boekes, M.D., Louis B. Kasunic, D.O., and Castle Rock Family Physicians, P.C. (collectively, "Castle Rock"), Castle Rock, Colorado, entered into a $54,982 settlement agreement with OIG. The settlement agreement resolved allegations that Castle Rock solicited and received remuneration from laboratory companies Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), in the form of "process and handling" payments related to the collection of blood. OIG alleged that Castle Rock solicited and received the remuneration from HDL and Singulex in exchange for Castle Rock and Castle Rock employees referring patients for laboratory testing services to HDL and Singulex, for which the Medicare program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
03-06-2020
Illinois Independent Diagnostic Testing Facility Settles Case Involving False Claims
On March 6, 2020, Dav-Kim Portable X-Ray Services Co. (Dav-Kim), Skokie, Illinois, entered into a $126,628.76 settlement agreement with OIG. The settlement agreement resolves allegations that Dav-Kim submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dav-Kim submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
02-18-2020
Texas Physician and Practice Settle Case Involving False Claims
On February 18, 2020, Mark R. Robbins, M.D. and Mark Robbins M.D., PA d/b/a Vascular Tyler (collectively, "Dr. Robbins"), Tyler, Texas, entered into a $71,168.20 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Robbins submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Robbins submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
02-10-2020
Maryland Hospital Settles Case Involving Patient Dumping Allegation
On February 10, 2020, Maryland General Hospital, Inc. d/b/a UM Medical Center Midtown Campus (UMMC), Baltimore, Maryland, entered into a $106,965 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, UMMC violated the Emergency Medical Treatment and Labor Act (EMTALA), when it failed to provide an adequate medical screening examination and stabilizing treatment for a 22-year old female patient. Specifically, the patient presented to UMMC's Emergency Department (ED) on January 9, 2018, via ambulance. The patient was diagnosed with a contusion of the face and lip abrasion, and was discharged. The patient refused to sign the discharge forms, stated that she was homeless, and refused to exit the premises. The patient was escorted by security off of UMMC's property wearing only a hospital gown and socks. The following day, the patient retuned to UMMC's ED via ambulance after a bystander called 911. The bystander found the patient at a bus stop outside the hospital in 30-degree weather. A nurse told the patient that she would need to go to a shelter if she did not have a place to stay. The patient was then discharged without receiving a medical screening examination or being stabilized. Associate Counsel Candace Ashford represented OIG.
02-03-2020
Kentucky Medical Group Settles Case Involving False Claims
On February 3, 2020, Kentucky Pain Management Services, LLC (KPMS), Hazard, Kentucky, entered into a $230,685.82 settlement agreement with OIG. The settlement agreement resolves allegations that KPMS submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
01-22-2020
New York Ambulance Company Settles Case Involving False Claims
On January 22, 2020, SeniorCare Emergency Medical Services, Inc. (SeniorCare), Bronx, New York, entered into a $1,231,854.09 settlement agreement with OIG. The settlement agreement resolves allegations that SeniorCare presented claims to Medicare Part B for ambulance transportation to and from skilled nursing facilities (SNFs) where such transportation was already covered by the SNF consolidated billing payment under Medicare Part A. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
Illinois Physician Settles Case Involving False Claims
On January 22, 2020, Dominic Tolitano, M.D., Wood Dale, Illinois, entered into a $130,253.98 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Tolitano submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Tolitano submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.

2019

12-31-2019
Pennsylvania Mental Health Facility and Owners Agree to Voluntary Exclusion
On December 31, 2019, in connection with the resolution of their False Claims Act liability, Tree of Life Behavioral Health Services, Inc., Tree of Life Professional Behavioral Health Services, Inc., Tree of Life Professional Behavioral Health Systems (collectively, "Tree of Life"), Ada Vidal, and Victor Vidal, Philadelphia, Pennsylvania, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7). Tree of Life agreed to be excluded for 25 years. Ada Vidal and Victor Vidal each agreed to be excluded for 20 years. The investigation revealed that Tree of Life, Ada Vidal, and Victor Vidal: (1) knowingly submitted or caused the submission of thousands of fraudulent Medicaid claims for outpatient mental health services for services never rendered or falsely inflated, services that were based on false patient progress notes and billing sheets and forged signatures of psychiatrists and therapists, and services provided by unqualified individuals; and (2) knowingly submitted or caused the submission of fraudulent outpatient mental health Medicaid claims that resulted from their payment of remuneration to a social worker for referrals of patients, including Medicaid patients. Senior Counsel Sarah Kessler represented OIG.
12-26-2019
Maryland Dentist Case Involving Excluded Individual
On December 26, 2019, Lynne S. Brodell, DDS (Dr. Brodell), Cumberland, Maryland, entered into a $94,096.64 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Brodell employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a dentist, provided items or services that were billed to Federal health care programs. OIG's Office of Investigations and Office of Counsel to the Inspector General, represented by Senior Counsels Katie Fink and Jennifer Leonardis, collaborated to achieve this settlement.
Nevada Hospital Settles Case Involving Patient Dumping Allegation
On December 26, 2019, St. Rose Dominican Hospital - Siena Campus (St. Rose), Henderson, Nevada, entered into a $90,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, St. Rose violated the Emergency Medical Treatment and Labor Act (EMTALA), when it failed to provide an appropriate medical screening examination, stabilizing treatment and transfer for a patient. On May 22, 2016, the patient presented to St. Rose's Emergency Department (ED) complaining of dizziness, black stool, yellow skin and stiff muscles. He was transferred with low blood pressure and without having received any blood products, and went into cardiac arrest and died shortly after arriving at the receiving hospital. Senior Counsel Sandra Sands represented OIG.
California Hospital Settles Case Involving Patient Dumping Allegation
On December 26, 2019, San Mateo Medical Center (San Mateo), a small hospital in San Mateo, California, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, San Mateo violated the Emergency Medical Treatment and Labor Act (EMTALA), when it failed to provide an appropriate medical screening examination, stabilizing treatment, and transfer for a 23-year old pregnant woman. On August 24, 2016, the patient presented to San Mateo's Emergency Department (ED) complaining of abdominal pain for about four hours, with some vaginal discharge and bleeding. She was approximately 25 weeks pregnant. San Mateo did not perform a vaginal exam and did not determine if the patient was in labor. San Mateo's ED physician arranged for the patient to be transferred to another hospital for a higher level of care. The ED physician was informed that it would take 45 minutes for ambulance transport to arrive at San Mateo's ED, so he recommended that the patient be transferred by private vehicle. The patient delivered her baby in her car on the way to the receiving hospital and the patient self-diverted to a different hospital, where she arrived 26 minutes later. The baby was not breathing upon arrival to the hospital and the Neonatal Intensive Care Unit was unable to resuscitate the baby. Senior Counsel Sandra Sands represented OIG.
12-16-2019
Florida Hospital Settles Case Involving Patient Dumping Allegation
On December 16, 2019, Florida Hospital Heartland Medical Center (FHHMC), Sebring, Florida, entered into a $35,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, FHHMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for an almost 18-year-old male. On January 30, 2015, the patient presented to FHHMC's Emergency Department (ED) complaining of left testicular pain and swelling for the past three days and rated his pain as a 5 out of ten. His scrotum was swollen and tender. After an examination by an ED physician, the patient was discharged with instructions to follow up with a pediatric urologist. The patient was not seen or evaluated by the on-call urologist before being discharged. OIG alleged that the patient did not receive an appropriate medical screening examination or stabilizing treatment for his emergency medical condition. Senior Counsel Sandra Sands represented OIG.
12-12-2019
Tennessee Laboratory Settles Case Involving False Claims
On December 12, 2019, American Toxicology Lab, LLC (ATL), Johnson City, Tennessee, entered into a $175,889.72 settlement agreement with OIG. The settlement agreement resolves allegations that ATL submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and David Traskey with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
12-11-2019
New York Physician and Practice Settle Case Involving False Claims
On December 11, 2019, Enrico Fazzini, D.O. and Enrico Fazzini, D.O., Ph.D., P.C. (collectively, "Dr. Fazzini"), with multiple locations in New York, entered into a $191,209.96 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Fazzini submitted claims: (1) using CPT code 95937 (neuromuscular junction (NMJ) testing) when he did not perform NMJ testing; and (2) for CPT code 95913 (for thirteen or more nerve conduction studies (NCS)) when he only performed twelve or fewer NCS. Senior Counsels Srishti Sheffner and Geoffrey Hymans represented OIG with the assistance of Program Analyst Mariel Filtz.
11-22-2019
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On November 22, 2019, Rockdale Medical Center (RMC), Conyers, Georgia, entered into a $70,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, RMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide a medical screening examination, stabilizing treatment or proper transfer to a 79-year-old female. Specifically, the patient presented to RMC's Emergency Department (ED) by ambulance after being involved in a motor vehicle crash with multiple injured individuals. EMS contacted RMC's ED for guidance about disposition of the injured individuals and the ED physician at RMC directed that the patient be taken to a trauma center. When one of the ambulances arrived in RMC's ambulance bay with the patient, a hospital nurse approached the ambulance and told the driver that the patient was supposed to go to the trauma center. The ambulance then transported the patient to the trauma center without the patient receiving a medical screening examination. During the transport, the patient's condition deteriorated, and she ultimately died at the receiving hospital. Senior Counsel Geeta Taylor represented OIG.
11-19-2019
New York Drug Rehabilitation Center Settles Case Involving Kickback and Stark Allegations
On November 19, 2019, A.R.E.B.A. - Casriel, Inc. (ACI), Manhattan, New York, entered into a $151,056.75 settlement agreement with OIG. The settlement agreement resolves allegations that ACI received remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of free point of care test cups provided in exchange for prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and ACI caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
11-17-2019
California Health Clinic and Executive Agree to Voluntary Exclusions
On November 17, 2019, in connection with the resolution of their False Claims Act liability, Norman Harr (Harr) and Horisons Unlimited Health Care (Horisons), with multiple locations in and around Merced, California, agreed to be excluded. Harr agreed to be excluded under 42 U.S.C. § 1320a-7(b)(7) for a period of 15 years. Horisons agreed to be excluded under 42 U.S.C. §§ 1320a-7(b)(7) and (8) for a period of 20 years. OIG alleged that Harr and Horisons billed Federal health care programs for services they knew were not reimbursable, including billing for the following: (1) services provided by unlicensed and/or unqualified practitioners; (2) dental services not rendered; (3) reimbursable health care services when acupuncture, a non-reimbursable service, was actually provided; (4) visits with licensed doctors when patients actually received Ziploc baggies of Suboxone handed to them in the parking lots of McDonald's or Rite Aid; (5) non-reimbursable experimental treatments using incorrect generic medical and dental codes; (6) unnecessary medical testing; (7) unnecessary orthodontia; (8) visits with a licensed social worker rather than for a routine office visit in order to increase reimbursement; and (9) mycotic toenail care when the patient actually received a toenail clipping, which would not have been covered. OIG also alleged that Harr and Horisons altered medical records, including making up diagnoses, in order to obtain reimbursement to which they were otherwise not entitled, and received cash payments from a lab in exchange for referring Federal health care program patients for testing. Senior Counsel Andrea Treese Berlin represented OIG.
11-12-2019
Florida Physicians and Practice Settles Case Involving Kickbacks
On November 12, 2019, Jose R. Gonzalez, M.D., Pedro Nam, M.D., and Wellington Medical Care Associates, LLC (collectively, "Wellington Medical"), Loxahatchee, Florida, entered into a $107,260 settlement agreement with OIG. The settlement agreement resolves allegations that Wellington Medical solicited and received remuneration from laboratory companies Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), in the form of "process and handling" payments related to the collection of blood. OIG alleged that Wellington Medical solicited and received the remuneration from HDL and Singulex in exchange for Wellington Medical and Wellington Medical employees referring patients for laboratory testing services to HDL and Singulex, for which the Medicare program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
11-08-2019
Diagnostic Imaging Company Agrees to Voluntary Exclusion
On November 8, 2019, Lakeshore Diagnostic Ultrasound Co. (Lakeshore), Essexville, Michigan, agreed to be excluded for a period of five years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Lakeshore submitted claims for Current Procedural Terminology (CPT) code 96965 for the same dates of service on which it submitted claims for CPT code 93970 or 93971. OIG contends that Lakeshore's submission of claims for CPT code 93965 were for a procedure that was already included as a component of the duplex ultrasound procedures for which Lakeshore submitted claims using CPT codes 93970 or 93971 for the same beneficiary on the same dates of service. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
11-06-2019
Tennessee Ambulance Provider Settles Case Involving False Claims
On November 6, 2019, Healthcare Transport, LLC (HT), Bartlett, Tennessee, entered into a $93,725.22 settlement agreement with OIG. The settlement agreement resolves allegations that HT submitted basic life support ambulance claims through a third-party billing agent where the trips were to destinations for which ambulance services are not covered by Medicare, such as trips to diagnostic and therapeutic sites (and the associated "return" trip was to a residence). OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this resolution.
Texas Ambulatory Surgery Center Settles Case Involving Excluded Individual
On November 6, 2019, Amarillo Endoscopy Center (AEC), Amarillo, Texas, entered into a $121,550.12 settlement agreement with OIG. The settlement agreement resolves allegations that AEC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a nursing assistant, provided items or services to AEC's patients that were billed to Federal health care programs. Associate Counsel Dennis Pangindian represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
11-04-2019
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On November 4, 2019, Hospital Authority of Valdosta and Lowndes County d/b/a South Georgia Medical Center (SGMC), Valdosta, Georgia, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, SGMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide examination and treatment by its on-call urologist for a 27-year old male. Specifically, on June 18, 2014, the patient presented to SGMC's Emergency Department (ED) complaining of pain from an episode of priapism lasting five days. He was seen by an ED physician who contacted SGMC's on-call urologist. The urologist, however, did not come in to the ED to further examine or treat the patient. Instead, the urologist requested that the patient be transferred to another hospital for treatment. The transfer did not take place for more than eight hours and was to a hospital approximately 150 miles away. Priapism is a serious medical condition and delaying proper treatment can lead to penile injury, necrosis, or loss. The patient's transfer was medically inappropriate and put the patient at further risk by delaying needed medical treatment. Senior Counsel Sandra Sands represented OIG.
11-01-2019
Ohio Ambulance Company and Owner Agree to Voluntary Exclusion
On November 1, 2019, Eastern Area Specialty Transport, Inc., and David Haines, its owner (collectively, "EAST"), Leesburg, Ohio, agreed to be excluded for a period of five years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that EAST presented claims to Medicare Part B for ambulance transportation to and from skilled nursing facilities (SNFs) where such transportation was already covered by the SNF consolidated billing payment under Medicare Part A. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
10-17-2019
Virginia Physician Settles False and Fraudulent Medicare Claims Case
On October 17, 2019, Julio C. Gonzalez, M.D., Falls Church, Virginia, entered into a $29,378.26 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Gonzalez submitted claims to Medicare for nerve conduction studies that are considered screening exams and not covered by Medicare. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsel Geoffrey Hymans, collaborated to achieve this resolution.
10-11-2019
Texas Chiropractic Practice Settles Case Involving Excluded Individual
On October 11, 2019, West Texas Multicare Clinic, P.A. d/b/a Precision Chiropractic (Precision Chiropractic), Amarillo, Texas, entered into a $10,000 settlement agreement with OIG. The settlement agreement resolves allegations that Precision Chiropractic employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a billing specialist, provided items or services to Precision Chiropractic's patients that were billed to Federal health care programs.
10-04-2019
Texas Laboratory Settles Case Involving False Claims
On October 4, 2019, Ohio River Laboratories, LLC (ORL), Houston, Texas, entered into a $49,493.48 settlement agreement with OIG. The settlement agreement resolves allegations that ORL submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels David Traskey and Geoffrey Hymans represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
10-02-2019
Florida Medical Practice Settles Case Involving Kickback and Stark Allegations
On October 2, 2019, Physicians Group Services, P.A. (PGS), with multiple locations in North Florida, entered into a $1,128,615.04 settlement agreement with OIG. The settlement agreement resolves allegations that PGS received remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and PGS caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
10-01-2019
Indiana Nursing Facility Settles Case Involving Excluded Individual
On October 1, 2019, Miller's Health System, Inc. d/b/a Miller's Merry Manor (Miller's), Portage, Indiana, entered into a $51,489.97 settlement agreement with OIG. The settlement agreement resolves allegations that Miller's employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a Director of Inservice Education, provided items or services to Miller's patients that were billed to Federal health care programs.
09-30-2019
Louisiana Laboratory Agrees to Voluntary Exclusion
On September 30, 2019, in connection with the resolution of its False Claims Act liability, UTC Laboratories, Inc. a/k/a RenRx (UTC), New Orleans, Louisiana agreed to be excluded for 25 years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that UTC was liable based on: (1) the alleged offer and payment of remuneration, directly or indirectly, to physicians to induce the ordering of pharmacogenetic tests, purportedly in return for their participation in a clinical trial, in violation of the Anti-Kickback Statute (AKS); (2) the alleged offer and payment of remuneration including sales commissions, to entities and individuals directly or indirectly, to induce referrals of pharmacogenetic tests, in violation of the AKS; and (3) furnishing of pharmacogenetic tests that were not medically necessary. Senior Counsel Karen Glassman represented OIG.
09-27-2019
Arizona Researcher Settles Case Involving Grant Fraud
On September 27, 2019, Dr. Ravi Goyal entered into a $73,975 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Goyal submitted or caused to be submitted three invoices from a third party to his university, an NIH grantee, while failing to disclose to the university that funds paid to the third party would ultimately flow to a company Dr. Goyal owned. The university was reimbursed from NIH grant funds for the funds it paid to the third party. Senior Counsel Michael Torrisi and Associate Counsel Dennis Pangindian represented OIG.
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On September 27, 2019, Doctors Hospital of Augusta (DHA), Augusta, Georgia, entered into a $180,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, DHA violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for a patient and failed to accept an appropriate transfer of a second patient. The first patient was a 25-year old female who presented to DHA's Emergency Department (ED) complaining of ingestion of an unknown substance and a loss of consciousness. The patient was reportedly tearful and anxious, and complained of a headache, neck pain, face pain, and left shoulder pain. A nurse triaged the patient and gave her an Emergency Severity Index score of three, which was "urgent" according to DHA's triage policy. A physician medically screened the patient; however, the screen did not include necessary laboratory tests related to the patient's presenting symptoms. The patient was entered into DHA's medical screening exam process for non-emergent patients and was asked for funds in order to continue evaluation. The patient was unable to pay, so she was discharged. The patient immediately sought treatment at another hospital, where she was treated.

The second patient was an 84-year-old female with pneumonia, and severe hypernatremia and hyperglycemia. The patient needed Intensive Care United (ICU) level care and the transferring hospital did not have an ICU. A physician at DHA refused to accept the transfer of the patient, stating that the referring facility could manage the patient. DHA had the capability and the capacity to care for the patient. Associate Counsel Candace Ashford represented OIG.
09-26-2019
Texas Physician Practice Settles Case Involving Excluded Individual
On September 26, 2019, Fredericksburg Family Practice PA d/b/a Cornerstone Clinic (Cornerstone Clinic), Fredericksburg, Texas, entered into a $53,549.66 settlement agreement with OIG. The settlement agreement resolves allegations that Cornerstone Clinic employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a medical coder, provided items or services to Cornerstone Clinic's patients that were billed to Federal health care programs.
09-25-2019
Pennsylvania Pharmacy and Owner Agree to Voluntary Exclusion
On September 25, 2019, in connection with the resolution of their False Claims Act liability, Dhanyabapa LLC d/b/a E-Z Pharmacy and Shardaben Patel, Philadelphia, Pennsylvania, each agreed to be excluded from participation in all Federal health care programs for ten years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that E-Z Pharmacy and Shardaben Patel billed Medicare for prescription medications that were not actually dispensed. Senior Counsel Katie Fink represented OIG.
09-24-2019
Pennsylvania Pharmacy and Owner Agree to Voluntary Exclusion
On September 24, 2019, in connection with the resolution of their False Claims Act liability, G & A Somerton Pharmacy, LLC d/b/a Somerton Pharmacy, and Polina Khodak, Philadelphia, Pennsylvania, each agreed to be excluded from participation in all Federal health care programs for ten years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Somerton Pharmacy and Polina Khodak billed Medicare for prescription medications that were not actually dispensed. Senior Counsel Katie Fink represented OIG.
09-16-2019
North Carolina DME Company Owner Agrees to Voluntary Exclusion
On September 16, 2019, in connection with the resolution of her False Claims Act liability, Margaret A. Gibson (Gibson), Newport, North Carolina, agreed to be excluded for 5 years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Gibson, through her company A Perfect Fit For You, Inc., falsely billed Medicaid for various durable medical equipment, including but not limited to the following items: Powered Air Flotation Beds, Bone Growth Stimulators, Power Wheelchair Accessories; Custom Knee/Ankle/Foot Orthotics; and Cough Stimulating Devices, all of which were not medically necessary, which had not been purchased by A Perfect Fit For You, Inc. through a wholesaler or manufacturer, and which were never delivered to any recipients. Senior Counsel Christina McGarvey represented OIG.
08-22-2019
Florida Laboratory Settles Case Involving False Claims
On August 22, 2019, American Clinical Solutions, LLC (ACS), Boca Raton, Florida, entered into a $61,546.31 settlement agreement with OIG. The settlement agreement resolves allegations that ACS submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Andrea Treese Berlin and Deputy Branch Chief Kirk Sripinyo represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
08-20-2019
Georgia Physician Settles Case Involving False Claims
On August 20, 2019, Gregory D. Martin, M.D., Valdosta, Georgia, entered into a $181,874.30 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Martin submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Martin submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
08-13-2019
New Jersey Diagnostic Testing Facility Settles False and Fraudulent Claims Case
On August 13, 2019, MDR Diagnostics, LLC (MDR), New Brunswick, New Jersey, entered into a $144,621.98 settlement agreement with OIG. OIG's investigation revealed that MDR submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsel Geoffrey Hymans, collaborated to achieve this resolution.
08-07-2019
Kentucky Laboratory Settles Case Involving False Claims
On August 7, 2019, PremierTox 2.0, Inc. (PremierTox), Russell Springs, Kentucky, entered into a $99,157 settlement agreement with OIG. The settlement agreement resolves allegations that PremierTox submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
New Jersey Physicians and Practice Settle Case Involving Kickbacks
On August 7, 2019, Joseph P. Clancy, Jr., M.D., Walter P. Miller, M.D., and Southern Ocean Primary Care Associates, LLC (collectively, "Southern Ocean"), with multiple locations in New Jersey, entered into a $311,626 settlement agreement with OIG. The settlement agreement resolves allegations that Southern Ocean solicited and received remuneration from laboratory companies Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), in the form of "process and handling" payments related to the collection of blood. OIG alleged that Southern Ocean solicited and received the remuneration from HDL and Singulex in exchange for Southern Ocean and a Southern Ocean employee referring patients for laboratory testing services to HDL and Singulex, for which the Medicare program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
Tennessee Laboratory Settles Case Involving False Claims
On August 7, 2019, Discover Diagnostic Laboratory, LLC (DDL), Oak Ridge, Tennessee, entered into a $95,882.36 settlement agreement with OIG. The settlement agreement resolves allegations that DDL submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
08-05-2019
Kansas Infusion Company Owner Agrees to Voluntary Exclusion
On August 5, 2019, in connection with the resolution of his False Claims Act liability, Donald R. Peterson, Overland Park, Kansas, agreed to be excluded from participation in all Federal health care programs under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Peterson, through IVXpress, Inc., submitted claims to Medicare for infusions and/or injections that lacked the requisite direct supervision of the infusion and/or injection by a physician or nurse practitioner. Associate Counsel Dennis Pangindian represented OIG.
07-31-2019
Tennessee Biotechnology Firm Settles Case Involving False Statement in an HHS Grant Application
On July 31, 2019, Prizam Healthcare Technologies, LLC d/b/a Raiven Healthcare and James Stefansic (collectively, "Raiven"), Nashville, Tennessee, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that Raiven submitted an NIH grant application that falsely represented that a community mental health center had agreed to recruit participants for Raiven's proposed study. Senior Counsels Michael Torrisi and David Traskey represented OIG.
07-19-2019
Georgia Pharmaceutical Company Settles Case Involving Drug Price Reporting
On July 19, 2019, U.S. Pharmaceutical Corporation (USPC), Decatur, Georgia, entered into a $380,142.05 settlement agreement with OIG. The settlement agreement resolves allegations that USPC failed to submit timely certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2012, 2015, 2016, and 2017. The Medicaid Drug Rebate Program requires manufacturers to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the manufacturer's covered outpatient drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Mary Riordan represented OIG with the assistance of Program Analyst Mariel Filtz.
Texas Physician and Hospital Executive Settles Case Involving Kickbacks
On July 19, 2019, Corazon Ramirez, M.D., Dallas, Texas, entered into a $171,480 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Ramirez, as the former CEO and COO of Pine Creek Medical Center, paid remuneration to various physician-owners of Pine Creek Medical Center in the form of payments for print and billboard advertisements for the physician-owners and their medical practices. Senior Counsel Karen Glassman, Senior Counsel Michael Torrisi, and Deputy Branch Chief Kirk Sripinyo represented OIG.
07-18-2019
Pennsylvania Physician Agrees to Voluntary Exclusion
On July 18, 2019, Richard Mintz, D.O., a physician in Dresher, Pennsylvania, agreed to be excluded from participation in all Federal health care programs for a period of 7 years under 42 U.S.C. 1320a-7(b)(6)(B). OIG alleged that Dr. Mintz issued medically unnecessary prescriptions for opioids in exchange for cash which failed to meet the professionally recognized standards of care. Senior Counsel Lisa Veigel represented OIG.
07-12-2019
Michigan Physician Practice Settles Case Involving Kickback and Stark Allegations
On July 12, 2019, Anesthesia Services, P.C. d/b/a University Pain Clinic (UPC), Detroit, Michigan, entered into a $44,900 settlement agreement with OIG. The settlement agreement resolves allegations that UPC received remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and UPC caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
Illinois Podiatry Practice Settles Case Involving Excluded Individual
On July 12, 2019, Smith Centers for Foot & Ankle Care (SCFAC), Chicago, Illinois, entered into a $37,688.76 settlement agreement with OIG. The settlement agreement resolves allegations that SCFAC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a medical assistant, provided items or services to SCFAC's patients that were billed to Federal health care programs.
07-08-2019
Pennsylvania Ambulance Companies, Owner, and Related Party Agree to Voluntary Exclusions
0n July 8, 2019, in connection with the resolution of their False Claims Act liability, Damon Wade, Amy Wade, Unicare Ambulance, LLC (Unicare), and PA Paramedics LLC d/b/a Eastern Care Ambulance (PA Paramedics), Bensalem, Pennsylvania, agreed to be excluded from participation in all Federal health care programs under 42 U.S.C. 1320a-7(b)(7). Damon Wade agreed to be excluded for a period of 10 years. Amy Wade, Unicare, and PA Paramedics agreed to be excluded for a period of 5 years. OIG alleged that Damon Wade, Amy Wade, Unicare, and PA Paramedics made repeated false statements to avoid overpayment debts to the Medicare program and to hide the fact that Damon Wade's state paramedic license had previously been suspended because he had admitted to forging a physician's signature. Senior Counsel Gregory Wellins represented OIG.
06-28-2019
Illinois Hospital Settles Case Involving Excluded Individual
On June 28, 2019, Fayette County Hospital (FCH), Vandalia, Illinois, entered into a $125,407.58 settlement agreement with OIG. The settlement agreement resolves allegations that FCH employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a nurse, provided items or services to FCH's patients that were billed to Federal health care programs. Associate Counsel James Hansen represented OIG.
Kentucky Laboratory Settles Case Involving False Claims
On June 28, 2019, Ethos Laboratory (Ethos), Newport, Kentucky, entered into a $1,345,959.74 settlement agreement with OIG. The settlement agreement resolves allegations that Ethos submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and Andrea Treese Berlin represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
Alabama Ambulance Provider Settles Case Involving False Claims
On June 28, 2019, Samaritan EMS, Inc. (Samaritan), Union Grove, Alabama, entered into a $942,373.67 settlement agreement with OIG. The settlement agreement resolves allegations that Samaritan submitted basic and advanced life support ambulance claims where the trips were to destinations for which ambulance services are not covered by Medicare, such as trips to diagnostic and therapeutic sites (and the associated "return" trip was to a residence). Senior Counsels Geoffrey Hymans and Andrea Treese Berlin represented OIG.
06-26-2019
North Carolina Hospital Settles Case Involving Patient Dumping Allegation
On June 26, 2019, Transylvania Regional Hospital (TRH), MH Transylvania Regional Hospital, LLLP, and Transylvania Community Hospital, Inc., Brevard, North Carolina, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, TRH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for a patient. The patient presented to TRH's Emergency Department (ED) complaining of abdominal pain and pain radiating bilaterally to his lower extremities. In addition, the patient had an elevated blood pressure and respiratory rate. Despite this presentment, TRH discharged the patient without providing an adequate medical screening examination or stabilizing treatment. The patient returned to TRH's ED later the same day via ambulance, complaining of paralysis of the lower extremities, leg pain, and leg swelling. TRH ultimately transferred the patient to another hospital. Under EMTALA, the maximum penalty for hospitals with fewer than 100 beds at time of this alleged violation was $25,000. Senior Counsel Geeta Taylor represented OIG.
06-17-2019
Florida Physician Practice Settles Case Involving Kickbacks
On June 17, 2019, Midland Medical, Inc. and its subsidiary, Midland Medical-Broward, Inc. (collectively, "Midland"), Oakland Park, Florida, entered into a $102,204 settlement agreement with OIG. The settlement agreement resolves allegations that Midland received remuneration from laboratory companies Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), in the form of "process and handling" payments related to the collection of blood. OIG alleged that Midland received the remuneration from HDL and Singulex in exchange for Midland and Midland employees referring patients for laboratory testing services to HDL and Singulex, for which the Medicare program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
06-14-2019
Massachusetts Physician Practice Settles Case Involving Kickback and Stark Allegations
On June 14, 2019, HKD Treatment Options, P.C. (HKD), Lowell, Massachusetts, entered into an $87,650 settlement agreement with OIG. The settlement agreement resolves allegations that HKD received remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and HKD caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
06-06-2019
New Mexico Federally Qualified Health Center Settles Case Involving Grant Fraud
On June 6, 2019, Pecos Valley Medical Center, Inc. (PVMC), Pecos, New Mexico, entered into a $70,000 settlement agreement with OIG. The settlement agreement resolves allegations that PVMC knowingly presented to the Department of Health and Human Services (HHS) a specified claim under an HHS grant that PVMC knew or should have known was false or fraudulent. Specifically, OIG alleged that PVMC made drawdowns from a Health Resources and Services Administration Health Infrastructure Investment grant and used the funds for unallowable operating costs not related to the grant. Senior Counsels David Traskey and Kirk Sripinyo represented OIG.
Florida Physician Group Settles Case Involving False Claims
On June 6, 2019, Southeastern Integrated Medical, PL (SIM), a physician group practice with multiple locations in North Central Florida, entered into an $62,727.88 settlement agreement with OIG. The settlement agreement resolves allegations that SIM submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Andrea Treese Berlin and Kirk Sripinyo represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
05-31-2019
Kentucky Laboratory Settles Case Involving False Claims
On May 31, 2019, Commonwealth Pain Associates, PLLC (Commonwealth), Louisville, Kentucky, entered into an $88,214.88 settlement agreement with OIG. The settlement agreement resolves allegations that Commonwealth submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
05-28-2019
Missouri Physician Agrees to Voluntary Exclusion
On May 28, 2019, in connection with the resolution of his False Claims Act liability, William Blake Rodgers, M.D., Jefferson City, Missouri, agreed to be excluded from participation in all Federal health care programs for a period of four years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Dr. Rodgers, a spine surgeon, submitted and caused submission of claims to Federal health care programs for surgical procedures not rendered and for neurophysiological monitoring services that were not properly performed. Senior Counsel David Fuchs represented OIG.
Maryland Dentist Settles Case Involving Excluded Individual
On May 28, 2019, Ryan D. Pensyl, DMD (Dr. Pensyl), Cumberland, Maryland, entered into a $10,941.60 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Pensyl employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a dentist, provided items or services that were billed to Federal health care programs. OIG's Office of Investigations and Office of Counsel to the Inspector General, represented by Senior Counsels Katie Fink and Jennifer Leonardis, collaborated to achieve this settlement.
05-22-2019
Diagnostic Services Provider Settles Case Involving False Claims
On May 22, 2019, On-Site Imaging, LLC (On-Site), Morganville, New Jersey, entered into an $82,065.08 settlement agreement with OIG. The settlement agreement resolves allegations that On-Site submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which On-Site submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
05-21-2019
California Physician Settles False and Fraudulent Claims Case
On May 21, 2019, Yousef Mehrabi, M.D. (Dr. Mehrabi), Encino, California, entered into a $52,799.61 settlement agreement with OIG. OIG's investigation revealed that Dr. Mehrabi submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, collaborated to achieve this resolution.
05-20-2019
Tennessee Hospital Settles Case Involving Excluded Individual
On May 20, 2019 Jackson-Madison County General Hospital District d/b/a West Tennessee Healthcare (WTH), Jackson, Tennessee, entered into a $102,714 settlement agreement with OIG. The settlement agreement resolves allegations that a subsidiary that WTH acquired, Tennova Regional Hospital (TRH), employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a registered nurse, provided items or services to TRH's patients that were billed to Federal health care programs. Senior Counsel Kenneth Kraft represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
Missouri Physicians and Practice Settle Case Involving Kickbacks
On May 20, 2019, Paul S. Moniz, D.O., Guy D. Roberts, D.O., and Midwest Health Group, LLC (collectively, "Midwest Health"), Farmington, Missouri, entered into a $96,880 settlement agreement with OIG. The settlement agreement resolves allegations that Midwest Health received remuneration from Health Diagnostic Laboratory, Inc. (HDL), a laboratory company, in the form of "process and handling" payments related to the collection of blood. OIG alleged that Midwest Health received the remuneration from HDL in exchange for Midwest Health and Midwest Health employees referring patients for laboratory testing services to HDL, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
05-07-2019
Kansas Physician Agrees to Voluntary Exclusion
On May 7, 2019, in connection with the resolution of his False Claims Act liability, Joseph P. Galichia, M.D. (Dr. Galichia), Kansas, agreed to be excluded from participation in all Federal health care programs for a period of three years under 42 U.S.C. 1320a-7(b)(6)(B). OIG alleged that Dr. Galichia submitted claims to Federal health care programs for surgical procedures he performed implanting coronary arterial stents that were not medically necessary. Senior Counsel David Fuchs represented OIG.
05-06-2019
Florida Hospital Settles Case Involving Patient Dumping Allegation
On May 6, 2019, Park Royal Hospital (Park Royal), Fort Meyers, Florida, entered into a $52,414 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, Park Royal violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to accept a transfer of a patient with an unstablilized emergency medical condition, from the emergency department of another hospital. The patient presented to that hospital's emergency department following a suicide attempt and was diagnosed with lacerations to the wrist and an emergency psychiatric condition. Park Royal is a hospital with specialized psychiatric capabilities. OIG alleged that Park Royal refused to accept a transfer of the patient, despite having the specialized capabilities to stabilize the patient and the capacity at the time of transfer, because the patient's insurance was out of network. Senior Counsel Geeta Taylor represented OIG.
04-25-2019
Georgia Urology Practice Settles Case Involving Excluded Individual
On April 25, 2019, Morganstern Urology (Morganstern), Atlanta, Georgia, entered into an $18,810.40 settlement agreement with OIG. The settlement agreement resolves allegations that Morganstern employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a physician, provided items or services to Morganstern's patients that were billed to Federal health care programs.
04-12-2019
Texas State Agency and Living Center Settle Case Involving Excluded Individual
On April 12, 2019, Texas Health and Human Services Commission and Lufkin State Supported Living Center (Lufkin SSLC), entered into a $121,068.42 settlement agreement with OIG. The settlement agreement resolves allegations that Lufkin SSLC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a registered nurse, provided items or services to Lufkin SSLC's patients that were paid for by Federal health care programs. Senior Counsel Katie Fink represented OIG with the assistance of Program Analyst Mariel Filtz.
04-12-2019
California Physician and Practice Settle False and Fraudulent Claims Case
On April 12, 2019, Complete Women Care, Inc., and Miriam Mackovic-Basic, M.D. (collectively, "CWC"), with multiple locations in Los Angeles County, California, entered into a $258,045 settlement agreement with OIG. The settlement agreement resolves allegations that CWC submitted claims to Medicare for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that CWC submitted claims for: (1) diagnostic electromyography services using CPT Code 51784 and diagnostic anorectal manometry (ARM) services using CPT Code 91122 when therapeutic, not diagnostic services, had been provided; (2) ARM services using CPT Code 91122 that were not performed according to CMS guidelines; (3) pelvic floor electrical stimulation that was not preceded by a four-week course of failed pelvic muscle exercise training; and (4) in 13 instances, evaluation and management services using CPT Code 99214 that did not meet the criteria for billing under that code. OIG's Division of Data Analytics and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Michael Torrisi, with the assistance of Program Analyst Mariel Filtz, collaborated to achieve this settlement.
04-04-2019
Maine Mental Health Service Provider Settles Case Involving Excluded Individual
On April 4, 2019, Aroostook Mental Health Services, Inc. (AMHS), Caribou, Maine, entered into a $17,750.12 settlement agreement with OIG. The settlement agreement resolves allegations that AMHS employed an individual who was excluded from participating in MaineCare, Maine's Medicaid program. OIG's investigation revealed that the excluded individual, a counselor, provided items or services to AMHS's patients that were billed to MaineCare.
03-28-2019
Texas Skilled Nursing Facility Settles Case Involving Excluded Individual
On March 28, 2019, Sweeny Community Hospital d/b/a Lake Jackson Healthcare (LJH), Lake Jackson, Texas, entered into a $113,802.80 settlement agreement with OIG. The settlement agreement resolves allegations that LJH employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a vocational nurse, provided items or services to LJH's patients that were billed to Federal health care programs.
03-26-2019
Wisconsin Mental Health Entity, Owner, and Related Party Agree to Voluntary Exclusions
On March 26, 2019, in connection with the resolution of their False Claims Act liability, Acacia Mental Health Clinic, LLC (Acacia), Abraham Freund, and Isaac Freund, agreed to be excluded from participation in all Federal health care programs under 42 U.S.C. 1320a-7(b)(7). Acacia and Abraham Freund agreed to be excluded for a period of 20 years. Isaac Freund agreed to be excluded for a period of 5 years. At the time of the allegations, Wisconsin Medicaid reimbursed providers for urine drug screens performed with point-of-care cups under Current Procedure Terminology (CPT) Code 80104 at the rate of approximately $20 per test, regardless of the number of drug classes tested. OIG alleged that: (1) at Abraham Freund's direction, Acacia submitted claims to Wisconsin Medicaid under CPT Code 80101 with a separate unit for each drug class, although CPT Code 80101 was appropriate only for more sophisticated tests performed using laboratory equipment that Acacia did not possess; (2) at Abraham Freund's direction, Acacia also misrepresented to Wisconsin regulators that it possessed the laboratory equipment necessary to perform tests covered by CPT Code 80101 to conceal its false billings; (3) Acacia and Abraham Freund knew that, by submitting claims for urine drug screens performed at Acacia under CPT Code 80101, they were misrepresenting the types of tests performed to Wisconsin Medicaid; and (4) by submitting these allegedly false claims to Medicaid, Acacia and Abraham Freund improperly increased the reimbursement received from Wisconsin Medicaid by hundreds of dollars per test. OIG further alleged that Acacia and Abraham Freund submitted or caused the submission of false telemedicine services claims to Wisconsin Medicaid because it was improper to submit claims for telemedicine services provided to patients by psychiatrists located outside of the United States and that, at Abraham Freund's direction and with Isaac Freund's involvement, Acacia performed medically unnecessary and duplicative urine drug screens for its Medicaid patients. Senior Counsel Keshia Thompson represented OIG.
03-21-2019
Ohio Skilled Nursing Facility Settles Case Involving Excluded Individual
On March 21, 2019, Berea Alzheimer's Care Center (BACC), Berea, Ohio, entered into a $75,998.54 settlement agreement with OIG. The settlement agreement resolves allegations that BACC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a medical records coordinator, provided items or services to BACC's patients that were billed to Federal health care programs.
03-13-2019
Kentucky Laboratory Settles Case Involving False Claims
On March 13, 2019, VerraLab JA, LLC (VerraLab), Louisville, Kentucky, entered into a $125,983.16 settlement agreement with OIG. The settlement agreement resolves allegations that VerraLab submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
Kentucky Medical Group Practice Settles Case Involving False Claims
On March 13, 2019, Medical Specialist of Kentuckiana, PLLC (MSK), Louisville, Kentucky, entered into a $69,776.24 settlement agreement with OIG. The settlement agreement resolves allegations that MSK submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
03-08-2019
Oklahoma Skilled Nursing Facility Settles Case Involving Excluded Individual
On March 8, 2019, Sweet Town, LLC d/b/a Cleveland Manor Nursing and Rehabilitation (Cleveland Manor), Cleveland, Oklahoma, entered into a $171,047 settlement agreement with OIG. The settlement agreement resolves allegations that Cleveland Manor employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an office manager, provided items or services to Cleveland Manor's patients that were billed to Federal health care programs.
03-01-2019
Tennessee Skilled Nursing Facility Settles Case Involving Excluded Individual
On March 1, 2019, MHC, Inc. d/b/a Maplewood Health Care Center (Maplewood), Jackson, Tennessee, entered into an $81,419.42 settlement agreement with OIG. The settlement agreement resolves allegations that Maplewood employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a registered nurse, provided items or services to Maplewood's patients that were billed to Federal health care programs. Senior Counsel Kenneth Kraft represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
02-13-2019
Diagnostic Services Provider Settles Case Involving False Claims
On February 13, 2019, Medical Diagnostics Services, Inc. (MDS), with locations in Michigan and Illinois, entered into an $878,180.08 settlement agreement with OIG. The settlement agreement resolves allegations that MDS submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which MDS submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
02-07-2019
Tennessee Prosthetics Company Settles Case Involving Kickback Allegations
On February 7, 2019, Amputee Associates, LLC (AA), Nashville, Tennessee, entered into a $681,774 settlement agreement with OIG. The settlement agreement resolves allegations that AA offered and paid illegal remuneration to two surgical practices and a prosthetist in the form of fee reductions and payments. Specifically, OIG alleged that AA reduced its monthly fee to a Texas surgical practice by an amount equal to the monthly salary the practice paid its prosthetist, in order to induce the practice to refer prosthetics business to AA. OIG also alleged that AA made payments to a prosthetist employed by a Georgia surgical practice in order to induce the prosthetist to refer prosthetics business to AA. In addition, OIG alleged that AA made payments to a Tennessee surgical practice in order to induce the practice to recommend the purchasing of goods and services from AA. Senior Counsel Michael Torrisi represented OIG.
02-06-2019
Ohio Practice and Owner Settle Case Involving False Claims
On February 6, 2019, Mohammad Mouhib Kalo, M.D., and Wheelersburg Internal Medicine Group, Inc. (collectively, "WIMG"), Wheelersburg, Ohio, entered into a $111,706 settlement agreement with OIG. The settlement agreement resolves allegations that WIMG submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
01-24-2019
Kentucky Pain Management Practice Settles Case Involving False Claims
On January 24, 2019, Northern Kentucky Center for Pain Relief, LLC (NKCPR), Florence, Kentucky, entered into a $126,799.90 settlement agreement with OIG. The settlement agreement resolves allegations that NKCPR submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
01-04-2019
Oklahoma Assisted Living Facility Settles Case Involving Excluded Individual
On January 4, 2019, Baptist Village of Owasso (BVO), Owasso, Oklahoma, entered into a $96,020.92 settlement agreement with OIG. The settlement agreement resolves allegations that BVO employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an admission specialist, provided items or services to BVO's patients that were billed to Federal health care programs.

2018

12-21-2018
Oklahoma Pain Management Practice and Physicians Settle Case Involving Kickback and Stark Allegations
On December 21, 2018, Tulsa Pain Consultants, Inc., Martin Martucci, M.D., and Andreas Revelis, M.D. (collectively, "TPC"), Tulsa, Oklahoma, entered into a $98,942.50 settlement agreement with OIG. The settlement agreement resolves allegations that TPC received remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and TPC caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
Alabama Hospital Settles Case Involving Patient Dumping Allegations
On December 21, 2018, Mobile Infirmary Medical Center (MIMC), Mobile, Alabama, entered into an $80,000 settlement agreement with OIG. The settlement resolves allegations that, based on OIG's investigation, MIMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for two individuals. The first patient, a 24-year-old male presented to MIMC's Emergency Department (ED) complaining of weakness and exhibited altered mental status. He was reportedly aggressive and non-compliant with staff directions. When he was leaving the ED he apparently collapsed. A security guard, a hospital employee, put him in a wheelchair and wheeled the patient off hospital property - where he was left on the ground. Approximately four hours later the patient was found cold, with decreased responsiveness. He was transported to another hospital by ambulance. He died two weeks later. The second patient, a 35-year-old male, presented to MIMC's ED accompanied by his girlfriend. The patient complained of shortness of breath and chest pain. The patient requested to see a physician and became belligerent when a nurse asked him why. That led to the patient being escorted out of the ED by security. Several minutes later, the patient returned to the ED. This time, the patient's girlfriend drove up to the ambulance bay and reported that the patient had suffered a seizure and was lying in her truck. She was informed by staff that they would not help get the patient out of the truck. In addition, the security guard told her she had to leave. The patient's girlfriend then took him to another hospital where he was pronounced dead within 20 minutes of his arrival. Senior Counsel Sandra Sands represented OIG.
12-20-2018
California Physician and Practice Settle Case Involving False Claims
On December 20, 2018, Michael Jadali, D.O., and the Center for Pain & Rehabilitation Medicine (collectively, "Dr. Jadali"), San Jose, California, entered into a $60,406.30 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Jadali submitted claims to Medicare for Healthcare Common Procedure Coding System codes 80500 (clinical pathology consultation; limited, without review of patient's history and medical records) and 80502 (clinical pathology consultation, comprehensive, for a complex diagnostic problem, with review of patient's history and medical records), where no consultation request had been made, no written narrative report by a consultant pathologist was produced, and no exercise of medical judgement by a consultant pathologist was required. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
12-12-2018
Connecticut Hospital Settles Case Involving Patient Dumping Allegation
On December 12, 2018, Hartford Hospital (Hartford), Hartford, Connecticut, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that Hartford violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination to a woman who was 23.5 weeks pregnant when she presented to Hartford's Emergency Department with symptoms of preeclampsia, an emergency medical condition. Senior Counsels Joan Matlack and Srishti Sheffner represented OIG.
12-01-2018
Georgia Mental Health Provider and Owner Agree to Voluntary Exclusion
On December 1, 2018, in connection with the resolution of their False Claims Act liability, Families United Services, Inc. (FUS), and Pamela McKenzie, Georgia, each agreed to be excluded from participation in all Federal health care programs for periods of five years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that FUS and Pamela McKenzie submitted claims to Georgia Medicaid for behavioral health services that were not provided. Senior Counsel Katie Fink represented OIG.
11-30-2018
Physician and Business Owner Agrees to Voluntary Exclusion
On November 30, 2018, in connection with the resolution of his False Claims Act liability, Zahid Aslam, M.D., a physician with ownership interests in multiple medical practices in Delaware and Maryland, agreed to be excluded from participation in all Federal health care programs for a period of eight years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Dr. Aslam improperly submitted claims for: (1) laboratory services that were not medically necessary, did not qualify for payment, and/or were not provided; (2) medical and/or counseling services that listed the wrong rendering provider and/or did not qualify for payment because they were not rendered by an eligible provider; and (3) medical services that listed the wrong Current Procedure Terminology (CPT) code and/or lacked documentation to support the listed CPT code. Senior Counsel Lisa Veigel represented OIG.
11-27-2018
Louisiana Clinic and Physician Settle False and Fraudulent Medicare Claims Case
On November 27, 2018, Michael L. Drerup, M.D., and the Alexandria Neurosurgical Clinic (collectively, "Drerup"), Alexandria, Louisiana, entered into an $80,941.82 settlement agreement with OIG. The settlement agreement resolves allegations that Drerup submitted claims to Medicare for nerve conduction studies that are considered screening exams and not covered by Medicare. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, collaborated to achieve this settlement.
Maine Mental Health Services Provider Settles Case Involving Excluded Individual
On November 27, 2018, Spurwink Services (Spurwink), Portland, Maine, entered into a $61,461.00 settlement agreement with OIG. The settlement agreement resolves allegations that Spurwink employed an individual who was excluded from participating in MaineCare, Maine's Medicaid program. OIG's investigation revealed that the excluded individual, a residential treatment specialist, provided items or services to Spurwink's patients that were billed to MaineCare.
11-19-2018
Connecticut Diagnostic Services Provider Settles Case Involving False Claims
On November 19, 2018, Southern Connecticut Vascular Center, LLC (SCVC), Stratford, Connecticut, entered into a $792,076.76 settlement agreement with OIG. The settlement agreement resolves allegations that SCVC submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965 when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which SCVS submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the submission of claims for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
11-13-2018
Texas Laboratory Excluded for Default
On November 13, 2018, OIG excluded Medicus Laboratories, LLC (Medicus), a Dallas, Texas, laboratory, for defaulting on payment obligations under a settlement agreement with OIG wherein OIG alleged that Medicus submitted false or fraudulent claims to Medicare. Medicus' exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates Medicus' participation in Federal health care programs. Senior Counsel Geoffrey Hymans represented OIG.
11-07-2018
Illinois Hospital Settles Case Involving Excluded Individual
On November 7, 2018, the University of Chicago Medical Center (UCMC), Chicago, Illinois, entered into a $253,671.20 settlement agreement with OIG. The settlement agreement resolves allegations that UCMC, through a staffing agency, employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a registered nurse, provided items or services to UCMC's patients that were billed to Federal health care programs.
11-01-2018
Ohio Nursing Home Settles Case Involving Excluded Individual
On November 1, 2018, Wayside Farm, Inc. (Wayside), Peninsula, Ohio, entered into a $293,842.58 settlement agreement with OIG. The settlement agreement resolves allegations that Wayside employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a state tested nurse aide, provided items or services to Wayside's patients that were billed to Federal health care programs.
10-30-2018
Texas Physician and Practice Settle Case Involving False Claims
On October 30, 2018, Angela Smith, M.D., and Willow Wellness Center, P.A. (collectively, "Dr. Smith"), Tyler, Texas, entered into a $629,264.14 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Smith submitted claims to Medicare for Healthcare Common Procedure Coding System code 80502 (clinical pathology consultation, comprehensive, for a complex diagnostic problem, with review of patient's history and medical records), where no consultation request had been made, no written narrative report by a consultant pathologist was produced, and no exercise of medical judgement by a consultant pathologist was required. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
10-30-2018
Illinois Diagnostic Services Provider Settles Case Involving False Claims
On October 30, 2018, Cal-Devon Urgent Care, Inc. (CDUC), Chicago, Illinois, entered into a $224,151.48 settlement agreement with OIG. The settlement agreement resolves allegations that CDUC submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965 when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which CDUC submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the submission of claims for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
10-30-2018
Kansas Financial Management Services Provider Settles Case Involving Excluded Individual
On October 30, 2018, Resource Center for Independent Living, Inc. (RCIL), Osage City, Kansas, entered into a $232,610 settlement agreement with OIG. The settlement agreement resolves allegations that RCIL employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a direct service worker, provided items and services to RCIL patients that were billed to Kansas Medicaid. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
10-24-2018
Florida Physicians and Practice Settle False and Fraudulent Claims Case
Jaime L. Sepulveda, MD, LLC (d/b/a Miami Urogynecology Center), Jaime L. Sepulveda, M.D., and Sujata Yavagal, M.D. (collectively, "Miami Urogynecology Center"), South Miami, Florida, entered into a $173,768.08 settlement agreement with OIG. The settlement agreement resolves allegations that Miami Urogynecology Center submitted claims to Medicare for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that Miami Urogynecology Center submitted claims for: (1) diagnostic electromyography services using CPT code 51784 when therapeutic, not diagnostic, services had been provided; (2) pelvic floor physical therapy services using CPT codes 97032 and 97110 when those services were provided by an unqualified individual; and (3) evaluation and management (E&M) services using CPT codes 99213 and 99214 that were billed in conjunction with pelvic floor therapy procedures when no separate and identifiable E&M services were provided. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Srishti Sheffner and Michael Torrisi, with the assistance of Program Analyst Mariel Filtz, collaborated to achieve this settlement.
10-16-2018
Pennsylvania Community Mental Health Clinics and Owners Agree to Voluntary Exclusions
On October 16, 2018, in connection with the resolution of their False Claims Act liability, Melchor Martinez (Martinez), Melissa Chlebowski (Chlebowski), Lehigh Valley Community Health Centers, Inc. (Lehigh Valley), Northeast Community Mental Health Centers, Inc. (Northeast), and Carolina Community Mental Health Centers, Inc. (Carolina), collectively ("MM"), agreed to be excluded from participation in all Federal health care programs under 42 U.S.C. 1320a-7(b)(7). Martinez is presently excluded and agreed to be excluded for an additional 10-years. Chlebowski, Lehigh Valley, Northeast, and Carolina agreed to be excluded for 5 years. OIG alleged that MM submitted or caused to be submitted false claims to Medicare and Medicaid arising from: (1) Martinez's undisclosed management of Northeast, Lehigh Valley, and Carolina in violation of his exclusion from Federal health care programs; (2) Northeast's, Lehigh Valley's, and Carolina's use of unqualified and/or unsupervised mental health therapists; and (3) the submission and payment of Medicaid claims for medication management visits that were upcoded to reflect longer visits. Senior Counsel Nancy Brown represented OIG.
10-11-2018
Illinois Therapy Service Provider and Owner Agree to Voluntary Exclusion
On October 11, 2018, in connection with the resolution of their False Claims Act liability, Quality Therapy & Consultation, Inc. (QTC) and Francis Parise (Parise), Orland Park, Illinois, agreed to be excluded from participation in all Federal health care programs under 42 U.S.C. 1320a-7(b)(7). QTC agreed to be permanently excluded and Parise agreed to be excluded for a period of five years. Parise is an occupational therapist and the Owner and President of QTC. OIG alleged that QTC, at Parise's direction, provided skilled nursing and skilled nursing rehabilitation therapy services that were not medically necessary, engaged in alteration of medical records, and improperly increased its Medicare reimbursements by "upcoding" patients' "Resource Utilization Group" scores. Senior Counsel David Fuchs represented OIG.
Nevada Medical Biller Agrees to 25 Year Exclusion
On October 11, 2018, Tymekka Greenough (Greenough), the in-house medical biller for First Initiative, LLC (First Initiative), a Nevada behavioral health services provider, agreed to be excluded for a period of 25 years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Greenough knowingly submitted or caused to be submitted claims to the Nevada Medicaid Program on behalf of First Initiative that were false or fraudulent or were not provided as claimed, including: (1) individual psychotherapy services using CPT Codes 90832, 90834, and 90837; (2) individual psychotherapy services utilizing biofeedback training using CPT Code 90876; (3) case management services using CPT Code T1016; and (4) skills training and development services using CPT Code H2014. Senior Counsels Srishti Sheffner and Michael Torrisi represented OIG.
10-05-2018
Arkansas Assisted Living Facility Settles Case Involving Excluded Individual
On October 5, 2018, Whispering Knoll, Pine Bluff, Arkansas, entered into a $35,195.95 settlement agreement with OIG. The settlement agreement resolves allegations that Whispering Knoll employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a licensed practical nurse, provided items or services to Whispering Knoll's patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
10-05-2018
New York Pharmacy Settles Case Involving Excluded Individual
On October 5, 2018, Healthways Worldwide Inc. d/b/a Healthways Pharmacy and Surgical (Healthways), Brooklyn, New York, entered into a $204,426.64 settlement agreement with OIG. The settlement agreement resolves allegations that Healthways employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded pharmacist provided items or services to Healthways patients that were billed to Federal health care programs. Senior Counsel Jennifer Leonardis represented OIG.
10-03-2018
Arizona Physician Settles Case Involving Kickback and Stark Allegations
On October 3, 2018, Ronald Burns, M.D. (Dr. Burns), Phoenix, Arizona, entered into a $75,409.15 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Burns, in his capacity as then owner of a pain management practice, entered into contracts on behalf of the pain management practice and received remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and that Dr. Burns caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
09-28-2018
Virginia Physician and Practice Settle False and Fraudulent Claims Case
On September 28, 2018, Atlantic Obstetrics & Gynecology, P.C. d/b/a Atlantic OB-GYN and Timothy J. Hardy, M.D. (collectively, "Atlantic OB-GYN"), with locations in Chesapeake and Virginia Beach, Virginia, entered into an $81,959.60 settlement agreement with OIG. The settlement agreement resolves allegations that Atlantic OB-GYN submitted claims to Medicare for items or services that it knew or should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended that Atlantic OB-GYN submitted claims for: (1) diagnostic electromyography services using CPT Code 51784 and diagnostic anorectal manometry services using CPT Code 91122 when therapeutic services, not diagnostic services, had been provided, and (2) pelvic floor electrical stimulation that was not preceded by a four-week course of failed pelvic muscle exercise training. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Michael Torrisi, with the assistance of Program Analyst Mariel Filtz, collaborated to achieve this settlement.
09-27-2018
New Jersey Health Center Settles Case Involving Excluded Individual
On September 27, 2018, Newark Community Health Centers, Inc. (NCHC), New Jersey, entered into a $98,750.36 settlement agreement with OIG. The settlement agreement resolves allegations that NCHC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a physician working in quality assurance and risk management, provided items and services to NCHC that were billed to Federal health care programs. Associate Counsel Srishti Sheffner represented OIG.
09-19-2018
South Carolina Physicians and Practice Settle Case Involving Kickbacks
On September 19, 2018, Sarah S. Cottingham, M.D., Russell E. Ditzler, M.D., and Lexington County Health Services District, Inc. d/b/a Lexington Medical Center (collectively, "Lexington"), Columbia, South Carolina, entered into a $97,784 settlement agreement with OIG. The settlement agreement resolves allegations that Lexington solicited and received remuneration from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "process and handling" payments related to the collection of blood. OIG alleged that Lexington solicited and received the remuneration from HDL and Singulex in exchange for Lexington and Lexington employees referring patients for laboratory testing services to HDL and Singulex, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
09-14-2018
Illinois Psychologist Agrees to 20 Year Exclusion
On September 14, 2018, Anthony D. Vertino, Psy.D. (Vertino), Illinois, agreed to be excluded from participation in all Federal health care programs for a period of twenty years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Vertino submitted claims for psychological services that were not provided as claimed or were false or fraudulent because the claims were for dates of service when patients were hospitalized or when Vertino was travelling out of state. Senior Counsel Joan Matlack represented OIG.
Tennessee Nurse Agrees to 10 Year Exclusion
On September 14, 2018, Cindy Scott, R.N., A.P.R.N. (Scott), Tennessee, agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. 1320a-7(b)(6)(B) and 1320a-7(b)(7). OIG alleged Scott submitted or caused the submission of false claims for controlled substance prescriptions that were medically unnecessary, substantially in excess of the needs of her patients, and below the professionally recognized standards of care. Specifically, OIG alleged Scott prescribed monthly prescriptions to individual patients exceeding a daily dosage of five hundred (500) morphine milligram equivalents (MME), which included inappropriate combinations of long and short acting opioids often combined with high amounts of a benzodiazepine and/or carisoprodol. OIG also alleged Scott prescribed controlled substances and combinations of controlled substances and other medication without appropriately documenting: (1) a clear objective finding of a chronic pain source to justify the ongoing and increasing prescribing; (2) attempts to identify the etiology of reported pain; (3) a thorough history or adequately inquiring into potential substance abuse history; or (4) a written treatment plan with regard to the use of the prescriptions. Senior Counsels Andrea Treese Berlin, Katie Fink, and Joan Matlack represented OIG.
09-06-2018
Florida Pediatric Practice and Physicians Settle Case Involving Kickback and Stark Allegations
On September 6, 2018, Milind V. Tilak, M.D., Suwarna Tilak, M.D., Doctor's Inlet Pediatrics and Primary Care, P.A., and Avenues Pediatrics and Internal Medicine (collectively, "Doctor's Inlet"), Middleburg and Jacksonville, Florida, entered into a $58,370 settlement agreement with OIG. The settlement agreement resolves allegations that Doctor's Inlet received improper remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and that Doctor's Inlet caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
09-05-2018
California Biotechnology Company Settles Case Involving False Grant Claims
On September 5, 2018, Sonata Biosciences, Inc. (Sonata), Auburn, California, entered into a $37,716.30 settlement agreement with OIG. The settlement agreement resolves allegations that Sonata knowingly presented to the Department of Health and Human Services (HHS) two specified claims under an HHS grant that Sonata knew or should have known were false or fraudulent. Specifically, OIG alleged that Sonata drew down $37,384.74 from a National Institutes of Health Small Business Innovation Research Grant for costs unrelated to the grant. Senior Counsels Michael Torrisi and David Traskey, assisted by Chief Investigator Jennifer Trussell, represented OIG.
08-24-2018
Maine Health System Settles Case Involving Excluded Individual
On August 24, 2018, St. Mary's Health System (St. Mary's), Lewiston, Maine, entered into a $68,497.32 settlement agreement with OIG. The settlement agreement resolves allegations that St. Mary's employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a call center patient scheduler, provided items and services to St. Mary's patients that were billed to Federal health care programs.
08-21-2018
Oklahoma Prosthetics Supplier Excluded for Default
On August 21, 2018, OIG excluded La Fuente Ocular Prosthetics, LLC (La Fuente), an Oklahoma City, Oklahoma, prosthetic supplier, for defaulting on payment obligations under a settlement agreement with OIG wherein OIG alleged that La Fuente submitted false or fraudulent claims to Medicare and created false records material to a false claim. La Fuente's exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates La Fuente's participation in Federal Health care programs. Senior Counsel Geoffrey Hymans represented OIG.
08-20-2018
Nevada Behavioral Health Services Provider and Owner Agree to 50 Year Exclusion
On August 20, 2018, First Initiative, LLC, a behavioral health services provider in Las Vegas, Nevada, and Shameika Amin, its owner (collectively, "First Initiative"), agreed to be excluded for a period of fifty years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that First Initiative knowingly submitted or caused to be submitted claims to the Nevada Medicaid program for: (1) individual therapy services using CPT Codes 90834 and 90837 when group therapy services had been provided; (2) individual psychotherapy services utilizing biofeedback training using CPT Code 90876 when no biofeedback training had been provided; and (3) behavioral health services that were billed under the names and national provider identifiers of providers who had not provided the services. Senior Counsel Michael Torrisi and Associate Counsel Srishti Sheffner represented OIG.
08-17-2018
ALJ Upholds OIG Exclusion Determination
On August 17, 2018, an Administrative Law Judge (ALJ) for the Departmental Appeals Board upheld OIG's 15-year exclusion of Karim Maghareh, Ph.D. (Maghareh), and BestCare Laboratory Services, LLC (BestCare), Webster, Texas, from participation in all Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). The ALJ found that Maghareh and BestCare submitted false claims to Medicare for reimbursement of travel costs associated with the collection of samples on which BestCare performed laboratory tests. Specifically, BestCare improperly billed Medicare for trained personnel travel, but instead used commercial airline flights to ship samples that were unaccompanied by trained personnel. Senior Counsels Lauren Marziani, Tamara Forys, and David Fuchs represented OIG. News Release
08-08-2018
California Independent Diagnostic Testing Facility and Owner Agree to Voluntary Exclusion
On August 8, 2018, CHJ Diagnostic, Inc., an independent diagnostic testing facility in Orange, California, and Andranik Tovmasyan, its owner (collectively, "CHJ"), agreed to be excluded for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that CHJ submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, collaborated to achieve this resolution.
08-06-2018
Hyperbaric Oxygen Therapy Operator Agrees to Voluntary Exclusion
On August 6, 2018, in connection with the resolution of his False Claims Act liability, Scott Warantz (Warantz), New York, agreed to be excluded from participation in all Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged Warantz improperly submitted or caused to be submitted claims for hyperbaric oxygen therapy purportedly supervised by a physician even though the physician was not providing supervision at that facility and was instead performing services at an unrelated facility in New Jersey. Associate Counsel Srishti Sheffner represented OIG.
08-02-2018
Texas Physician and Practice Settle Case Involving Kickbacks
On August 2, 2018, Elizabeth Seymour, M.D., and ERS Medical Associates of Denton (collectively, "ERS"), Denton, Texas, entered into a $54,860 settlement agreement with OIG. The settlement agreement resolves allegations that ERS solicited and received remuneration from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "process and handling" payments related to the collection of blood. OIG alleged that ERS solicited and received the remuneration from HDL and Singulex in exchange for ERS and an ERS employee referring patients for laboratory testing services to HDL and Singulex, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
08-02-2018
South Carolina Physician and Practice Settle Case Involving Kickbacks
On August 2, 2018, Horace E. Walpole, M.D., and Powdersville Internal Medicine (collectively, "Powdersville IM"), Piedmont, South Carolina, entered into a $68,500 settlement agreement with OIG. The settlement agreement resolves allegations that Powdersville IM solicited and received remuneration from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "process and handling" payments related to the collection of blood. OIG alleged that Powdersville IM solicited and received the remuneration from HDL and Singulex in exchange for Powdersville IM referring patients for laboratory testing services to HDL and Singulex, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
08-02-2018
Ohio Skilled Nursing Facility Settles Case Involving Excluded Individual
On August 2, 2018, Ireland Health Care Center, Inc. d/b/a Singleton Health Care Center (SHCC), Cleveland, Ohio, entered into a $45,735.42 settlement agreement with OIG. The settlement agreement resolves allegations that SHCC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a licensed practical nurse, provided items or services to SHCC's patients that were billed to Federal health care programs. Senior Counsel Nancy Brown, with the assistance of Paralegal Specialist Eula Taylor, represented OIG.
08-02-2018
Maine Chiropractic Practice Settles Case Involving Excluded Individual
On August 2, 2018, Gerrish Chiropractic Center (GCC), Bar Harbor, Maine, entered into a $7,019.10 settlement agreement with OIG. The settlement agreement resolves allegations that GCC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an office manager and chiropractic assistant, provided items or services to GCC's patients that were billed to Federal health care programs.
07-02-2018
Vermont Physician and Practice Settle Case Involving Excluded Individual
On July 2, 2018, William H. Newman, M.D., and Allergy & Asthma Specialists of Northern Vermont, P.C. (collectively, "Dr. Newman"), entered into a $61,142.96 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Newman employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a registered nurse, provided items or services to Dr. Newman's patients that were billed to Federal health care programs. OIG's Office of Audit Services, Office of Investigations and Office of Counsel to the Inspector General, represented by Senior Counsel John O'Brien, collaborated to achieve this settlement.
07-02-2018
New Jersey Pediatrician Settles Case Involving False Claims
On July 2, 2018, Rashmi Sandeep, MD (Dr. Sandeep), Brick, New Jersey, entered into a $336,298.52 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Sandeep knowingly presented to Medicaid, through certain New Jersey Medicaid Managed Care Organizations (MCOs), claims for items or services that she knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG alleged that Dr. Sandeep: (1) submitted or caused to be submitted claims for items or services provided to Medicaid beneficiaries, who were enrolled with certain MCOs, in which Dr. Sandeep failed to personally perform or directly supervise services billed under her NPI number because she was either not present in the United States or was otherwise not in the State of New Jersey; (2) caused the resubmission of previously denied claims for items or services provided to Medicaid beneficiaries enrolled with a particular MCO by identifying herself as the rendering provider when, in fact, she was not; and (3) submitted or caused to be submitted claims for items or services provided to Medicaid beneficiaries enrolled with a particular MCO under her NPI number for services performed by non-credentialed providers who were not supervised by Dr. Sandeep. Associate Counsel Srishti Sheffner represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
06-29-2018
Florida Company Settles Case Involving Select Agent Regulations
On June 29, 2018, a Florida company agreed to pay $100,000 to resolve its liability for violating the select agent regulations. OIG alleged that the laboratory violated the select agent regulations when it transferred a select toxin to an entity that was not registered to possess, use, or transfer that toxin, and the company did not obtain prior authorization from the Centers for Disease Control and Prevention for this transfer. OIG contends this conduct subjects the company to civil money penalties under the Public Health Security and Bioterrorism Preparedness and Response Act, 42 U.S.C. 262a(i), and 42 C.F.R. 1003.102(b)(16).
06-11-2018
Oklahoma Ambulance Authority Settles Case Involving False Claims
On June 11, 2018, Comanche County Hospital Authority d/b/a Comanche County Memorial Hospital, (Comanche), Lawton, Oklahoma, entered into a $566,806 settlement agreement with OIG. The settlement agreement resolves allegations that Comanche submitted claims to Medicare 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. In addition, during the course of OIG's investigation, Comanche discovered and disclosed that it submitted claims to Medicare for emergency ambulance transportation that were not medically reasonable or necessary. Comanche also disclosed that it submitted claims to Medicare for transports where the documentation for the transport was not consistent with the patient's condition, and therefore did not support the documented medical necessity for the transport. 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.
California Physician and Practice Settle False and Fraudulent Claims Case
On June 11, 2018, James S. Dunn, Jr., MD, and James S. Dunn Jr., MD, Inc. d/b/a Auburn Urogynecology and Women's Health (collectively, "Dr. Dunn"), Auburn, California, entered into a $419,578 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Dunn submitted claims to Medicare for items or services that he knew or should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended that Dr. Dunn submitted claims for: (1) diagnostic electromyography services using CPT Code 51784 and diagnostic anorectal manometry using CPT Code 91122 when therapeutic, not diagnostic, services had been provided; (2) pelvic floor electrical stimulation that was not preceded by a four-week course of failed pelvic muscle exercise training; and (3) pelvic floor physical therapy services that were provided by an unqualified individual. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Michael Torrisi, Associate Counsel Srishti Sheffner, and Associate Counsel Jonathan Culpepper, with the assistance of Paralegal Specialist Mariel Filtz, collaborated to achieve this settlement.
05-30-2018
Virginia Non-Profit and Federally Qualified Health Center Settles Case Involving Grant Fraud
On May 30, 2018, St. Charles Health Council, Inc. (St. Charles), Pennington Gap, Virginia, entered into a $115,000 settlement agreement with OIG. The settlement agreement resolves allegations that St. Charles knowingly presented to the Department of Health and Human Services (HHS) a specified claim under an HHS grant that St. Charles knew or should have known was false or fraudulent and knowingly and improperly avoided an obligation to transmit funds to HHS with respect to such grant. Specifically, OIG alleged that St. Charles drew down $500,000 from a Health Resources and Services Administration Capital Development Grant and used the funds for unallowable operating costs unrelated to the grant. OIG further alleged that St. Charles improperly failed to return such funds for over three months. Senior Counsels Michael Torrisi and David Traskey, assisted by Chief Investigator Jennifer Trussell, represented OIG.
05-24-2018
Michigan Drug and Alcohol Rehab Center Settles Case Involving Kickback and Stark Allegations
On May 24, 2018, Recovery Pathways, LLC (Recovery Pathways), Essexville, Michigan, entered into a $64,555 settlement agreement with OIG. The settlement agreement resolves allegations that Recovery Pathways received improper remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and that Recovery Pathways caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
05-21-2018
Missouri Ambulance District Settles Case Involving False Claims
On May 21, 2018, Pettis County Ambulance District (Pettis), Sedalia, Missouri, entered into a $66,580.10 settlement agreement with OIG. The settlement agreement resolves allegations that Pettis submitted claims to Medicare 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 Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
05-17-2018
Pennsylvania Home Health Company Settles Case Involving Excluded Individual
On May 17, 2018, Immediate Home Care (IHC) in Bensalem, Pennsylvania, entered into a $189,445.68 settlement agreement with OIG. The settlement agreement resolves allegations that IHC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a home health nurse, provided items or services to IHC's patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG.
05-07-2018
Georgia Medical Assistant Agrees to Voluntary Exclusion
On May 7, 2018, in connection with the resolution of his False Claims Act liability, Robert Gennaro (Gennaro), Woodstock, Georgia, agreed to be excluded again from participation in all Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Gennaro worked at pain management clinics in Georgia and Kentucky that were owned by Dr. Robert Windsor (Dr. Windsor) and operated under the umbrella of National Pain Care, Inc. Dr. Windsor contracted with a company to provide online, real time intraoperative monitoring (IOM) of surgeries. IOM is a medical procedure in which a physician monitors nerve and spinal cord activity during surgical procedures in order to minimize potential adverse effects to a patient's nervous system during surgery. The company billed federal health care programs on behalf of Dr. Windsor for the professional component of the IOM services when Gennaro was performing IOM on Dr. Windsor's behalf. Senior Counsel Lisa Veigel represented OIG.
05-04-2018
Tennessee Hospital Settles Case Involving Patient Dumping Allegation
On May 4, 2018, Houston County Community Hospital (HCCH) in Erin, Tennessee, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegations that HCCH violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination or treatment to stabilize an emergency medical condition for a 58-year-old patient. Specifically, after the patient presented to HCCH's Emergency Department (ED) seeking examination and treatment for blurred vision and dizziness, HCCH failed to provide an appropriate medical screening examination within the capability of the hospital's ED, including ancillary services routinely available to the ED, to determine whether the patient had an emergency medical condition. Instead, an ED nurse directed to the patient to a local eye doctor, delaying provision of an appropriate medical screening examination ultimately performed by another hospital later that same day. Additionally, HCCH failed to provide medical treatment to stabilize the patient's emergency medical condition, a cerebral infarction. Senior Counsel Ellen Slavin represented OIG.
05-04-2018
California Health System Settles Case Involving Excluded Individual
On May 4, 2018, Alameda Health System (AHS), California, entered into a $257,874 settlement agreement with OIG. The settlement agreement resolves allegations that AHS employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an eligibility clerk, provided items or services to AHS's patients that were paid for by Federal health care programs.
04-30-2018
Iowa Hospital Settles Case Involving Patient Dumping Allegation
On April 30, 2018, Covenant Medical Center (Covenant) in Waterloo, Iowa, entered into a $90,000 settlement agreement with OIG. The settlement agreement resolves allegations that Covenant violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination and stabilizing treatment for a patient and then inappropriately transferred them to another hospital. The patient, a 54-year-old man, arrived by ambulance to Covenant's Emergency Department (ED) complaining of shortness of breath, chest pain, and diaphoresis. The ED physician screened the patient and consulted the on-call cardiologist. The patient's condition worsened and he was intubated. On advice of the on-call cardiologist, the ED physician began transcutaneous pacing. The ED physician did not request the on-call cardiologist present to the ED nor did the on-call cardiologist present to the ED to examine and treat the patient. The ED physician requested transfer to a nearby hospital for placement of a transvenous pacemaker. The patient was transferred to the receiving hospital nearly three hours after he presented to Covenant's ED. The receiving hospital placed a transvenous pacemaker on the patient, but he expired shortly after. OIG alleged that Covenant's on-call cardiologist was capable of providing a transvenous pacemaker. Associate Counsel Madeline Bainer represented OIG.
04-23-2018
Alaska Disability Service Provider Settles False and Fraudulent Claims Case
On April 23, 2018, The Arc of Anchorage (the Arc), Anchorage, Alaska, entered into a $2,049,392.08 settlement agreement with OIG and the Alaska MFCU, and a 5-year corporate integrity agreement with OIG. The settlement agreement resolves allegations that the Arc knowingly submitted or authorized the submission of claims to the Alaska Medicaid program for items or services that the Arc knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG and Alaska MFCU alleged the Arc (1) billed for services not provided; (2) billed for individual and group services at the same time with the same servicing provider; and (3) billed for overlapping services with the same servicing provider. OIG and Alaska MFCU also alleged that the Arc knowingly retained an overpayment owed to the Alaska Medicaid program which was identified in audits performed by or at the direction of the Arc. Senior Counsel Katherine Matos represented OIG.
04-11-2018
New York Group Home Owner Agrees to Voluntary Exclusion
On April 11, 2018, in connection with the resolution of his False Claims Act liability, Benard Rorie (Rorie), Brooklyn, New York, agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Rorie accepted kickbacks in the form of cash payments from Narco Freedom, Inc. (Narco Freedom), an operator of outpatient substance abuse rehabilitation programs, to refer the residents of group homes managed by Rorie's company, Joining Hands, to Narco Freedom for outpatient programs and to enforce the residents' attendance at those programs regardless of the need for outpatient treatment. Senior Counsels David Fuchs and Geeta Taylor represented OIG.
04-09-2018
Colorado Physicians and Practice Settle Case Involving Kickbacks
On April 9, 2018, C. David Bird, M.D., Kurt W. Lesh, M.D., and Colorado Springs Family Practice (collectively, "CS Family Practice"), Colorado Springs, Colorado, entered into a $152,554 settlement agreement with OIG. The settlement agreement resolves allegations that CS Family Practice solicited and received remuneration from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "process and handling" payments related to the collection of blood. OIG alleged that CS Family Practice solicited and received the remuneration from HDL and Singulex in exchange for CS Family Practice and CS Family Practice employees referring patients for laboratory testing services to HDL and Singulex, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
04-09-2018
North Carolina Hospital Settles Case Involving Patient Dumping Allegation
On April 9, 2018, CAH Acquisition Company 1 d/b/a Washington County Hospital (WCH), Plymouth, North Carolina, entered into a $52,414 settlement agreement with OIG. The settlement agreement resolves allegations that WCH violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment for a patient. An ambulance was called to provide medical assistance to the patient, a 54-year-old woman, who was suffering from a worsening of the shortness of breath that she had been experiencing for two weeks. The emergency medical technicians (EMTs) arrived at the patient's residence and found that she was experiencing uncontrolled hypertension and increased shortness of breath with dyspnea on exertion. The EMTs drove the patient to WCH's Emergency Department (ED), which was located two minutes from the patient's residence. En route, the EMTs called WCH to report on the patient's condition and to notify WCH that the EMTs were bringing the patient to WCH's ED. When the ambulance carrying the patient was on WCH's property, the EMTs were asked to call WCH. Subsequently, WCH's ED staff informed the EMTs that WCH was on diversion and could not see the patient. WCH, however, was not on diversion and, even though WCH was aware that the ambulance was already on its property, WCH directed the EMTs to take the patient to another hospital located 22 miles away. Associate Counsel Srishti Sheffner represented OIG.
04-05-2018
Alabama Physician and Practice Settle Case Involving Kickbacks
On April 5, 2018, Rex A. Butler, M.D., and South Central Medical Center, P.C. (collectively, "SCMC"), Andalusia, Alabama, entered into a $505,030 settlement agreement with OIG. The settlement agreement resolves allegations that SCMC solicited and received remuneration from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "process and handling" payments related to the collection of blood. OIG alleged that SCMC solicited and received the remuneration from HDL and Singulex in exchange for SCMC referring patients for laboratory testing services to HDL and Singulex, for which the Medicare Program paid. OIG also alleged another laboratory company provided SCMC with an in-office phlebotomist for the purpose of collecting blood samples from SCMC's patients, at no cost to SCMC, and SCMC used the blood samples collected by the phlebotomist to order tests from HDL, Singulex, and the other laboratory. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
04-05-2018
Alabama Physician and Practice Settle Case Involving Kickback and Stark Allegations
On April 5, 2018, AMC - Affordable Medical Care f/k/a Andalusia Medical Center and Dr. Kevin Diel (collectively, "AMC"), Opp, Alabama, entered into a $40,500.50 settlement agreement with OIG. As a result of its investigation, OIG alleged that AMC received improper remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and that AMC caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
04-02-2018
North Carolina Hospital Settles Case Involving Patient Dumping Allegations
On April 2, 2018, Southeastern Regional Medical Center (SRMC), Lumberton, North Carolina, entered into a $200,000 settlement agreement with OIG. The settlement resolves allegations that, based on OIG's investigation, SRMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate medical screening exam, stabilizing treatment, and/or an appropriate transfer for four individuals.

Specifically, in the following two instances, SRMC failed to provide an appropriate medical screening examination and/or stabilizing treatment. The first patient, a 71-year-old male who had been living independently, presented to SRMC's Emergency Department (ED) on January 21, 2016, complaining of leg pain, weakness, inability to walk, and a drastic change in behavior and functioning. His daughter reported that he was occasionally disoriented, but that he had just made a trip to visit her and was in good health. The ED physician ordered labs and IV fluids. After about ten hours, the patient was discharged with a diagnosis of dehydration and weakness. Less than six hours later, the patient returned to the ED with similar symptoms and complaints. This time, another ED physician diagnosed the patient with a traumatic subdural hemorrhage and transferred the patient for brain surgery. At the receiving hospital, the patient remained in critical condition for two weeks with diagnoses of acute respiratory failure, possible stroke, and seizures. The patient passed away the following week. The second patient, a 49-year-old male, presented to SRMC's ED on August 27, 2015, with lethargy and overdose of multiple medications. The patient said he was depressed and expressed suicidal ideations. The ED physician ordered blood and urine tests, an EKG, and a head CT, and noted the patient had a history of depression and chronic back pain. The patient was placed on suicide precaution watch, but no psychiatric evaluation was ordered. The patient was discharged about 4.5 hours later with diagnoses of polypharmacy and asthenia with discharge instructions for near-syncope and weakness. Four days later, the patient died due to a self-inflicted gunshot wound to the head.

In two additional instances, SRMC failed to meet its EMTALA obligations when it failed to re-evaluate the patient at the time of transfer to determine whether: (1) the benefits to each patient continued to outweigh the risks, (2) the previous arrangements for appropriate personnel and transportation equipment were appropriate given the patient's deterioration, and (3) additional medical treatment was needed to minimize the risks to the individual's health, and in the case of a woman in labor, the health of the unborn child. The third patient, a 44-year-old female, presented to SRMC's ED on February 28, 2014 at 3:38 p.m. for evaluation of an altered mental status when she was found unresponsive with an empty bottle of butalbital beside her. A CT scan revealed an extensive acute subarachnoid hemorrhage with possible artery aneurysm bleed. At 9:30 p.m., the ED physician certified that the medical benefits of neurosurgery at a hospital over 122 miles away outweighed the risks of transfer. However, the patient was not transferred until 2:16 a.m. the following day, when her condition had significantly deteriorated. The fourth patient, a 26-year-old who was 28 weeks pregnant, presented to the ED on March 13, 2014 with a complaint of ruptured membranes and lower back discomfort. The ED physician examined the patient at 11:15 a.m. and determined that her unborn child required tertiary services not available at SRMC and certified that the medical benefits of delivery at a hospital over 80 miles away outweighed the risks of transfer. However, the patient was not transferred until 1:00 p.m. Between the time of the ED physician's certification and the patient's transfer, the patient continued to have contractions. Senior Counsel Sandra Sands and Associate Counsel Matthew J. Westbrook represented OIG.
03-27-2018
Ohio Home Health Company Settles Case Involving Excluded Individual
On March 27, 2018, ASAP Home Nurses, Inc. (ASAP), located in Wadsworth, Ohio, entered into a $11,406.26 settlement agreement with OIG. The settlement agreement resolves allegations that ASAP employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a state tested nurse aide, provided items or services to ASAP's patients that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Eula Taylor.
03-26-2018
Pennsylvania Physician Agrees to Voluntary Exclusion
On March 26, 2018, Stephen Latman (Latman), a physician in Reading, Pennsylvania, agreed to be excluded from participation in all Federal health care programs for a period of 10 years under 42 U.S.C. § 1320a-7(b)(6)(B). OIG alleged that Latman issued prescriptions for opioids to patients that were substantially in excess of the needs of those patients and failed to meet the professionally recognized standards of care. Senior Counsel Lisa Veigel represented OIG.
03-26-2018
Wisconsin Independent Living Support Provider Settles Case Involving Excluded Individual
On March 26, 2018, Community Care, Inc. (CCI), located in Brookfield, Wisconsin, entered into a $208,585.20 settlement agreement with OIG. The settlement agreement resolves allegations that CCI, a care management organization, contracted with an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual provided for residential items or services to CCI's patients that were billed to Federal health care programs. Associate Counsel Jonathan Culpepper represented OIG.
03-23-2018
Florida Hospital Settles Case Involving Patient Dumping Allegation
On March 23, 2018, Peace River Regional Medical Center (Peace River), Port Charlotte, Florida, entered into a $42,500 settlement agreement with OIG. The settlement agreement resolves allegations that based on OIG's investigation, Peace River violated the Emergency Medical Treatment and Labor Act when it failed to accept an appropriate transfer of a patient. Specifically, the patient, a 17-year-old female, presented to another hospital's Emergency Department (ED), 6 weeks pregnant, complaining of abdominal pain continuing for approximately one week. An ultrasound confirmed the intrauterine fetus with a heartbeat and a left ectopic ruptured mass. The patient needed obstetric care, which was not available at that hospital. Accordingly, the ED contacted the Hospital Corporation of America Transport Center (TC) and requested transfer for a possible ruptured ectopic pregnancy. When TC communicated to Peace River's ED that it was trying to facilitate an ED-to-ED transfer, Peace River's representative replied that it did not accept ED-to-ED transfers and hung up. TC called Peace River back and the call was transferred to the ED, where it was reiterated that Peace River did not accept ED-to-ED transfers. The ED employee also mentioned that they had given the transferring hospital the contact information for Peace River's on-call OB/GYN. The transferring hospital called Peace River's on-call OB/GYN who requested all of the patient medical reports be faxed to him before he would consider accepting the patient. During this conversation the doctor learned that the patient was "out of county" and he did not accept the transfer. Senior Counsel Sandra Sands represented OIG.
03-21-2018
New Jersey Pharmacy and Owner Settle Case Involving Excluded Individual
On March 21, 2018, Pharmex Pharmacy, LLC, and Israel Weber (collectively, "Pharmex"), Lakewood, New Jersey, entered into a $314,205.76 settlement agreement with OIG. The settlement agreement resolves allegations that Pharmex employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded pharmacist provided items or services to Pharmex patients that were billed to Federal health care programs. Associate Counsel Srishti Sheffner represented OIG.
03-19-2018
Pennsylvania Cardiologist Agrees to Voluntary Exclusion
On March 19, 2018, in connection with the resolution of his False Claims Act liability, Vidya Banka, MD (Dr. Banka), Pennsylvania, agreed to be excluded from participation in all Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Dr. Banka caused the submission of claims to Medicare for medically unnecessary cardiac stent procedures. Senior Counsel Geeta Taylor represented OIG.
03-05-2018
Texas Physician and Practice Settle Case Involving Kickbacks
On March 5, 2018, Ankur Doshi, M.D., and PrimeCare Medical Group (collectively, "PrimeCare"), with locations in Houston and Katy, Texas, entered into a $53,260 settlement agreement with OIG. The settlement agreement resolves allegations that PrimeCare solicited and received remuneration from Health Diagnostic Laboratory, Inc. (HDL), a laboratory company, in the form of "process and handling" payments related to the collection of blood. OIG alleged that PrimeCare solicited and received the remuneration from HDL in exchange for PrimeCare referring patients for laboratory testing services to HDL, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
03-08-2018
Ohio Hospital Settles Case Involving Patient Dumping Allegation
On March 8, 2018, Paulding County Hospital (PCH), Paulding, Ohio, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that PCH violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening and effectuate an appropriate transfer for a patient. The patient, a 33-week pregnant woman, presented to PCH's Emergency Department (ED) complaining of leaking fluids, pelvic pain, and vomiting. A nurse at PCH's ED brought the patient to an examination room. The nurse told the patient that the hospital did not have an obstetrician on-site, and that the patient could either start treatment at PCH and be transferred later, or that her male companion could drive her immediately to another hospital, where her obstetrician practiced. After being told this, the patient left PCH by private vehicle to another hospital, a thirty-minute drive. PCH never provided the patient or her unborn child a medical screening examination. At the receiving hospital, the patient underwent an emergency C-Section and delivered a male infant without a heartbeat. The receiving hospital's efforts to revive the infant were unsuccessful. Associate Counsel James Hansen represented OIG.
02-28-2018
Florida Drug and Alcohol Rehab Center and Owners Settle Case Involving Kickback and Stark Allegations
On February 28, 2018, The Pain Institute, Inc. d/b/a Space Coast Pain Institute, Stanley Golovac, M.D. and Richard Gayles, M.D. (collectively, "Space Coast"), Merritt Island, Florida, entered into a $95,302.50 settlement agreement with OIG. As a result of its investigation, OIG alleged that Space Coast received improper remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and that Space Coast caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
02-16-2018
Arkansas Skilled Nursing Facility Settles Case Involving Excluded Individual
On February 16, 2018, Arkansas Convalescent Center (ACC), Pine Bluff, Arkansas, entered into a $189,805.55 settlement agreement with OIG. The settlement agreement resolves allegations that ACC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a licensed practical nurse, provided items and services to ACC patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
02-13-2018
Arizona Physicians and Practice Settle False and Fraudulent Claims Case
On February 13, 2018, Modocurogyn, PLLC d/b/a AZ Urogynecology and Pelvic Health Center, a urogynecology practice with locations in Mesa, Scottsdale, and Glendale, Arizona, and its physician partners Dr. Mohamed Akl and Dr. Ahmed Akl (collectively, "AZ Urogynecology"), entered into an $877,474 settlement agreement with OIG. The settlement agreement resolves allegations that AZ Urogynecology submitted claims to Medicare for items or services that it knew or should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended that AZ Urogynecology submitted claims for: (1) diagnostic electromyography (EMG) services using CPT Code 51784 and diagnostic anorectal manometry (ARM) services using CPT Code 91122 when therapeutic services, not diagnostic services, had been provided; (2) evaluation and management (E&M) services billed in conjunction with pelvic floor therapy procedures when no separate and identifiable E&M services were provided; (3) unbundled biofeedback procedures; and (4) EMG- and ARM-aided biofeedback therapy that was not preceded by a four-week course of failed pelvic muscle exercise training. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Michael Torrisi and Associate Counsel Srishti Sheffner with the assistance of Paralegal Specialist Mariel Filtz, collaborated to achieve this settlement.
02-13-2018
Management Company Settles Case Involving Excluded Individual
On February 13, 2018, Southwest Trinity Management, LLC (STM), entered into a $141,986.36 settlement agreement with OIG. The settlement agreement resolves allegations that STM, through a skilled nursing facility it owns and manages in Oklahoma City, Oklahoma, employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a licensed practical nurse, provided items or services that were billed to Federal health care programs.
01-23-2018
Chiropractor and his Practice Management Company Agree to Voluntary Exclusion
On January 23, 2018, Matthew Anderson and PMC Management Company, LLC (PMC), Tennessee, agreed to be excluded from participation in all Federal health care programs for a period of 5 years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Anderson and PMC caused pharmacies to submit requests for payment to Part D Plan Sponsors and TennCare for medications, including controlled substances that were not dispensed for a legitimate medical purpose and/or that were dispensed without obtaining valid prescriptions under Tennessee law. OIG also alleged that Anderson and PMC submitted, or caused the submission of claims to Medicare that were : (1) coded with CPT code 99214 and modifier -25 when those claims were not payable as such; and (2) provided by a nurse practitioner who was not collaborating with a physician as required by Tennessee law. Senior Counsel Andrea Treese Berlin represented OIG.
01-12-2018
Virginia Hospital Settles False and Fraudulent Medicare Claims Case
On January 12, 2018, Carilion Medical Center, Inc. d/b/a Carilion Roanoke Memorial Hospital, Carilion Services, Inc., and Carilion Clinic (collectively, "Carilion"), Virginia, entered into a $403,960.75 settlement agreement with OIG. The settlement agreement resolves allegations that Carilion submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99201-99205 when the patients at issue were actually "established patients" and, thus, Carilion should have submitted those claims using the generally lower-paying HCPCS codes 99211-99215. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
01-11-2018
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On January 11, 2018, Piedmont Newton Hospital (Piedmont), Covington, Georgia, entered into a $52,414 settlement agreement with OIG. The settlement agreement resolves allegations that Piedmont violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment for a patient and then inappropriately transferred the patient to another hospital. The patient, a 58-year-old woman, arrived at Piedmont's Emergency Department (ED) by private vehicle, complaining of left-sided pleuritic chest pain and abdominal pain. An ED physician examined the patient and noted that her abdomen was diffusely firm with hypoactive bowel sounds. The patient's blood samples revealed that her lactic acid and bleeding and clotting time were elevated. The patient's chest x-ray showed a large amount of intraperitoneal air under the right diaphragm, which suggested bowel perforation. The ED physician discussed the patient's condition with the on-call surgeon, who recommended that the patient be transferred to the other hospital where she had undergone a dilation and curettage procedure two days earlier. The other hospital agreed to accept the transfer and asked that the patient be air-lifted to its facility. Three hours and forty-seven minutes after her arrival at Piedmont's ED, the patient was transferred to the other hospital in critical condition. Upon arrival at the other hospital, the patient was in septic shock and on the verge of respiratory collapse. Even after receiving emergency surgery to repair the bowel perforation, the patient's condition continued to worsen and she died later that day. Associate Counsel Srishti Sheffner represented OIG.
01-10-2018
Tennessee Hospital Settles Case Involving Patient Dumping Allegation
On January 10, 2018, Clarksville Health System, f/k/a Gateway Medical Center (CHS), entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that CHS violated the Emergency Medical Treatment and Labor Act when it failed to accept an appropriate transfer. A 13-year-old presented to a hospital Emergency Department (ED) complaining of testicular pain. An ultrasound indicated no evidence of blood flow in the right testicle and a large amount of fluid surrounding the testicle. In order to access the needed specialized services of a urologist, which that hospital did not have, the ED requested that CHS accept the patient for transfer. CHS's on-call urologist, however, refused to accept the transfer of the patient, recommending instead that the patient be transferred to another facility. OIG alleged that CHS declined to accept the appropriate transfer when it had both the capability and capacity to stabilize the patient's emergency medical condition. Senior Counsel Sandra Sands represented OIG.

2017

12-29-2017
Texas Mental Health and Drug Treatment Facility Settles Case Involving Excluded Individual
On December 29, 2017, Turtle Creek Recovery Center (Turtle Creek), Dallas, Texas, entered into a $24,428.58 settlement agreement with OIG. The settlement agreement resolves allegations that Turtle Creek employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a counselor, provided items or services to Turtle Creek's patients that were billed to Federal health care programs. Deputy Branch Chief Nicole Caucci represented OIG with the assistance of Paralegal Specialist Eula Taylor.
12-29-2017
Virginia Physician and Practice Settle False and Fraudulent Claims Case
On December 29, 2017, The Female Pelvic Medicine Institute of Virginia, P.C., and Nathan Guerette, M.D. (collectively, Dr. Guerette), a urogynecology practice and physician with locations in Richmond and North Chesterfield, Virginia, entered into a $1,401,344 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that Dr. Guerette submitted claims to Federal health care programs for items or services that he knew or should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended that Dr. Guerette submitted claims for: (1) pelvic floor therapy services that were provided by unqualified individuals; (2) diagnostic electromyography services under CPT Code 51784 that had not been performed according to the requirements of the indicated code; (3) unbundled biofeedback and physical therapy procedures; and (4) "incident to" services that lacked the required level of physician supervision. OIG also contended that Dr. Guerette submitted claims for electromyography services under CPT Code 51784 and anorectal manometry services under CPT Codes 91120 and 91122 that were not supported by adequate medical record documentation. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Michael Torrisi and David Traskey with the assistance of Paralegal Specialist Mariel Filtz, collaborated to achieve this settlement.
12-26-2017
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On December 26, 2017, Phoebe Putney Memorial Hospital (Phoebe Putney), Albany, Georgia, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that Phoebe Putney violated the Emergency Medical Treatment and Labor Act when it failed to accept an appropriate transfer. A 54-year-old man presented to another hospital's Emergency Department (ED) suffering from a subdural hematoma. A CT scan showed that this subdural hematoma was on top of a previous hematoma. The patient needed to be evaluated by a neurosurgeon, which was not available at that hospital. Accordingly, the ED physician at the transferring hospital attempted to transfer the patient to Phoebe Putney for neurosurgical services. Phoebe Putney treated the patient approximately one week earlier for the previous hematoma. Phoebe Putney refused to accept the transfer when it had both the capabilities and capacity to treat the patient. Subsequently, the patient was transferred to another hospital and immediately admitted to its neuro ICU, where he remained for several days before being discharged. Senior Counsel Sandra Sands represented OIG.
12-12-2017
Massachusetts Hospital Settles Case Involving Patient Dumping Allegation
On December 12, 2017, Cambridge Health Alliance (Cambridge), Cambridge, Massachusetts, entered into a $90,000 settlement agreement with OIG. The settlement agreement resolves allegations that based on OIG's investigation, Cambridge violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination to a patient who presented to Cambridge's Somerville Hospital campus (Somerville). The patient was experiencing an acute asthma attack, a life-threatening condition needing immediate medical attention. OIG contends that the patient tried unsuccessfully to gain entry to Somerville's Emergency Department (ED) at its ambulance bay entrance, but the door was locked and unattended. The patient then called 911 and alerted the dispatcher that she was having an asthma attack and could not enter the hospital's ED. The dispatcher then called the Somerville ED and notified the responding registered nurse (RN) that the patient was experiencing an asthma attack outside the ED doors. Three minutes after this notification, the OIG further contends, the RN opened the ambulance bay door and looked around for the patient but did not let go of the door, search the area outside the entrance, or send another staff member to continue the search. Police and Fire Department emergency responders later found the patient collapsed on a bench adjacent to the Ambulance Bay door in full cardiac arrest with no signs of breathing. The Fire Department emergency responders began life-saving techniques before the patient was brought into the ED. The patient died six days later of hypoxic brain injury. OIG alleged that Cambridge failed to conduct a reasonable search for the patient and therefore failed to provide her with an appropriate medical screening examination after she presented to Cambridge's Somerville ED. Senior Counsels Kenneth Kraft and Sandra Sands represented OIG.
12-06-2017
Tennessee Hospital Settles Case Involving Patient Dumping Allegation
On December 6, 2017, Dyersburg Hospital Company, LLC d/b/a Dyersburg Regional Medical Center (DRMC), Dyersburg, Tennessee, entered into a $45,000 settlement agreement with OIG. The settlement agreement resolves allegations that based on OIG's investigation, DRMC violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment to a patient who presented to DRMC's Emergency Department (ED). The patient, a 58-year-old woman and resident of a long-term care facility, fell in the shower and was taken to DRMC's ED for evaluation and treatment. The ED physician initiated a medical screening examination and documented the patient's symptoms of head pain, altered mental state, and her reported symptom of near fainting. Lab work revealed an abnormal glucose level and abnormal hematocrit results. The ED physician planned to discharge the patient back to the nursing home. Before discharge, it was noticed that the patient's right arm was swollen compared to when she arrived. Her discharge was cancelled and x-rays were ordered which revealed no evidence of a fracture. Six hours after triage, a nurse reported that the patient required suctioning. Nine hours after triage the patient received a neurological check and the nurse documented that she was not oriented to time, place, person, or situation. The physician then ordered Narcan and a CT scan. Since DRMC's CT scan could not support the patient's weight, DRMC's ED contacted other hospitals to transfer the patient. Approximately 2.5 hours later the patient was admitted to another hospital where she received a CT scan. The CT scan showed a hematoma on her brain as well as Coumadin intoxication. The hospital then ordered an EEG, which showed no brain activity, and the patient died later that day. Senior Counsel Sandra Sands represented OIG.
12-05-2017
Ohio Addiction Treatment Providers Settle Case Involving Kickback and Stark Allegations
On December 5, 2017, Addiction Medical Care of Norwalk, Practice Management Associates Norwalk, LLC, Addiction Medical Care of Columbus, and Practice Management Associates, LLC (collectively, "AMC"), with locations in Norwalk and Columbus, Ohio, entered into a $79,880.50 settlement agreement with OIG. As the result of its investigation, OIG alleged that AMC received improper remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and that AMC caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG
12-04-2017
Missouri Physician and Practice Settle Case Involving Kickbacks
On December 4, 2017, Rodney Malisos, M.D., and Liberty Medical Center (collectively, "Liberty Medical"), Liberty, Missouri, entered into a $60,839 settlement agreement with OIG. The settlement agreement resolves allegations that Liberty Medical solicited and received remuneration from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "process and handling" payments related to the collection of blood. OIG alleged that Liberty Medical solicited and received the remuneration from HDL and Singulex in exchange for Liberty Medical referring patients for laboratory testing services to HDL and Singulex, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
12-04-2017
Alabama Hospital Settles Case Involving Patient Dumping Allegation
On December 4, 2017, Greenville Hospital Corporation d/b/a L.V. Stabler Memorial Hospital (L.V. Stabler), Greenville, Alabama, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, L.V. Stabler violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination and stabilizing treatment for a 16-year-old female patient. The patient was 27-weeks pregnant and had presented by ambulance to L.V. Stabler's Emergency Department (ED), complaining of vaginal bleeding and a sharp pain in her lower abdomen. A nurse obtained the patient's vital signs and measured the fetal heart rate. An ED physician examined the patient and called the patient's obstetrician to discuss the patient's condition. Without providing an appropriate medical screening examination, the ED physician decided to send the patient for monitoring to another hospital where the patient's obstetrician was located. The ED physician discharged the patient and instructed her to go to the other hospital that was 55 miles away from L.V. Stabler. On the way to the other hospital, the patient's family members called emergency medical services (EMS). When EMS arrived, the patient was lying on the ground next to her car, experiencing severe abdominal pain, vaginal pain, and light bleeding. EMS drove the patient to a different hospital where she delivered a stillborn infant within minutes of arriving. Associate Counsel Srishti Sheffner represented OIG.
12-04-2017
North Carolina Physician and Practice Settle Case Involving False Claims, Kickback, and Stark Allegations
On December 4, 2017, Dr. Josette Maria (Dr. Maria) and Maria Medical Center (collectively, "MMC"), with offices in Dunn and Spring Lake, North Carolina, entered into a $60,000 settlement agreement with OIG. The settlement agreement resolves allegations that MMC: (1) billed for services provided "incident to" Dr. Maria's supervision despite her absence from the office suite; (2) routinely billed for services provided by unlicensed individuals; and (3) received remuneration from laboratory companies in the form of "process and handling" payments in exchange for referring patients for laboratory testing services, which were paid by Medicare. Deputy Branch Chief Tamara Forys and Senior Counsel Jennifer Leonardis represented OIG.
12-04-2017
Missouri Neurologist Agrees to Voluntary Exclusion
On December 4, 2017, Dr. Sherry Ma (Dr. Ma), a neurologist in Saint Louis, Missouri, agreed to be excluded from participation in all Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7) for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Ma received vials of Botox§ and Myobloc§ (Medications) at no charge that were supposed to be used for specific patients with private insurance. Instead of discarding the reminder of the Medications contained within vials labeled as single-dose vials, Dr. Ma kept and stored the remainder in excess of 24 hours. Subsequently, Dr. Ma used the remaining portion of the Medications on Medicare patients but submitted claims for payment to Medicare as if she had purchased new vials. Senior Counsel David Fuchs represented OIG.
11-29-2017
New York Physical Therapist and Physical Therapy Practice Settle Case Involving False Claims
On November 29, 2017, Lino Chuang and Excellent Choice Physical Therapy, P.C. (collectively, Excellent Choice), a physical therapy practice with locations in Queens and Long Island, New York, entered into a $500,000 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that Excellent Choice submitted claims for physical therapy services that were: (1) provided by individuals without the required licensure and qualifications; (2) not properly supervised on-site by a physical therapist; and (3) provided in a group therapy environment when one-on-one contact was required. Senior Counsels Michael Torrisi and David Blank represented OIG.
11-06-2017
Ohio Home Health Agency Settles Case Involving Excluded Individual
On November 6, 2017, Diamonds & Pearls Health Services, LLC (DPHS), Cleveland, Ohio, entered into a $75,471.92 settlement agreement with OIG. The settlement agreement resolves allegations that DPHS employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a scheduling/staffing coordinator, provided items or services to DPHS patients that were billed to Federal health care programs.
11-06-2017
Indiana Practice Settles Case Involving Excluded Individual
On November 6, 2017, Center for Ear, Nose Throat & Allergy, P.C. (CENTA), Carmel, Indiana, entered into a $51,564.14 settlement agreement with OIG. The settlement agreement resolves allegations that CENTA employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a medical records file clerk, provided items or services to CENTA's patients that were billed to Federal health care programs. Associate Counsel Srishti Sheffner represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
11-01-2017
Texas Physicians and Practice Settle Case Involving Kickbacks
On November 1, 2017, Ladan Bakhtari, M.D., David E. Garza, M.D., and Doctors of Internal Medicine (collectively, "Doctors of IM"), Plano, Texas, entered into a $53,820 settlement agreement with OIG. The settlement agreement resolves allegations that Doctors of IM solicited and received remuneration from Health Diagnostic Laboratory, Inc. (HDL), a laboratory company, in the form of "process and handling" payments related to the collection of blood. OIG alleged that Doctors of IM solicited and received the remuneration from HDL in exchange for Doctors of IM and Doctors of IM employees referring patients for laboratory testing services to HDL, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
10-24-2017
California Independent Diagnostic Testing Facility and Owner Agree to Voluntary Exclusion
On October 24, 2017, Prohealth Neurodiagnostic, Inc., an independent diagnostic testing facility in Van Nuys, California, and Arsen Oganesyan, its owner (collectively, "Prohealth"), agreed to be excluded for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Prohealth submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare, in violation of a Local Coverage Determination governing the medical necessity of such studies. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, collaborated to achieve this resolution.
10-19-2017
Florida Laboratory Agrees to Voluntary Exclusion
On October 19, 2017, in connection with the resolution of its False Claims Act liability, Total Lab Care, LLC (Total Lab Care), Jacksonville, Florida, agreed to be permanently excluded from participation in all Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Total Lab Care knowingly billed Federal health care programs for urine toxicology samples that were not reimbursable. Specifically, OIG alleged that Total Lab Care sought reimbursement for urine toxicology samples referred by a physician whom Total Lab Care paid improper financial remuneration. Senior Counsel Felicia Heimer represented OIG.
10-17-2017
New Jersey Physicians and Practice Settle Case Involving Kickbacks
On October 17, 2017, Scott R. Eisenberg, D.O., Robert G. Kayser, Jr., M.D., and Change of Heart Cardiology, LLC (collectively, "COH Cardiology"), Sea Girt, New Jersey, entered into a $208,450 settlement agreement with OIG. The settlement agreement resolves allegations that COH Cardiology solicited and received remuneration from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "process and handling" payments related to the collection of blood. OIG alleged that COH Cardiology solicited and received the remuneration from HDL and Singulex in exchange for COH Cardiology and a COH Cardiology employee referring patients for laboratory testing services to HDL and Singulex, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
10-17-2017
Texas Marking Company CEO Agrees to Voluntary Exclusion
On October 17, 2017, in connection with the resolution of his False Claims Act liability, Mitch Edland (Edland), Addison, Texas, agreed to be excluded from participation in all Federal health care programs for a period of 5 years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Edland's company, DNA Stat, LLC (DNA Stat), entered into an agreement with a laboratory to market a pharmacogenomics clinical trial of which the laboratory was the sponsor. OIG's investigation revealed that Edland, in his capacity as CEO of DNA Stat, caused the submission of claims to Medicare that were false and fraudulent because of the following conduct in violation of the Anti-Kickback Statue: (1) paying physicians to participate in a clinical study, which OIG contends was not a legitimate clinical study, to induce those physicians to order pharmacogenetic tests from the laboratory; (2) paying physicians based on the volume of referrals made to his company, to induce those physicians to order pharmacogenetics tests from the laboratory; (3) providing physicians with in-office medical technicians to induce those physicians to order pharmacogenetic tests from the laboratory; (4) entering into a marketing arrangement with the laboratory that took into account the volume or value of referrals with the intention of inducing the referrals of tests to the laboratory; and (5) entering into marketing arrangements with individual marketers that took into account the volume or value of referrals with the intention of inducing referrals of tests to the laboratory. Senior Counsel Karen Glassman represented OIG.
10-17-2017
Alabama Ambulance Companies Settles Case Involving False Claims
On October 17, 2017, Lifeguard Ambulance Service, LLC, Lifeguard Ambulance Service of Florida, LLC, and Lifeguard Ambulance Service of Texas, LLC (collectively, "Lifeguard"), headquartered in Birmingham, Alabama, entered into a $110,813.69 settlement agreement with OIG. The settlement agreement resolves allegations that Lifeguard submitted claims to Medicare 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 Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
10-17-2017
Texas Mental Health Provider Settles Case Involving Excluded Individual
On October 17, 2017, MHMR of Tarrant County (MHMR), Fort Worth, Texas, entered into a $97,869.78 settlement agreement with OIG. The settlement agreement resolves allegations that MHMR employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a program director, provided items or services to MHMR clients who were receiving services funded by a Medicaid waiver program. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Eula Taylor.
10-17-2017
Missouri Hospital Settles Case Involving Patient Dumping Allegations
On October 17, 2017, Southeast Missouri Hospital (SEM), Cape Girardeau, Missouri, entered into a $100,000 settlement agreement with OIG. The settlement agreement resolves allegations that SEM violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination and stabilizing treatment for two patients who presented to SEM's Emergency Department (ED) in 2011. OIG alleged that instead of being properly evaluated and treated, the patients were discharged with unstabilized emergency medical conditions to the custody of police pursuant to a hospital policy: if a patient had a blood alcohol level (BAL) above 100, the patient was given to local law enforcement and taken to jail. The first patient was 25 years old when she called a crisis hotline and an ambulance was dispatched to her residence. She was transported to SEM's ED for evaluation of a possible suicide attempt by overdose. The patient's BAL was 422 and the ED physician discharged her into the custody of local law enforcement where she was detained in jail and expected to see a counselor. The second patient was 41 years old when he presented to SEM after attempting suicide by overdose. The patient was depressed, had a history of psychiatric problems, and had recently been admitted for electroconvulsive therapy. The patient's BAL was 288 and he was discharged into the custody of local law enforcement and taken to jail. The next day the patient was seen by a counselor in jail and then released from custody. The patient returned to SEM that evening after again attempting suicide by overdose. The patient had slurred speech, was lethargic and had a flat affect and was admitted to the intensive care unit in guarded condition. Senior Counsel Sandra Sands represented OIG.
10-11-2017
Illinois Case Management Provider Settles Case Involving Excluded Individual
On October 11, 2017, Shawnee Health Services (Shawnee), Carterville, Illinois, entered into a $107,761.08 settlement agreement with OIG. The settlement agreement resolves allegations that Shawnee employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a case manager, provided items or services to Shawnee clients that were receiving services under a Medicaid waiver program.
10-10-2017
Arkansas Department of Health Settles Case Involving Excluded Individual
On October 10, 2017, The Arkansas Department of Health (ADH) entered into a $39,343.61 settlement agreement with OIG. The settlement agreement resolves allegations that ADH employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a hospice social worker, provided items or services to patients of a community based hospice operated by ADH that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Eula Taylor.
09-27-2017
New Jersey Physician Agrees to Voluntary Exclusion
On September 27, 2017, in connection with the resolution of his False Claims Act liability, Dr. Dinesh Patel (Dr. Patel), Edison, New Jersey, agreed to be excluded again from participation in all Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that despite previously having been excluded from participation in New Jersey Medicaid on March 17, 2012, and excluded from participation in all Federal health care programs on February 20, 2014, Dr. Patel continued to provide administrative and management services to Edison Adult Medical Daycare (EAMD) in violation of the terms of his exclusion. Dr. Patel had a previous ownership interest in EAMD, which he transferred to his wife around the time of his exclusion from New Jersey Medicaid. Senior Counsel David Fuchs represented OIG.
09-27-2017
Arizona Pain Management Practice Settles Case Involving Kickback and Stark Allegations
On September 27, 2017, Advanced Pain Management (APM), a pain management practice with multiple locations in Arizona, entered into a $186,210.20 settlement agreement with OIG. As the result of its investigation, OIG alleged that APM received improper remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and that APM caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG
09-22-2017
Georgia Physician and Practice Settle Case Involving Kickbacks
On September 22, 2017, Alan D. Justice M.D., and Ocmulgee Physicians, LLC, formerly doing business as Poplar Physicians, LLC, (collectively, "Ocmulgee"), Macon, Georgia, entered into a $277,202 settlement agreement with OIG. The settlement agreement resolves allegations that Ocmulgee solicited and received remuneration from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "process and handling" payments related to the collection of blood. OIG alleged that Ocmulgee solicited and received the remuneration from HDL and Singulex in exchange for Ocmulgee referring patients for laboratory testing services to HDL and Singulex, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
09-22-2017
Podiatrist Agrees to Voluntary Exclusion
On September 22, 2017, Patricia Anne Chapman (Chapman), Liberty Lake, Washington, agreed to be excluded from participation in all Federal health care programs for a period of 10 years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that, in her Clinton, Iowa, podiatric practice, Chapman submitted false or fraudulent claims to Medicare using Current Procedural Terminology Code 97032: (1) for electrical stimulation services (e-stim) that were not medically reasonable or necessary, (2) for e-stim services not administered with "constant attendance" and "manual application," according to the requirements of the code, (3) for twice the number of e-stim units than documented in the beneficiaries' patient files, and (4) for using false records and statements to support the false e-stim claims. Senior Counsel Keshia Thompson represented OIG.
09-18-2017
New York Pharmacy Settles Case Involving Excluded Individual
On September 18, 2017, Century Pharmacy (Century), Brooklyn, New York, entered into a $10,000 settlement agreement with OIG. The settlement agreement resolves allegations that Century employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, who assisted in filling prescriptions in addition to performing other clerical tasks, provided items or services to Century patients that were billed to Federal health care programs. Senior Counsel Kenneth Kraft represented OIG with the assistance of Paralegal Specialist Eula Taylor.
09-18-2017
New York Addiction Treatment Center Settles Case Involving Kickback Allegations
On September 18, 2017, Parallax Center, Inc. (Parallax), New York, New York, entered into a $64,203.30 settlement agreement with OIG. As the result of its investigation, OIG alleged that Parallax received improper remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and that Parallax caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
09-18-2017
North Shore Medical Center Settles Case Involving Patient Dumping Allegation
On September 18, 2017, North Shore Medical Center (NSMC), Lynn, Massachusetts, entered into a $60,000 settlement agreement with OIG. The settlement agreement resolves allegation that NSMC violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination for a fourteen-year-old patient and inappropriately transferred her to another hospital. The patient arrived at NSMC's Union Hospital emergency department by ambulance, secured to a stretcher and under police escort, for psychiatric evaluation after combative behavior at home and banging her head against a wall. Upon arrival at NSMC Union Hospital the patient was placed in a room, still secured to the stretcher. NSMC Union Hospital's emergency department physician came into the room and told the paramedics that the patient should be transported to NSMC's Salem Hospital emergency department for pediatric psychiatric evaluation. Before recommending transfer, NSMC failed to provide the patient with a medical screening exam. On route to NSMC Salem Hospital, the police instructed the ambulance to take the patient to a different hospital where her mother was waiting. Senior Counsel Kristen Schwendinger represented OIG.
09-15-2017
Texas Mental Health Facility Settles Case Involving Excluded Individual
On September 15, 2017, Sundance Behavioral Healthcare System (Sundance), Texas, entered into a $49,183.48 settlement agreement with OIG. The settlement agreement resolves allegations that Sundance employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a licensed vocational nurse, provided items or services to Sundance patients that were billed to Federal health care programs. Deputy Branch Chief Nicole Caucci represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
09-11-2017
West Virginia Physician Agrees to Voluntary Exclusion
On September 11, 2017, in connection with the resolution of her False Claims Act liability, Dr. Cheryl Wingate (Dr. Wingate), Fairmont, West Virginia, agreed to be excluded from participation in all Federal health care programs for a period of 5 years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Dr. Wingate caused compounding pharmacies to submit false claims for compound creams and medications to TRICARE and the Medicare Program by issuing or approving prescriptions that were not legitimate because Dr. Wingate did not examine or evaluate the patients in question and did not have an established physician-patient relationship with them. OIG's investigation also revealed that Dr. Wingate issued and approved the medication prescriptions in exchange for compensation paid to her by the pharmacies, telemedicine entities, or other intermediaries acting on behalf of the pharmacies.
09-08-2017
California Independent Diagnostic Testing Facility and Owner Agree to Voluntary Exclusion
On September 8, 2017, Olive Sleep & EEG, Inc., an independent diagnostic testing facility, and Mariam Unjughulyan, its owner, (collectively, "Olive Sleep") agreed to be excluded for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Olive Sleep submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare in violation of a Local Coverage Determination governing the medical necessity of such studies. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, collaborated to achieve this resolution.
09-05-2017
Montana Physician Agrees to Voluntary Exclusion
On September 5, 2017, in connection with the resolution of False Claims Act liability, Dr. Cory Lee Pickens, Billings, Montana, agreed to be excluded for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that despite previously having been excluded from participation in all Federal health care programs on September 20, 2011, Dr. Pickens provided services to beneficiaries of the Medicaid program while he was excluded. Senior Counsel David Traskey represented OIG.
08-31-2017
Florida Pharmaceutical Company Settles Case Involving Drug Price Reporting
On August 31, 2017, Stratus Pharmaceuticals Inc. (Stratus), Florida, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that Stratus failed to submit certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2014 and 2015. The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Mary Riordan represented OIG.
08-23-2017
Tennessee Transportation Service Provider and Owner Agree to Voluntary Exclusion
On August 23, 2017, in connection with the resolution of False Claims Act liability, Employment & Assessment Solutions, Inc., a transportation service provider, and Chris Manus, its owner (collectively, "EASI"), agreed to be excluded for a period of nine years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that EASI caused the submission of claims to Federal health care programs for services billed but not actually provided by EASI for patients, including transportation services not provided to patients who were incarcerated or hospitalized at the time of their purported transport. Associate Counsel Srishti Sheffner represented OIG.
08-15-2017
Utah Laboratory Settles Case Involving Select Agent Regulations
On August 15, 2017, a Utah laboratory agreed to pay $250,000 to resolve its liability for violating the select agent regulations. OIG alleged that the laboratory violated the select agent regulations by allowing access to select agents or toxins maintained in registered laboratory space to an individual who lacked a security risk assessment approval, and who was later identified as a restricted person. OIG contends this conduct subjects the laboratory to civil money penalties under the Bioterrorism Preparedness Act, 42 U.S.C. 262a(i) and 42 C.F.R. 1003.102(b)(16).
08-14-2017
Michigan Laboratory Settles Case Involving Select Agent Regulations
On August 14, 2017, a Michigan laboratory agreed to pay $55,000 to resolve its liability for violating the select agent regulations. OIG alleged that the laboratory violated the select agent regulations by allowing access to select agents or toxins maintained in registered laboratory space to an individual who lacked a security risk assessment approval, and who was later identified as a restricted person. OIG contends this conduct subjects the laboratory to civil money penalties under the Bioterrorism Preparedness Act, 42 U.S.C. 262a(i) and 42 C.F.R. 1003.102(b)(16).
08-11-2017
Texas Home Health Company Settles Case Involving Excluded Individual
On August 11, 2017, ASAP Professional Home Health (ASAP), Houston, Texas, entered into a $21,797.76 settlement agreement with OIG. The settlement agreement resolves allegations that ASAP employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an attendant, provided items or services to ASAP patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Eula Taylor.
07-21-2017
Utah Pain Doctor and Medical Practice Settle False and Fraudulent Medicare Claims Case
On July 21, 2017, Jahan Imani, M.D. (Imani), and Intermountain Medical Management, P.C. (IMM), a Utah based pain management specialist and his practice, entered into a $399,895.92 settlement agreement with OIG. The settlement agreement resolves allegations that IMM, through Imani, submitted false or fraudulent claims for payment by inappropriately using modifier 59 for multiple units of HCPCS code G0431 when only a single unit may be billed per patient encounter. 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.
07-06-2017
Texas Physicians and Practice Settle Case Involving Kickbacks
On July 6, 2017, Jonathan B. Shaffer, M.D., Dina B. White, M.D., and Sweetwater Medical Associates (collectively, "Sweetwater"), Sugar Land, Texas, entered into a $62,400 settlement agreement with OIG. The settlement agreement resolves allegations that Sweetwater solicited and received remuneration from Health Diagnostic Laboratory, Inc. (HDL), a laboratory company, in the form of "process and handling" payments related to the collection of blood. OIG alleged that Sweetwater solicited and received the remuneration from HDL in exchange for Sweetwater referring patients for laboratory testing services to HDL, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
07-06-2017
Pennsylvania Hospice CEO Agrees to Voluntary Exclusion
On July 6, 2017, Malvina Yakobashvili, the President, CEO, and owner of a Pennsylvania hospice company, agreed to be excluded for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Yakobashvili's company, Home Care Hospice, Inc.: (1) submitted claims to Medicare for hospice services that were provided to beneficiaries who did not qualify under the Medicare guidelines for (a) routine hospice care because patients were improperly certified as terminally ill or (b) continuous care; and (2) engaged in a cover-up scheme that included falsification of documents to conceal the fraud.
06-23-2017
South Carolina Hospital Settles Case Involving Patient Dumping Allegations
On June 23, 2017, AnMed Health (AnMed), in Anderson, South Carolina, entered into a $1,295,000 settlement agreement with OIG. The settlement agreement resolves allegations that, in 36 incidents investigated by OIG, AnMed violated the Emergency Medical Treatment and Labor Act (EMTALA). In these incidents, individuals presented to AnMed's Emergency Department (ED) with unstable psychiatric emergency medical conditions. Instead of being examined and treated by an on-call psychiatrist, and despite empty beds in its psychiatric unit to which the patients could have been admitted for stabilizing treatment, the patients were involuntarily committed and kept in AnMed's ED for between 6 and 38 days each. The following is an example of one such incident. A patient presented to AnMed's ED via law enforcement with psychosis and homicidal ideation and was involuntarily committed. The patient did not receive psychiatric examination or treatment by available AnMed psychiatrists and was not admitted to the psychiatric unit for stabilizing treatment. Instead, the patient was kept in the ED for 38 days and at one point was seen by a psychiatrist from another facility that was familiar with her condition. The psychiatrist prescribed a variety of medications for agitation. The patient eventually was discharged home. Senior Counsel Sandra Sands represented OIG.
06-21-2017
Louisiana Dentist Settles Case Involving Medically Unnecessary Claims
On June 21, 2017, Robert J. Edwards, DDS (Dr. Edwards), Baton Rouge, Louisiana, entered into a $80,070.10 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Edwards submitted claims for medically unnecessary root canals on permanent teeth, extractions, restorations, and stainless steel crowns for a number of pediatric Medicaid dental beneficiaries. OIG's Office of Evaluations and Inspections and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Geeta Tyalor, collaborated to achieve this settlement.
06-20-2017
Florida Pharmacy Settles Case Involving Excluded Individual
On June 20, 2017, Linton Square Pharmacy & Medical Supplies, Inc. (Linton Square), Delray Beach, Florida, entered into a $339,956.05 settlement agreement with OIG. The settlement agreement resolves allegations that Linton Square employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a pharmacist, provided items or services to Linton Square patients that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
06-16-2017
UMass Medical Center Settles False and Fraudulent Medicare Claims Case
On June 16, 2017, UMass Memorial Medical Center, Inc. (UMass), entered into a $441,047.36 settlement agreement with OIG. The settlement agreement resolves allegations that UMass submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205 when the patients at issue were actually "established patients" and, thus, UMass should have submitted those claims using the lower-paying HCPCS codes 99213-99215. 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.
06-16-2017
Boston Medical Center Settles False and Fraudulent Medicare Claims Case
On June 16, 2017, Boston Medical Center Corporation d/b/a Boston Medical Center (BMC), entered into a $313,246 settlement agreement with OIG. The settlement agreement resolves allegations that BMC submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205 when the patients at issue were actually "established patients" and, thus, BMC should have submitted those claims using the lower-paying HCPCS codes 99213-99215. 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.
05-30-2017
Mental Health Services Company Agrees to Permanent Exclusion
On May 30, 2017, in connection with the resolution of False Claims Act liability, Complementary Support Services, CCS South, LLC, CCS Central, LLC, CCS North, LLC, CCS Metro, LLC, and Clinical Support Services, LLC (collectively, "CSS"), Minnesota, agreed to be permanently excluded from participation in all Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that CSS submitted false claims for mental health services to the Minnesota Medicaid program. OIG alleged that CSS billed for documentation time despite a state statute and regulations permitting reimbursement only for face-to-face services. Senior Counsel Geeta Taylor and Associate Counsel David Fuchs represented OIG.
Illinois Skilled Nursing Facilities Settle Case Involving Excluded Individual
On May 30, 2017, Heritage Robinson, LLC and Burnsides Community Health Center, Inc. (collectively, "Heritage"), entered into a $26,748.22 settlement agreement with OIG. The settlement agreement resolves allegations that Heritage employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a licensed practical nurse, provided items or services to Heritage patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG.
05-17-2017
New York Physician Agrees to Another Voluntary Exclusion
On May 17, 2017, in connection with the resolution of his False Claims Act liability, Dr. Michael Esposito (Dr. Esposito), Albany, New York, agreed to be excluded again from participation in all Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that despite previously having been excluded from participation in all Federal health care programs on December 9, 2016, for a period of five years, he forged another physician's signature on prescriptions, including opioids, in order to obtain medications for himself and another person. In the instant matter, Dr. Esposito presented claims for payment to Medicare for services that he furnished, ordered, and prescribed to Medicare beneficiaries while he was excluded. Senior Counsel David Traskey represented OIG.
05-16-2017
Missouri Physician and Practice Settle Case Involving Kickbacks
On May 16, 2017, Timothy W. McPherson, D.O., and McPherson Medical and Diagnostic, LLC (collectively, "McPherson"), Steele, Missouri, entered into a $61,392 settlement agreement with OIG. The settlement agreement resolves allegations that McPherson received remuneration from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "process and handling" payments related to the collection of blood. OIG alleged that McPherson received the remuneration from HDL and Singulex in exchange for McPherson referring patients for laboratory testing services to HDL and Singulex, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
05-15-2017
California Dentist Settles Case Involving Medically Unnecessary Claims
On May 15, 2017, Ana M. Gama, DDS and Ana M. Gama, DDS, Inc. (collectively, Dr. Gama), Ontario, California, entered into a $31,817.88 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that Dr. Gama submitted claims for medically unnecessary pulpotomies, extractions, restorations, and stainless steel crowns for a number of pediatric Medicaid dental beneficiaries. OIG's Office of Evaluations and Inspections and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Geeta Tyalor, collaborated to achieve this settlement.
05-15-2017
New York Physician Agrees to Voluntary Exclusion
On May 15, 2017, Dr. Haroutyoun Margossian (Dr. Margossian), a New York physician specializing in female urinary incontinence, agreed to be excluded from participation in all Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Dr. Margossian knowingly presented or caused to be presented claims to Medicare and Medicaid relating to the treatment of patients suffering from urinary incontinence that he should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended Dr. Margossian failed to: (1) employ licensed individuals to perform the urodynamic and pelvic floor therapy (PFT) services; and (2) properly supervise the individuals performing the urodynamic and PFT services. Senior Counsel David Blank and Associate Counsel Jennifer Leonardis represented OIG.
05-12-2017
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On May 12, 2017, Monroe County Hospital (MCH) in Forsyth, Georgia, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegation that MCH violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment for a woman who presented to MCH's Emergency Department (ED) complaining she was 36 weeks pregnant and her water had broken. The patient told a nurse that she wanted to see her physician in Macon, Georgia. Without providing a medical screening examination, ED staff decided that the patient could go see her physician in Macon. The patient was then escorted to her car and told to call 911. Emergency medical services arrived and found the patient in her car. She was brought to another hospital where she delivered her child within an hour of arriving. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Associate Counsel Srishti Sheffner represented OIG.
04-20-2017
Health Care Administrator Agrees to Voluntary Exclusion
On April 20, 2017, in connection with the resolution of his False Claims Act liability, Yogesh K. Pancholi (Pancholi), Michigan, agreed to be excluded from participation in all Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Pancholi caused the submission of false claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care services that were referred in exchange for illegal remuneration or kickbacks paid by Pancholi. Senior Counsel David Traskey represented OIG.
04-18-2017
Connecticut Hospital Settles False and Fraudulent Medicare Claims Case
On April 18, 2017, Hartford Hospital (Hartford), Connecticut, entered into a $2,469,374 settlement agreement with OIG. The settlement agreement resolves allegations that Hartford submitted claims where patients received home health services within three days of the patients' release from Hartford that were improperly coded as discharged rather than as a post-acute care transfer. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Nancy Brown, collaborated to achieve this settlement.
Connecticut Hospital Settles False and Fraudulent Medicare Claims Case
On April 18, 2017, Midstate Medical Center (Midstate), Connecticut, entered into a $436,748 settlement agreement with OIG. The settlement agreement resolves allegations that Midstate submitted claims where patients received home health services within three days of the patients' release from Midstate that were improperly coded as discharged rather than as a post-acute care transfer. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Nancy Brown, collaborated to achieve this settlement.
Texas Independent Diagnostic Testing Facility Settles False and Fraudulent Medicare Claims Case
On April 18, 2017, Frontera Strategies, LP (Frontera), Texas, entered into a $510,938.74 settlement agreement with OIG. The settlement agreement resolves allegations that Frontera submitted claims to Medicare for nerve conduction studies (NCS) that are considered screening exams and not covered by Medicare. Medicare Administrative Contractor Local Coverage Determinations specified that an electromyography must be performed as well as NCS for diagnostic purposes. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, collaborated to achieve this settlement.
04-14-2017
Mental Health Services Company Owner Agrees to Voluntary Exclusion
On April 14, 2017, in connection with the resolution of her False Claims Act Liability, Teri Dimond (Dimond), Minnesota, agreed to be excluded from participation in all Federal health care programs for a period of eight years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Dimond, through her company, caused to be presented false claims for mental health services to the Minnesota Medicaid program. OIG alleged the claims were false for one or more of the following reasons: (1) the services were provided by unlicensed practitioners without adequate clinical supervision; and (2) claims for reimbursement were submitted for the time spent maintaining patient records and/or the preparation of reports, in violation of state Medicaid regulations. Senior Counsel Geeta Taylor and Associate Counsel David Fuchs represented OIG.
03-31-2017
Texas Ambulance Company Settles Case Involving False Claims
On March 31, 2017, Freedom Ambulance, LLC (Freedom Ambulance), an ambulance company in Beeville, Texas, entered into a $846,563.92 settlement agreement with OIG. The settlement agreement resolves allegations that Freedom Ambulance knowingly presented to Medicare and Texas Medicaid false or fraudulent claims for non-emergency repetitive ambulance services between beneficiaries' residences or skilled nursing facilities and non-hospital based dialysis facilities. Senior Counsels Ellen Slavin and Katie Fink represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
Massachusetts Ambulance Company Settles Case Involving False Claims
On March 31, 2017, EasCare, LLC (EasCare), an ambulance company in Dorchester, Massachusetts, entered into a $255,768.14 settlement agreement with OIG. The settlement agreement resolves allegations that EasCare submitted claims to Medicare 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 Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
03-16-2017
Florida Neurologist Excluded for Default
On March 16, 2017, OIG excluded Dr. Sean Orr (Dr. Orr), a Florida neurologist, for defaulting on his payment obligations under a Settlement Agreement (Agreement) with the Department of Justice (DOJ) and OIG. Dr. Orr previously entered into the Agreement for knowingly misdiagnosing certain patients with various neurological disorders, such as multiple sclerosis, which caused claims to be submitted to Federal health care programs for medically unnecessary items and services. The terms of the Agreement provided that Dr. Orr would make an initial upfront payment plus additional payments over a five-year period. On January 23, 2017, DOJ issued a Notice of Default to Dr. Orr. Senior Counsel Karen Glassman represented OIG.
03-13-2017
Iowa Chiropractor Agrees to 3-Year Exclusion
On March 13, 2017, Elizabeth Kressin, D.C. (Kressin), an Iowa chiropractor, agreed to be excluded from participation in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7) for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kressin caused claims to be submitted to Iowa Medicaid for chiropractic services performed on children, which were not provided as claimed and were for treatment of conditions for which payment is not allowed under applicable rules. Associate Counsel Jennifer Leonardis represented OIG.
03-08-2017
Michigan Physician Agrees to 3-Year Exclusion
On March 8, 2017, Dr. Vinod Sharma, (Dr. Sharma) a Michigan physician and pain management specialist, agreed to be excluded from participation in Medicare and the State health care programs for a period of three years under 42 U.S.C. § 1320c-5 following a referral to OIG by Kepro, the Beneficiary and Family Centered Care Quality Improvement Organization (QIO). OIG's investigation determined that Dr. Sharma substantially violated the obligation to provide services (1) of a quality that met professionally recognized standards of health care, and (2) that were supported by evidence of medical necessity and quality in such form and fashion and at such time as was reasonably required by the QIO in the exercise of its duties and responsibilities. Specifically, OIG alleged that Dr. Sharma failed to sufficiently document his response to the results of urine drug screenings and any discussions he had with patients regarding the urine drug screening results when these patients (1) tested positive for illicit drugs; (2) tested positive for controlled substances Dr. Sharma did not prescribe; (3) tested positive for noncontrolled substances Dr. Sharma did not prescribe; or (4) tested negative for controlled substances Dr. Sharma prescribed. Senior Counsel Kristen Schwendinger, Senior Counsel Geoffrey Hymans and Associate Counsel Srishti Sheffner represented OIG.
01-17-2017
Iowa Hospital Settles Case Involving a Patient Dumping Allegations
On January 17, 2017, Covenant Medical Center (Covenant) in Waterloo, Iowa, entered into a $100,000 Settlement Agreement with OIG. The Settlement Agreement resolves allegations that Covenant violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate psychiatric screening examination or stabilizing treatment for three patients who presented to the emergency department (ED) when an on-call psychiatrist was available. A woman presented to the ED complaining of depression and suicidal thoughts, but was later discharged with instructions to follow-up with her primary care physician. A child presented to the ED following violent outbursts, but was later discharged with instructions to follow-up with his primary care physician. A man presented to the ED stating his mind was "disturbed," but later eloped from the ED into single degree weather wearing paper scrubs while his discharge was processed. His body was found about 300 feet from Covenant with the cause of death attributed to hypothermia. Senior Counsel Henry Green and Associate Counsel Madeline Bainer represented OIG.
01-13-2017
Michigan Physician Agrees to Voluntary Exclusion
On January 13, 2017, in connection with the resolution of his False Claims Act liability, Dr. Sotero Ureta, Lake City, Michigan, agreed to be excluded from participation in all Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Dr. Ureta caused the submission of false claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care services that he referred in exchange for illegal remuneration or kickbacks. Senior Counsel David Traskey represented OIG.
01-11-2017
New Jersey Dentist Agrees to $1.1 Million Payment and 50-Year Exclusion To Settle Civil Monetary Penalty Case
Roben Brookhim, an unlicensed Dentist in New Jersey, agreed to pay $1,134,000 for allegedly violating the Civil Monetary Penalties Law and agreed to be excluded from participation in Federal health care programs for a period of fifty years under 42 U.S.C. § 1320a-7a and 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Brookhim owned, controlled, and managed Associated Dental NP, LLC (ADNP), a New Jersey dental practice with multiple locations, in violation of his exclusion from Federal health care program participation in August 2000. OIG further alleged that as part of his fraud scheme, Brookhim assumed the identity of a licensed New Jersey dentist (Dentist A), to provide services to ADNP patients. Brookhim assumed Dentist A's identity because Brookhim's license to practice dentistry was suspended in 1999 and revoked in 2004. OIG contends that Brookhim presented claims for services to various New Jersey Medicaid Managed Care Organizations identifying Dentist A as having providing services; in fact, Dentist A never rendered services to ADNP patients. Brookhim continued to pose as Dentist A and submit claims in his name -- even after Dentist A died. Senior Counsels David Blank and Michael Torrisi represented OIG with the assistance of Paralegal Specialist Mariel Filtz. News Release
01-10-2017
North Carolina Hospital Settles Case Involving Patient Dumping Allegation
On January 10, 2017, Cape Fear Medical Center (Cape Fear) in Fayetteville, North Carolina, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that Cape Fear violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination and stabilizing treatment for a woman who presented to Cape Fear's Emergency Department in labor with her third child. The patient was discharged a little over one hour after she presented to Cape Fear. OIG alleged that Cape Fear did not properly examine the patient (including checking the progress of her labor) before the patient was discharged. The patient drove home and immediately gave birth to her child at home. Senior Counsel Sandra Sands represented OIG.
01-06-2017
Manager of Oklahoma Behavioral Health Counseling Center Agrees to Voluntary Exclusion
On January 6, 2017, Heather Doss agreed to be excluded from participation in all Federal health care programs for a period of two years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Doss knowingly submitted or caused to be submitted false or fraudulent claims to Medicaid for services not provided or provided by unqualified individuals, as well as claims with falsified dates or time of services. Senior Counsel Kenneth Kraft represented OIG.
01-06-2017
Utah Nursing Home and Owner Agree to 30 Year Exclusion
On January 6, 2017, Deseret Health Group and Jon Robertson (Robertson), Bountiful, Utah, agreed to be excluded from participation in all Federal health care programs for a period of thirty years under 42 U.S.C. §§ 1320a-7(b)(7) and 1320a-7(b)(6)(B). OIG alleged that Deseret Health Group and Robertson: (a) failed to provide adequate care planning and assessments of residents; (b) failed to provide medications, treatments, laboratory tests, physical therapy, and other services as ordered and/or prescribed by residents' physicians; (c) failed to properly use and/or administer psychotropic drugs; (d) failed to follow appropriate pressure ulcer and infection control protocols for some residents; (e) failed to follow appropriate fall protocols for some residents; (f) failed to properly administer medications to some of the residents to avoid medication errors; (g) failed to provide a safe living environment for residents; and (h) failed to answer some residents' call lights promptly. Senior Counsel Felicia Heimer represented OIG.

2016

12-29-2016
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On December 29, 2016, Phoebe Putney Memorial Hospital (Phoebe Putney) in Albany, Georgia, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that Phoebe Putney violated the Emergency Medical Treatment and Labor Act when it failed to accept an appropriate transfer. A 73-year-old man was transported to another hospital by EMS and presented with hematuria, bleeding at the site of his Foley catheter and abdominal pain. The patient required urological services that were unavailable at that hospital. The hospital requested Phoebe Putney accept the transfer of this patient. OIG alleged that Phoebe Putney's on-call urologist refused the transfer when Phoebe Putney had both the capability and capacity to treat the patient. Senior Counsel Sandra Sands represented OIG.
12-22-2016
South Carolina Hospital Settles Case Involving Patient Dumping Allegation
On December 22, 2016, McLeod Medical Center (MMC), a small hospital located in Dillon, South Carolina, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that MMC violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment of a patient who presented to MMC after being assaulted and hit in the head. The patient resisted efforts by his mother to get him into a wheelchair to enter the Emergency Department (ED). Security guards observed the patient's behavior and told the patient's mother that if she brought her son into the ED the guard would have him locked up. OIG alleges that the mother explained to the security guard that her son had been hit in the head and was bleeding and that a guard allegedly answered by reasserting that he would call the police if her son entered the ED. At that point the mother left with her son and later took him to another hospital for evaluation and treatment. Senior Counsel Sandra Sands represented OIG.
12-22-2016
Missouri Hospital Settles Case Involving a Patient Dumping Allegation
On December 22, 2016, OIG entered into a settlement agreement with HCA Midwest Division d/b/a Belton Regional Medical Center (BRMC), Belton, Missouri. BRMC agreed to pay $40,000.00 to resolve its liability for civil money penalties under the patient dumping statute. Specifically, OIG alleged that BRMC violated the Emergency Medical Treatment and Labor Act by failing to provide an appropriate medical screening examination and stabilizing treatment to two patients who came to BRMC's emergency department with emergency psychiatric conditions. Senior Counsel Henry E. Green represented OIG.
12-21-2016
Texas Doctors Settle Case Involving Kickback Allegations
On December 21, 2016, Mark Sands, D.P.M., and Jeffrey Baxter, D.P.M., Houston, Texas, entered into an $85,000 settlement agreement with OIG. OIG's investigation revealed that Dr. Sands and Dr. Baxter each received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from Medical Directorship agreements. OIG contends that the medical directorship agreements took into account the value and volume of referrals made to OneStep by Dr. Sands and Dr. Baxter's podiatric practice. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
12-16-2016
New York Chiropractor and Practices Agree to 40 Year Exclusion
On December 16, 2016, Alexander Khavash, a chiropractor, and the two chiropractic practices he owned, Alexander Khavash, DC, P.C., and AK Chiropractic, P.C., agreed to be excluded from participation in all Federal health care programs for a period of forty years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Khavash and his practices submitted claims to Medicare for chiropractic services that were not medically necessary and not provided as claimed. Senior Counsels Michael Torrisi, Joan Matlack and Andrea Treese Berlin represented OIG.
12-09-2016
New York Physician Agrees to 5 Year Exclusion
On December 9, 2016, Dr. Michael Esposito agreed to be excluded from participation in all Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Dr. Esposito forged the signature of another physician on prescriptions for medications for himself and another person that were paid for by the Medicare program. Senior Counsel David Blank and Associate Counsel Jennifer Leonardis represented OIG.
11-30-2016
New York Skilled Nursing Facility Settles Case Involving Excluded Individual
On November 30, 2016, Ditmas Park Rehab/Care Center (Ditmas Park), Brooklyn, New York, entered into a $205,089.22 settlement agreement with OIG. The settlement agreement resolves allegations that Ditmas Park employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a licensed practical nurse, provided items or services to Ditmas Park patients that were billed to Federal health care programs. Senior Counsel Katie Fink represented OIG with the assistance of Paralegal Specialist Eula Taylor.
Florida Hospital Settles Case Involving a Patient Dumping Allegation
On November 30, 2016, Okaloosa Hospital, Inc. d/b/a Twin Cities Hospital (Twin Cities), a small hospital in Niceville, Florida, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that Twin Cities violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment of a 56-year-old male patient who was experiencing difficulty breathing and was unstable. Twin Cities' Emergency Department staff met the emergency medical transport in the ambulance bay and redirected the transport to another hospital, where the patient previously received treatment. Twin Cities failed to provide the patient with a medical screening examination or stabilizing treatment before redirecting the emergency medical transport. The patient died shortly after arriving at the other hospital. Twin Cities self-reported the incident shortly thereafter. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Senior Counsel Geeta Taylor represented OIG.
New Jersey Doctor Enters Settlement Agreement with OIG on Kickback Allegations
On November 30, 2016, Dr. Robert Collin, a Newark, New Jersey, internist, entered into a $111,415 settlement agreement with OIG. The settlement resolves allegations that Dr. Collin received remuneration from Orange Community MRI, LLC, an imaging facility in Orange, New Jersey, in exchange for patient referrals. Senior Counsels David M. Blank and Lauren E. Marziani represented OIG.
11-28-2016
Missouri Hospital Settles Case Involving Patient Dumping Allegations
On November 28, 2016, Research Medical Center (RMC) in Kansas City, Missouri, entered into a $360,000 settlement agreement with OIG. The settlement agreement resolves allegations that RMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and improperly transferred a patient. The patient presented to RMC's Emergency Department (ED) with a psychiatric emergency medical condition. Without providing stabilizing treatment, RMC transferred the patient to a nearby facility by private vehicle; en route, the patient exited the vehicle and was struck by another vehicle. RMC self-disclosed the incident involving this patient. Based on its investigation, OIG concluded that RMC implemented a transfer policy applicable to patients who presented to RMC's ED with psychiatric emergency medical conditions that also resulted in multiple violations of EMTALA. Specifically, OIG found seventeen occasions where RMC failed to provide adequate medical screening examinations and improperly transferred or discharged, without providing stabilizing treatment, patients who presented to RMC's ED with psychiatric emergency medical conditions. At the time each patient presented, RMC had the capacity to treat, stabilize, or admit each patient. Senior Counsel Geeta Taylor represented OIG.
Illinois Ambulance Company Settles Case Involving False Claims
On November 28, 2016, Mitchell-Jerdan Funeral Home, Ltd. (MJFH), an ambulance company in Mattoon, Illinois, entered into a $126,425.02 settlement agreement with OIG. The settlement agreement resolves allegations that MJFH submitted claims to Medicare 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 Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
11-15-2016
New York Skilled Nursing Facility Settles Case Involving Excluded Individuals
On November 15, 2016, Fort Tryon Rehabilitation and Healthcare Facility, LLC (Fort Tryon), New York, New York, entered into a $110,223.36 settlement agreement with OIG. The settlement agreement resolves allegations that Fort Tryon employed two individuals who were excluded from participating in Federal health care programs. OIG's investigation revealed that one excluded individual was a registered nurse supervisor and the other was a licensed practical nurse. While excluded, both individuals provided items or services to Fort Tryon patients that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Eula Taylor.
New Jersey Physician and Practice Settles False and Fraudulent Medicare Claims Case
On November 15, 2016, Lawrence C. Antonucci, M.D., Clifford Sebastian, M.D., and Lawrence C. Antonucci MD LLC, entered into a $60,884.90 settlement agreement with OIG. The settlement agreement resolves allegations that they submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
11-07-2016
Tennessee Hospital Settles Case Involving a Patient Dumping Allegation
On November 7, 2016, Metro Knoxville HMA, LLC (Metro Knoxville), in Knoxville, Tennessee, entered into a $45,000 settlement agreement with OIG. The settlement agreement resolves allegations that Metro Knoxville violated the Emergency Medical Treatment and Labor Act when it discharged a patient without having provided an adequate medical screening examination or treatment sufficient to stabilize the patient. OIG's investigation revealed that blood test results indicated the presence of an emergency medical condition; however, Metro Knoxville discharged the patient without confirming that such blood levels had stabilized. Senior Counsel Katherine Matos represented OIG.
11-04-2016
Physician Agrees to 20-Year Exclusion To Resolve Civil Monetary Penalty Case
Labib Riachi, M.D., a New Jersey based OB/GYN with a subspecialty in urogynecology, agreed to be excluded from participation in Federal health care programs for a period of twenty years under 42 U.S.C. § 1320a-7(b)(7) for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Riachi knowingly submitted claims to Medicare and Medicaid for pelvic floor therapy services that he knew or should have known were not provided as claimed or were false or fraudulent. These claims were not provided as claimed or were false or fraudulent for one or more of the following reasons: (1) Dr. Riachi failed to personally perform or directly supervise services while he was traveling outside the United States or State of New Jersey; (2) Dr. Riachi failed to personally supervise the performance of a diagnostic procedure performed by his medical assistants; (3) services were not actually provided; (4) physical therapy services were provided by unlicensed and unqualified individuals; (5) services were not documented; and (6) diagnostic services were not reasonable and necessary. David Blank, Tamara Forys, and Jennifer Leonardis represented OIG with assistance from Paralegal Specialist Mariel Filtz. News Release
11-02-2016
Arizona Physician and Practice Settles False and Fraudulent Medicare Claims Case
On November 2, 2016, A. Clark Ruttinger, DO, and A. Clark Ruttinger DO, PLLC (Ruttinger), entered into a $52,961.20 settlement agreement with OIG. The settlement agreement resolves allegations that Ruttinger claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
10-31-2016
Colorado Health System Settles Case Involving False Claims
On October 31, 2016, UCH-MHS d/b/a Memorial Health System (Memorial) entered into a $58,512.00 settlement agreement with OIG. The settlement agreement resolves allegations that Memorial submitted claims to Medicare for health care items and services provided to individuals who were in the custody of penal authorities and which were not eligible for payment under Medicare Part A or B. Senior Counsel Geeta Taylor represented OIG.
10-27-2016
Missouri Ambulance Company Settles Case Involving False Claims
On October 27, 2016, American Paramedical Services, Inc. (APS), entered into a $187,480.12 settlement agreement with OIG. The settlement agreement resolves allegations that APS submitted claims to Medicare 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 Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
Virginia Health System Settles Case Involving False Claims
On October 27, 2016, Centra Health, Inc. (Centra), entered into a $137,864.68 settlement agreement with OIG. The settlement agreement resolves allegations that Centra submitted claims to Medicare 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 Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
10-26-2016
California Hospital Settles Case Involving a Patient Dumping Allegation
On October 26, 2016, Sonoma Valley Hospital (Sonoma), a small hospital in Sonoma, California, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegations that Sonoma violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide needed stabilizing treatment and an appropriate transfer for a 59-year old woman. OIG's investigation revealed that the patient arrived at Sonoma's Emergency Department (ED) via ambulance. The patient had a fever, no palpable pulses or blood pressure, a low respiratory rate and severe pain. Ten days earlier she had undergone surgery for diversional ileostomy (surgical formation of an opening of the intestine to the surface of the abdomen, through which fecal matter is emptied). The patient was diagnosed with sepsis and needed immediate surgery. Although Sonoma had the capabilities to provide this surgery, Sonoma's doctors wanted to send the patient back to the surgeon who performed her original surgery. Approximately 7.5 hours after the patient arrived at Sonoma's ED, she was inappropriately transferred to another hospital. At that hospital she received immediate surgery and died soon after. Senior Counsel Sandra Sands represented OIG.
Illinois Physician Agrees to Voluntary Exclusion
On October 26, 2016, in connection with the resolution of False Claims Act liability, Duttala Obul Reddy, M.D., agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Dr. Reddy submitted claims to Medicaid and Medicare seeking payment for Evaluation and Management services billed at Current Procedural Terminology code 93310 purportedly provided at long-term care facilities that either had not been provided or had not been provided to the extent claimed. Senior Counsel Geeta Taylor represented OIG.
10-19-2016
North Carolina Hospital Settles Case Involving a Patient Dumping Allegation
On October 19, 2016, Park Ridge Health (Park Ridge), a small hospital in Hendersonville, North Carolina, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that Park Ridge violated the Emergency Medical Treatment and Labor Act when it inappropriately transferred a patient, who was pregnant and experiencing contractions, to another hospital without properly stabilizing her emergency medical condition. Senior Counsel Gregory Wellins represented OIG.
10-17-2016
DME Company Owner Agrees to 10 Year Exclusion
On October 17, 2016, Phillip A. Minga, the owner of a durable medical equipment (DME) company, agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7) and 42 U.S.C. § 1320a-7(b)(16). OIG's investigation revealed that Minga knowingly caused claims to be submitted to Medicare for diabetes supplies that were not delivered, were the result of unsolicited Medicare beneficiary contact, in violation of the Social Security Act's DME Telemarketing Provisions and not covered by applicable exceptions, or were the result of a kickback. OIG's investigation further revealed that Minga knowingly retained or caused the retention of an overpayment owed to the Center for Medicare and Medicaid Services as a result of a Medicare Benefit Integrity Post-Payment Review conducted by Zone Program Integrity Contractor AdvanceMed. OIG's investigation also revealed that Minga knowingly made or caused to be made an omission or misrepresentation of a material fact in the applications of a DME company and its affiliates to participate or enroll as a supplier under Medicare, including organizations under Part C and D, when: (a) Minga was omitted as a managing employee; and (b) as a managing employee, Minga was not disclosed as having been convicted of a felony offense within the 10 years preceding enrollment or revalidation of enrollment. Senior Counsel Kristen Schwendinger and Associate Counsel David Fuchs represented OIG.
09-28-2016
University of California Medical Center Settles False and Fraudulent Medicare Claims Case
On September 28, 2016, University of California San Francisco Health d/b/a UCSF Medical Center (UCSF), entered into a $1,443,016 settlement agreement with OIG. The settlement agreement resolves allegations that UCSF submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205 when the patients at issue were actually "established patients" and, thus, UCSF should have submitted those claims using the lower-paying HCPCS codes 99213-99215. 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.
09-27-2016
Former South Carolina Hospital CEO Agrees to Voluntary Exclusion
On September 27, 2016, in connection with the resolution of False Claims Act and Stark Law liability, Ralph J. Cox, III, agreed to be excluded from participating in Federal health care programs for a period of four years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that during Cox's tenure as CEO and Board Member of the Board of Trustees of Tuomey Healthcare System, Inc. (Tuomey), in Sumter, South Carolina, he caused Tuomey to submit claims for payment to the Medicare and Medicaid Programs that were false because they violated the Stark Law. A jury had previously determined that Tuomey violated the False Claims Act by knowingly submitting to Medicare false claims for designated health services that had been referred to Tuomey in violation of the Stark Law. Deputy Branch Chief Kevin Barry represented OIG.
09-22-2016
Massachusetts Social Worker Agrees to Voluntary Exclusion
On September 22, 2016, in connection with the resolution of False Claims Act liability, David Margolis, a social worker, agreed to be excluded from participation in all Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Margolis submitted false claims to Medicare for: (1) more therapy sessions than he actually provided to the beneficiaries; (2) therapy sessions that did not occur because Margolis was actually on vacation; (3) therapy sessions that did not occur because of late cancellations by the beneficiaries; (4) therapy sessions that did not occur because the beneficiaries did not appear for appointments; and (5) therapy sessions for relatives of the beneficiaries. Senior Counsel John O'Brien represented OIG.
09-21-2016
New Jersey Physicians and Practice Settle False and Fraudulent Medicare Claims Case
On September 21, 2016, John G. Ciciarelli, II, MD, Jason Arash Nehmad, MD, and Northern Ocean County Medical Associates, PC, entered into a $36,850.38 settlement agreement with OIG. The settlement agreement resolves allegations that they submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced that went beyond the report of the laboratory results; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
Kentucky Hospital Settles Case Involving a Patient Dumping Allegation
On September 21, 2016, T.J. Samson Community Hospital (T.J. Samson), in Glasgow, Kentucky, entered into a $35,000 settlement agreement with OIG. The settlement agreement resolves allegations that T.J. Samson violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to accept an appropriate transfer of a 29-year old woman in need of specialized capabilities available at T.J. Sampson. OIG's investigation revealed that the patient presented to a small hospital's Emergency Department with complaints of abdominal pain and right side back pain. She was diagnosed with appendicitis and in need of emergency surgery, which was unavailable at the hospital. That hospital contacted T.J. Samson to arrange for a transfer of the patient. The on-call surgeon at T.J. Samson inquired about the patient's insurance. When the on-call surgeon was told that the patient did not have insurance, he refused to accept the transfer. Senior Counsel Sandra Sands represented OIG.
09-19-2016
New Jersey Medical Biller Settles False and Fraudulent Claims Case and Agrees to 5-Year Exclusion
On September 19, 2016, Susan Toy, entered into a $100,000 settlement agreement with OIG and agreed to be excluded from participating in Federal health care programs for a minimum of five years. On July 1, 2016, OIG issued a letter to Toy, proposing to impose a civil money penalty and program exclusion on her, pursuant to the Civil Monetary Penalties Law. The settlement agreement resolves OIG's allegations that Toy prepared and submitted claims for services that were never performed. Toy, through her health care billing company, prepared and submitted claims for an obstetrics and gynecology physician practice located in New Jersey. Toy was responsible for preparing and submitting claims based, in part, on superbills identifying the services purportedly performed during a patient encounter. OIG contended that Toy prepared and submitted claims for Current Procedural Terminology code 91122 (anorectal manometry) for patient encounters where the procedure was neither performed nor identified as performed on the superbill. Senior Counsels David Blank and Tamara Forys represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
09-16-2016
Arkansas Ambulance Company Settles Case Involving False Claims
On September 16, 2016, Arkansas Excellent Transport, Inc. (AET), entered into a $35,208.35 settlement agreement with OIG. The settlement agreement resolves allegations that AET submitted claims to Medicare 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 Senior Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
09-13-2016
Tennessee Hospital Settles Case Involving a Patient Dumping Allegation
On September 13, 2016, HMA Fentress County General Hospital, LLC f/d/b/a Jamestown Regional Medical Center (Jamestown), a small hospital in Jamestown, Tennessee, entered into a $10,000 settlement agreement with OIG. The settlement agreement resolves allegations that Jamestown violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination, treatment or transfer for a 69-year-old woman. OIG's investigation revealed that the patient presented to Jamestown's Emergency Department (ED) with the chief complaint of gastrointestinal bleeding accompanied with blood clots, abdominal pain, and back pain. The patient's pain level was 7 out of 10. A lab test revealed an elevated white blood cell count, and a CT scan of her abdomen and pelvis did not reveal anything abnormal. The patient was given antibiotics and pain medication and discharged with a diagnosis of sinusitis. Upon leaving the ED, the patient used the bathroom and passed blood clots. She requested the help of a nurse, but the ED doctor said she could come back in the ED for more tests or she could go to another hospital, without providing for an appropriate transfer. Senior Counsel Sandra Sands represented OIG.
09-12-2016
Jackson Health System in Florida Settles Case Involving a Patient Dumping Allegation
On September 12, 2016, Public Health Trust of Miami-Dade County, Florida d/b/a Jackson Health System (Jackson), in Miami, Florida, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that Jackson violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to accept the appropriate transfer of a patient who required the specialized capabilities available at Jackson. OIG's investigation revealed that a hospital in the Virgin Islands (requesting hospital) contacted Jackson and requested to transfer a patient who had a life-threatening Type A Aortic Dissection with Thrombus, which required immediate cardiothoracic surgical intervention. OIG's investigation revealed that Jackson declined to accept the transfer of the patient unless it received a guarantee of payment. The requesting hospital obtained the guarantee of payment, but Jackson still declined to accept the transfer because the request needed to be approved by a supervisor who would not be in until the following business day. A few hours later, the patient died at the requesting hospital. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Felicia Heimer represented OIG.
09-07-2016
New Jersey DME Company Agrees to Permanent Exclusion
On September 7, 2016, in connection with the resolution of False Claims Act liability, Oxford Diabetic Supply, Inc. (Oxford), agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Oxford set up and controlled an entity that it used to make unsolicited telephone calls to suspected Medicare beneficiaries in order to sell durable medical equipment (DME) to those beneficiaries, in violation of the Social Security Act's DME Telemarketing Provisions. OIG alleged that Oxford billed Medicare for DME that was sold pursuant to these unsolicited calls. Associate Counsel David Fuchs represented OIG.
09-06-2016
Puerto Rico Physician Agrees to Voluntary Exclusion
On September 6, 2016, in connection with the resolution of False Claims Act liability, Narciso Reyes Carrillo, MD, agreed to be excluded from participation in all Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Dr. Reyes submitted or caused to be submitted false claims under Medicare when he furnished healthcare services to Medicare beneficiaries in a hospital emergency department while he was excluded from participating in Federal healthcare programs. OIG had previously excluded Dr. Reyes in October 2009 for five years for his felony conviction in the U.S. District Court for the District of Puerto Rico. Senior Counsel Sarah Kessler represented OIG.
09-01-2016
West Virginia Psychiatrist Agrees to 10 Year Exclusion
On September 1, 2016, in connection with the resolution of False Claims Act liability, Delano H. Webb, MD, a West Virginia psychiatrist, 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 Dr. Webb signed and supplied blank prescriptions and incomplete Certificates of Medical Necessity (CMNs) to durable medical equipment (DME) suppliers to complete and use in support of false claims to Medicare and West Virginia Medicaid for DME without regard for diagnosis or medical necessity. OIG alleged that the fraudulent prescriptions and CMNs containing Dr. Webb's signature purported to show that Dr. Webb had prescribed and certified the medical necessity and propriety of the DME when, in fact, he had not. After the initiation of an investigation in this matter, Dr. Webb participated in a scheme to obstruct the investigation by re-signing some of the fraudulent prescriptions and CMNs previously created by the DME supplier and ratifying those prescriptions and CMNs without regard to medical necessity or propriety. These re-signed claims were placed in patient records in an attempt to avoid having to repay Medicare and West Virginia Medicaid for the payments previously made based on the false claims submitted. Associate Counsel David Fuchs represented OIG.
08-31-2016
Texas Pharmacy and Pharmacy Manager Settle Case Involving Excluded Individual
On August 31, 2016, Lifechek 336 Pharmacy, LLC, Lifechek Staff Services, Inc., and Bruce Gingrich (collectively, "Lifechek"), Texas, entered into a $30,000 settlement agreement with OIG. The settlement agreement resolves allegations that Lifechek employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a store manager and pharmacy technician, provided items or services that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG.
08-29-2016
ALJ Upholds OIG Civil Monetary Penalty and Exclusion Determination
On August 29, 2016, an Administrative Law Judge (ALJ) for the Departmental Appeals Board issued an order upholding OIG's imposition of penalties, an assessment, and exclusion against Dr. Mohammad Siddique and Shoals Medical Group, LLC (collectively, Siddique) for knowingly presenting claims to Medicare for items or services that Siddique knew or should have known were not provided as claimed and were false or fraudulent. Specifically, the ALJ found that through the use of Modifier 59, Siddique knowingly submitted or caused to be submitted excess claims for payment for multiple units of Healthcare Common Procedure Coding System (HCPCS) code G0434 for a single patient encounter when HCPCS code G0434 can only be billed once per patient encounter.

The ALJ also found that a Civil Money Penalty of $1,710,400, an assessment of $1,057,251.78, and exclusion of Siddique from all federal health care programs for ten years were reasonable sanctions. OIG was represented in the investigation and litigation of this matter by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin.
08-24-2016
Connecticut Physicians and Practice Settle False and Fraudulent Medicare Claims Case
On August 24, 2016, Robert Borkowski, MD, Robert D. Malkin, MD, James St. Pierre, MD, Manny Katsetos, MD, and Lexington Cardiology Associates, LLC, entered into a $30,349.14 settlement agreement with OIG. The settlement agreement resolves allegations that they submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
Texas Physicians and Practice Settle False and Fraudulent Medicare Claims Case
On August 24, 2016, Harold J. Pean, MD, Mihaela Shuaib, MD, and Mission Internal Medicine, PA, entered into a $28,757.18 settlement agreement with OIG. The settlement agreement resolves allegations that they submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
08-19-2016
Pennsylvania Audiology Practice Agrees to Voluntary Exclusion
On August 19, 2016, in connection with the resolution of False Claims Act liability, John Balko & Associates, Inc. d/b/a Senior Healthcare Associates (SHA), agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that SHA knowingly and intentionally submitted or caused to be submitted claims for payment to Medicare for cerumen removal procedures, nail debridement procedures, and evaluation and management services using modifier-25, which were not medically necessary, were not authorized or requested by patients, were not supported by patient medical records, lacked required medical documentation, and/or were provided in reliance upon improper standing orders.
08-17-2016
Texas Hospice Provider Settles False and Fraudulent Medicare Claims Case
On August 17, 2016, Community Hospice of Texas (CHT), Texas, entered into a $34,986.68 settlement agreement with OIG. The settlement agreement resolves allegations that CHT submitted claims for hospice services at the general inpatient level of care when it knew or should have known that routine care should have been billed. Senior Counsels Geoffrey Hymans and David Traskey represented OIG.
08-12-2016
Florida Physician and Practice Settle False and Fraudulent Medicare Claims Case
On September 26, 2016, Chika E. Okereke, MD, and his medical practice, Cardiovascular Partners, PA, (collectively, Dr. Okereke), Florida, entered into a $139,383.72 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Okereke filed claims for Healthcare Common Procedure Coding System (HCPCS) code G0248 (demonstrate use home INR monitoring) where Dr. Okereke did not perform such services, and should instead have filed less frequent claims for HCPCS code G0250 (MD INR test review interpretation management). Senior Counsel Geoffrey Hymans represented OIG.
Arizona Physician Settles False and Fraudulent Medicare Claims Case
On August 12, 2016, Manith Mann, M.D., Arizona, entered into a $66,513.50 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Mann submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgement by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Kenneth Kraft and Geoffrey Hymans represented OIG.
08-04-2016
Georgia Podiatrist Settles False and Fraudulent Claims Case
On August 4, 2016, Janaki Nadarajah, DPM, Georgia, entered into a $115,000 settlement agreement with the OIG. The settlement resolves allegations that Dr. Nadarajah improperly submitted claims: (1) for nail debridement and other podiatric services rendered to patients in assisted living facilities when she neither personally performed nor supervised the service; and (2) for Dermagraft skin substitute not provided in accordance with the product's Food and Drug Administration-approved label and applicable Medicare rules.
08-02-2016
Texas Skilled Nursing Facility Settles Case Involving Excluded Individual
On August 2, 2016, PHCC-The Pointe Rehabilitation & Healthcare Center LLC d/b/a The Pointe Rehabilitation and Healthcare Center, and PHCC-Paramount Health Care Company, LLC (The Pointe), Webster, Texas, entered into a $408,159.53 settlement agreement with OIG. The settlement agreement resolves allegations that The Pointe employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an office manager, provided items or services to The Pointe patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
08-01-2016
Palestine Regional Medical Center in Texas Settles Case Involving a Patient Dumping Allegation
On August 1, 2016, Palestine Regional Medical Center (PRMC), in Palestine, Texas, entered into a $45,000 settlement agreement with OIG. The settlement agreement resolves allegations that PRMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide stabilizing treatment and an appropriate transfer to a patient who presented to PRMC's emergency department. OIG's investigation revealed that a patient, who had a kidney transplant and was on dialysis, was waiting in the parking lot of a local dialysis center when she experienced significant shortness of breath. The patient was transported by ambulance to PRMC's emergency department, where she was diagnosed with acute pulmonary edema and discharged to receive dialysis on an outpatient basis. The patient arrived at the dialysis center where dialysis was started promptly, but the patient's condition deteriorated and she was taken back to PRMC's emergency department where she was pronounced dead. OIG's investigation concluded that PRMC failed to provide needed stabilizing treatment and an appropriate transfer when the patient presented to the emergency department the first time. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
07-29-2016
Missouri Pharmacy Settles False and Fraudulent Claims Case
On July 29, 2016, JSH Group, LLC (JSH Group), Missouri, entered into a $75,477.84 settlement agreement with the OIG. The settlement resolves allegations that JSH Group submitted claims to Medicare and Medicaid for Precision Xtra blood glucose test strips that JSH Group knew or should have known were not provided as claimed. Specifically, OIG alleged that JSH Group submitted claims for Precision Xtra blood glucose test trips that, based on inventory records, it could not have dispensed.
07-26-2016
Drug Testing Laboratory and Owner Agree to 7 Year Exclusion
On July 26, 2016, Nexus Medical Services, Inc. (Nexus), and its owner, French McClung (McClung), agreed to be excluded from participation in all Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Nexus and McClung paid remuneration in the form of an inflated monthly rent payment to a physician's practice to sublease a portion of the practice's office space in exchange for referrals from the practice's physician owner to Nexus. OIG also alleged that Nexus and McClung employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
07-20-2016
Missouri Physician and Practice Settle False and Fraudulent Medicare Claims Case
On July 20, 2016, William Boulware, MD, and Boulware Medical Clinic, LLC (Boulware), entered into a $10,653.54 settlement agreement with OIG. The settlement agreement resolves allegations that Boulware submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
Florida Ambulance Company Settles Case Involving False Claims
On July 20, 2016, Courtesy Transport Services, LLC (Courtesy), of Northeast Florida, entered into a $362,188 settlement agreement with OIG. The settlement agreement resolves allegations that Courtesy 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 Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
Florida Pharmaceutical Company Settles Case Involving Drug Price Reporting
On July 20, 2016, Nephron Pharmaceuticals Corporation (Nephron), Florida, entered into a $60,000 settlement agreement with OIG. The settlement agreement resolves allegations that Nephron failed to submit certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2013, 2014, and 2015. The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
South Carolina Pharmaceutical Company Settles Case Involving Drug Price Reporting
On July 20, 2016, Cipher Pharmaceuticals US LLC (Cipher), South Carolina, entered into a $60,000 settlement agreement with OIG. The settlement agreement resolves allegations that Cipher failed to submit certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2014, 2015, and 2016. The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
Oklahoma Behavioral Health Counseling Center and Owner Agree to 5 Year Exclusion
On July 20, 2016, LXE Counseling, LLC (LXE), and its owner, Lexie Darlene George a/k/a Lexie Darlene Batchelor (Batchelor), agreed to be excluded from participation in all Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that LXE and Batchelor knowingly submitted claims to Medicaid for services not provided, services provided by unqualified individuals, telemedicine services not approved, as well as claims with falsified dates, codes, and lengths of service. Senior Counsels Kenneth Kraft and Nancy Brown represented OIG.
07-14-2016
Colorado Hospice Settles Case Involving Excluded Individual
On July 14, 2016, Pinnacle Hospice Care (PHC), Colorado, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that PHC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual provided items or services to PHC patients that were billed to Federal health care programs. Senior Counsel Ellen Slavin represented OIG with the assistance of Paralegal Specialist Eula Taylor.
07-11-2016
OIG Excluded Alabama Physician
Effective July 11, 2016, OIG excluded Bobby Merkle, MD, from participation in all Federal health care programs for a period of three years under 42 U.S.C. § 1320c-5 following a referral to the OIG by Kepro, the Beneficiary and Family Centered Care Quality Improvement Organization (QIO). OIG's investigation determined Dr. Merkle violated his obligations to provide services to five Medicare beneficiaries: (1) when, and to the extent, they were medically necessary; (2) of a quality that met professionally recognized standards of care; and (3) supported by the appropriate evidence of medical necessity and quality in a form and fashion and at such time as they were required by the QIO. Dr. Merkle violated his obligations through prescription practices and choices of medications which violated professionally recognized standards of care, through documentation that did not support the proper management of chronic conditions or diseases in the patients, through failure to assess pain or response to treatment in patient with chronic pain, and for failure to document response to treatment or patient progress for pain, edema, or gastrointestinal upset. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
07-08-2016
Texas Doctor Settles Case Involving Kickback Allegations
On July 8, 2016, Angel Perez, M.D., Channelview, Texas, entered into a $73,939.44 settlement agreement with OIG. OIG's investigation revealed that Dr. Perez received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Perez. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
07-07-2016
Regional One Health in Tennessee Settles Case Involving a Patient Dumping Allegation
On July 7, 2016, Regional One Health (ROH), in Memphis, Tennessee, entered into a $45,000 settlement agreement with OIG. The settlement agreement resolves allegations that ROH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment to a patient and inappropriately transferred the patient to another hospital. The patient presented at ROH with complaints of sudden pain in the lower right quadrant of his abdomen. OIG's investigation revealed that despite the fact that ROH was aware of the patient's abnormal lactic acid levels and perforated viscus, ROH failed to fully evaluate the severity and cause of the patient's emergency condition and failed to provide the patient stabilizing treatment for sepsis. Instead, ROH transferred the patient to another hospital, even though ROH was capable of providing the highest level of care to the patient. OIG contends that the transfer by ROH was inappropriate because the patient was not informed of the risks of transfer, the benefits of transfer did not outweigh the risks, and the transfer unnecessarily cause a delay in the patient's care. The patient died due to septic shock and respiratory failure within a week of his transfer by ROH. Under EMTALA, hospitals can be fined up to $50,000 per violation. Associate Counsel Srishti Miglani represented OIG.
06-24-2016
California Ambulance Company Settles Case Involving False Claims
On June 24, 2016, Enloe Medical Center (Enloe), of Butte County, California, entered into a $570,912.40 settlement agreement with OIG. The settlement agreement resolves allegations that Enloe 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 Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
06-22-2016
Former Owner of Illinois Home Health Agency Enters Settlement Agreement with OIG Based on Kickback Allegations
On June 22, 2016, Tariq Chaudhry entered into a settlement agreement with OIG for $50,000 to resolve kickback allegations. Chaudhry is a former owner of a Chicago-area home health agency (HHA). OIG contends that Chaudhry paid illegal remuneration to a Chicago physician in exchange for the physician's referral of patients for home health care services to Chaudhry's HHA. The kickback was disguised as medical director fees, when, in fact, no services were performed. OIG also contends that Chaudhry and the HHA he formerly owned made the payments to the physician through one or more of its marketer employees or contractors.
Arizona Hospice Provider Settles False and Fraudulent Medicare Claims Case
On June 24, 2016, Hospice of the Valley (HOTV), Arizona, entered into a $91,932.16 settlement agreement with the OIG. The settlement resolves allegations that HOTV submitted claims for hospice services at the general inpatient level of care when it knew or should have known that routine care was the correct level of hospice care that should have been billed. Senior Counsels Geoffrey Hymans and David Traskey represented OIG.
Oklahoma Chiropractic Center Settles Case Involving Excluded Individual
On June 24, 2016, Simpson Chiropractic (Simpson), Oklahoma, entered into a $31,000 settlement agreement with OIG. The settlement agreement resolves allegations that Simpson employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a chiropractic assistant, provided items or services to Simpson patients that were billed to Federal health care programs. Senior Counsel Ellen Slavin represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
06-17-2016
Florida Physician and Practice Settle False and Fraudulent Medicare Claims Case
On June 17, 2016, Francis Glicksman, MD and Francis Glicksman, MD, PA (Glicksman), entered into a $12,613.72 settlement agreement with OIG. The settlement agreement resolves allegations that Glicksman submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
06-13-2016
Florida County and its Biller Settle Case Involving False Ambulance Claims
On June 13, 2016, The Board of County Commissioners of Flagler County, Florida (Flagler County), and PST Services, Inc. (PST), entered into an $86,251 settlement agreement with OIG. The settlement agreement resolves allegations that between September 1, 2009, and May 30, 2011, Flagler County and PST submitted, or caused to be submitted, Medicare claims for 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. The settlement agreement also resolves allegations that between June 1, 2011, and March 28, 2015, Flagler County (with no involvement of PST) submitted or caused to be submitted Medicare claims for 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.
06-10-2016
Louisiana Hospital Owner Agrees to 15 Year Exclusion
On June 10, 2016, Mark Goff, agreed to be excluded from participation in all Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Goff submitted or caused the hospital he co-owned and managed, to submit to the Medicare program false or fraudulent claims for Intensive Outpatient Program (IOP) psychiatric services. Senior Counsel Ellen Slavin represented OIG.
06-09-2016
Wisconsin Podiatrist Agrees to 10 Year Exclusion
On June 9, 2016, in connection with the resolution of False Claims Act liability, Alan Balkansky, a Wisconsin podiatrist, 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 Balkansky and his practices submitted false claims to the Medicare program for: (1) physical therapy services that had been provided by massage therapists, rather than licensed physical therapists; (2) podiatry services that were not rendered; (3) routine foot care services provided to patients who did not meet the medical criteria to be eligible for Medicare coverage of such services; and (4) podiatry services that failed to meet documentation requirements that are Medicare conditions of payment. Senior Counsel Geeta Taylor represented OIG.
06-08-2016
Minnesota Skilled Nursing Facility Settles Case Involving Excluded Individual On June 8, 2016, KASKA, Inc. d/b/a St. Otto's Care Center (SOCC), Minnesota, entered into a $65,000 settlement agreement with OIG. The settlement agreement resolves allegations that SOCC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a certified nursing assistant, provided items or services to SOCC patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
05-31-2016
Tennessee Physician Agrees to Voluntary Exclusion
Effective May 31, 2016, in connection with the resolution of False Claims Act liability, Dr. Jonathan Oppenheimer, a Tennessee laboratory owner, who is also 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). Based on OIG's investigation, it was alleged that Dr. Oppenheimer donated money towards the physician practices' purchase of Electronic Health Records (EHR) systems in violation of the Anti-Kickback Statute and the Limitation on Certain Physician Referrals. Specifically, OIG alleged that Dr. Oppenheimer: (1) directly considered the volume and/or value of referrals and business between his laboratory and the physician practice when determining whether to make an EHR donation and the size of the EHR donation; (2) improperly considered the volume of Medicare business supplied by the physician practice when considering an EHR donation; and (3) occasionally withheld agreed-upon EHR donation payments until a certain number of cases/referrals were received from the physician practice. OIG further alleged that Dr. Oppenheimer submitted false claims to the Medicare and TRICARE programs by billing for a non-covered form of fluorescence in situ hybridization (FISH) testing. It was specifically alleged that Dr. Oppenheimer continued billing for this test despite an adverse coverage determination indicating that this form of test was experimental and, accordingly, not billable. Senior Counsel Andrea Treese Berlin represented OIG.
05-27-2016
Arkansas Physician and Practice Settle False and Fraudulent Medicare Claims Case
On May 27, 2016, Koyia Latrece Figures, MD, and Alliance Senior Health, PLLC (Figures), entered into a $15,071.20 settlement agreement with OIG. The settlement agreement resolves allegations that Figures submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
05-18-2016
Georgia Dermatology Practice and Owners Excluded for Default
On May 18, 2016, OIG excluded a dermatology practice headquartered in Georgia, and the practice's two owners (collectively, "dermatology practice"), for defaulting on their payment obligations under their Settlement Agreement (Agreement) with the Department of Justice (DOJ) and OIG. The dermatology practice had previously entered into the Agreement for allegedly submitting false claims to the Medicare program that violated the False Claims Act because they: (1) were for laboratory referrals from physicians whose financial relationship with the dermatology practice violated the Stark Law, or (2) improperly included a Modifier 25 billing code on claims submitted for services provided in Georgia. The terms of the Agreement provided that the dermatology practice would make an initial upfront payment plus additional payments over a five-year period. The dermatology practice failed to make a payment in April 2016, and DOJ issued a Notice of Default to the dermatology practice on May 5, 2016. Senior Counsel Karen Glassman represented OIG.
05-18-2016
Grady Health System in Georgia Settles Case Involving a Patient Dumping Allegation
On May 18, 2016, Grady Memorial Hospital Corporation d/b/a/ Grady Health System (GHS), in Atlanta, Georgia, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that GHS violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment to a patient. OIG's investigation revealed the following. The patient was extracted from his apartment by a SWAT team and brought to GHS's emergency department (ED) by a police officer due to complaints of suicidal and homicidal ideations. While at GHS, two Licensed Professional Counselors (LPCs) evaluated the patient and determined that the patient should be held involuntarily for further evaluation and treatment. Approximately five hours after the patient's arrival in the ED, the ED physician discharged the patient without consulting the LPCs or the on-call psychiatrist. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands and Associate Counsel Srishti Miglani represented OIG.
05-06-2016
Minnesota Pharmaceutical Company Settles Case Involving Drug Price Reporting
On May 6, 2016, Coloplast Corp. (Coloplast), Minnesota, entered into a $600,000 settlement agreement with OIG. The settlement agreement resolves allegations that Coloplast failed to submit certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2013, 2014, and 2015. The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
05-05-2016
Arizona Physician and Practice Settle False and Fraudulent Medicare Claims Case
On May 5, 2016, Eduardo Montes, DPM, and Eduardo Montes, DPM, PLLC (Montes), entered into a $10,887.60 settlement agreement with OIG. The settlement agreement resolves allegations that Montes submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgement by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
Florida Podiatrist Agrees to 30 Year Exclusion
On May 5, 2016, Eugene A. Fox, D.P.M., agreed to be excluded from participation in all Federal health care programs for a period of thirty years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Dr. Fox submitted claims to Medicare for podiatric services that were not rendered or were rendered by unqualified personnel. Senior Counsel Lauren Marziani and Associate Counsel David Fuchs represented OIG.
05-05-2016
Michigan Ambulance Company Settles Case Involving False Claims
On May 5, 2016, Allied EMS Systems, Inc. (Allied), of Petoskey, Michigan, entered into a $121,722.63 settlement agreement with OIG. The settlement agreement resolves allegations that Allied submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
05-05-2016
Florida Skilled Nursing Facilities Settle Case Involving Excluded Individual
On May 5, 2016, CCRC PropCo-Cypress Village, LLC (Cypress Village), and BLC Atrium-Jacksonville, LLC (Atrium), Florida, entered into a $17,881.65 settlement agreement with OIG. The settlement agreement resolves allegations that Cypress Village and Atrium employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a speech-language pathologist, provided items or services to Cypress Village and Atrium patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG.
04-15-2016
Texas Home Health Agency Settles Case Involving Excluded Individual
On April 15, 2016, Choice Home Health Care, Inc., and its former owners Patrick Fettinger and Ann Voss (collectively "CHHC"), Texas, entered into a $89,587.82 settlement agreement with OIG. The settlement agreement resolves allegations that CHHC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a home health community liaison/marketing specialist, provided items or services to CHHC patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG.
03-11-2016
Utah Ambulance Company Settles Case Involving False Claims
On March 11, 2016, Ogden City Corporation (Ogden), of Ogden, Utah, entered into a $363,159.38 settlement agreement with OIG. The settlement agreement resolves allegations that Ogden submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate (upcoding). OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
Oregon Physical Therapy Practice and Owner Settle Case Involving False Claims
On March 11, 2016, Dan Ibarra and Northwest Physical Therapy (collectively, NPT), Oregon, entered into a $200,000 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that NPT submitted claims to Medicare for payment for direct services rendered by unlicensed employees and also submitted claims for direct, one-on-one services when these services were rendered to multiple patients at the same time. Senior Counsel Nancy Brown represented OIG.
03-04-2016
Oklahoma Physician and Practice Settle False and Fraudulent Medicare Claims Case
On March 4, 2016, James R. Higgins, MD, and James R. Higgins MD, Inc. (Higgins), entered into a $10,346.96 settlement agreement with OIG. The settlement agreement resolves allegations that Higgins submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced ; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
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.
02-22-2016
Arizona Physician Settles False and Fraudulent Medicare Claims Case
On February 22, 2016, Ronald Dale Parker, MD (Parker), entered into a $15,036.50 settlement agreement with OIG. The settlement agreement resolves allegations that Parker submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
Mississippi Physician Settles False and Fraudulent Medicare Claims Case
On February 22, 2016, Michael Baker, MD (Baker), entered into a $13,238.16 settlement agreement with OIG. The settlement agreement resolves allegations that Baker submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
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
Arizona Physician Settles False and Fraudulent Medicare Claims Case
On February 5, 2016, Benjamin H. Venger, MD (Venger), entered into a $15,956.74 settlement agreement with OIG. The settlement agreement resolves allegations that Venger submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
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.
01-28-2016
Texas Doctor Settles Case Involving Kickback Allegations
On January 28, 2016, Jeffrey Ross, D.P.M, Houston, Texas, entered into a $116,388.56 settlement agreement with OIG. OIG's investigation revealed that Dr. Ross received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Ross. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
01-27-2016
Texas Physician Settles False and Fraudulent Medicare Claims Case
On January 27, 2016, Martin E. Gilliland, MD (Gilliland), entered into a $49,041.58 settlement agreement with OIG. The settlement agreement resolves allegations that Gilliland submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
Texas Physician Settles False and Fraudulent Medicare Claims Case
On January 27, 2016, Roger C. Willette, MD (Willette), entered into a $44,120.14 settlement agreement with OIG. The settlement agreement resolves allegations that Willette submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
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.
01-21-2016
Texas Doctor Settles Case Involving Kickback Allegations
On January 21, 2016, Nicolas Nammour, M.D., Houston, Texas, entered into a $111,709.04 settlement agreement with OIG. OIG's investigation revealed that Dr. Nammour received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Nammour. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
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.
01-05-2016
Three Florida Companies Agree to Permanent Exclusion
Effective January 5, 2016, in connection with the resolution of False Claims Act liability, three Florida based companies American Therapeutic Corporation, American Sleep Institute, and MedLink Professional Management (collectively, "the practices"), agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the practices: (1) paid kickbacks to "patient brokers" who owned Assisted Living Facilities and Halfway Houses in the Miami area, in exchange for referring individuals known to be ineligible for treatment; (2) submitted or caused claims to be submitted to Medicare for medically unnecessary services and (3) falsified medical documentation to obtain Medicare reimbursement. Senior Counsel Kristen Schwendinger represented OIG.

2015

12-29-2015
Moses H. Cone Memorial Hospital in North Carolina Settles Case Involving a Patient Dumping Allegation
On December 29, 2015, Moses H. Cone Memorial Hospital (MCMH), in Greensboro, North Carolina, entered into a $35,000 settlement agreement with OIG. The settlement agreement resolves allegations that MCMH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for an 86-year-old female who presented to MCMH's emergency department after falling at home. OIG's investigation revealed that although an emergency room doctor evaluated her knee pain and performed other imaging tests, he did not fully evaluate her reported severe pain and inability to ambulate. OIG alleged she was discharged with a displaced fracture of her hip. Senior Counsel Sandra Sands represented OIG.
12-23-2015
Vermont Municipality Settles Case Involving False Claims
On December 23, 2015, the City of Barre, Vermont (Barre), entered into a $127,669.90 settlement agreement with OIG. The settlement agreement resolves allegation that Barre submitted claims for basic life support (emergency) and advanced life support (emergency) ambulance transportation claims that did not meet Medicare requirements for emergency transport services and 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 Senior Counsel Nicole Caucci, collaborated to achieve this settlement.
Texas Doctor Settles Case Involving Kickback Allegations
On December 23, 2015, Gustavo Grieco, M.D., Houston, Texas, entered into a $208,000 settlement agreement with OIG. OIG's investigation revealed that Dr. Grieco received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Grieco. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
12-21-2015
Mississippi Ambulance Company Settles Case Involving False Claims
On December 21, 2015, South Central Regional Medical Center (SCRMC), of Laurel, Mississippi, entered into a $318,885.62 settlement agreement with OIG. The settlement agreement resolves allegations the SCRMC 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 Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
Santa Rosa Memorial Hospital in California Settles Case Involving a Patient Dumping Allegation
On December 21, 2015, Santa Rosa Memorial Hospital (SRMH), in Santa Rosa, California, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that SRMH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate medical screening examination and stabilizing treatment to a patient found on SRMH's property. OIG's investigation revealed the following. The patient was seen the previous day in SRMH's emergency department for alcohol withdrawal and neck pain. The physician prescribed a medication for alcohol withdrawal and discharged the patient with instructions for alcohol withdrawal and alcohol abuse. The next morning, the patient was seen by multiple members of the hospital staff, including security, lying on the ground near the perimeter of SRMH's parking lot, possibly in need of medical assistance. Despite being notified several times that the patient may be in need of medical assistance, SRMH failed to respond. Eventually, a staff member who was jogging saw the patient on the ground and called 911. When EMS arrived, the patient had died shortly before EMS's arrival. An autopsy report revealed the cause of death to be acute bacterial pneumonia of the left lung. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
Lake City Medical Center in Florida Settles Case Involving a Patient Dumping Allegation
On December 21, 2015, Lake City Medical Center (LCMC), in Lake City, Florida, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegations that LCMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate medical screening examination and stabilizing treatment for a 42-year-old female. OIG's investigation revealed the following. The patient arrived at LCMC's emergency department complaining of headaches, right arm pain and diarrhea the previous day. She was seen by a physician's assistant and then asked to wait in the waiting room. While there, she vomited and continued to complain of right arm pain. The physician's assistant concluded that she did not need immediate medical attention and asked the patient to leave the emergency department. When the patient resisted and her family complained, the emergency department personnel called the police to escort her out of the emergency department. After unsuccessful attempts by police and paramedics to get the patient into a car, her family requested the emergency department call an ambulance so she could be taken to another hospital. When the ambulance arrived, the patient was unresponsive and taken to another hospital where she was placed on a ventilator in the Intensive Care Unit and later diagnosed with bacterial meningitis. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Senior Counsel Sandra Sands represented OIG.
Pennsylvania Chiropractor Agrees to 25-Year Exclusion
On December 21, 2015, in connection with the resolution of False Claims Act liability, a Pennsylvania chiropractor agreed to be excluded from participating in Federal health care programs for a period of twenty-five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the chiropractor knowingly submitted or caused to be submitted false or fraudulent claims to Medicare for services rendered as a de facto executive and administrator of a chiropractic center notwithstanding the fact that he was excluded from participating in Federal health care programs. Senior Counsel Katherine Matos and Associate Counsel Kaitlyn Dunn represented OIG.
12-16-2015
Arizona Physician and Practice Settles False and Fraudulent Medicare Claims Case
On December 16, 2015, Frank Agnone, MD (Agnone), entered into a $28,863.14 settlement agreement with OIG. The settlement agreement resolves allegations that Agnone submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
Texas Physician and Practice Settle False and Fraudulent Medicare Claims Case
On December 16, 2015, Roberto Diaz, MD (Diaz), entered into a $13,418.56 settlement agreement with OIG. The settlement agreement resolves allegations that Diaz submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
12-11-2015
St. Francis Hospital - Downtown in South Carolina Settles Case Involving Patient Dumping Allegations
On December 11, 2015, St. Francis Hospital - Downtown (St. Francis), in Greenville, South Carolina, entered into a $100,000 settlement agreement with OIG. The settlement agreement resolves allegations that St. Francis violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to fully evaluate and treat two gunshot victims. OIG's investigation revealed that the first patient presented to St. Francis after being robbed and shot in the left leg within close range and the second patient after being shot in the abdomen at a club. OIG contends that although St. Francis had the capacity and capability to provide treatment to both gunshot victims, St. Francis transferred the patients to another hospital. OIG further contends that the benefits of the transfers did not outweigh the risks and unnecessarily placed the health of both gunshot victims at further risk. Under EMTALA hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
12-07-2015
Texas Ambulance Company Settles Case Involving False Claims
On December 7, 2015, EMS Mediventure, Inc. (EMS), of Lampasas, Texas, entered into a $92,020 settlement agreement with OIG. The settlement agreement resolves allegations that EMS submitted claims for basic life support (emergency) and advanced life support (emergency) ambulance transportation claims that did not meet Medicare requirements for emergency transport services and 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 Senior Counsel Nicole Caucci, collaborated to achieve this settlement.
11-13-2015
New York Ambulance Company Settles Case Involving False Claims
On November 13, 2015, SeniorCare Emergency Medical Services, Inc. (SeniorCare), of the Bronx, New York, entered into a $103,334 settlement agreement with OIG. The settlement agreement resolves allegations that SeniorCare 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 Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
Texas Doctor Settles Case Involving Kickback Allegations
On November 13, 2015, Sohail Siddiqui, M.D., Sugar Land, Texas, entered into a $75,000 settlement agreement with OIG. OIG's investigation revealed that Dr. Siddiqui received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Siddiqui. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
11-12-2015
Wisconsin Ambulance Company Settles Case Involving False Claims
On November 12, 2015, Shawano Ambulance Service, Inc. (Shawano), of Shawano, Wisconsin, entered into a $108,086 settlement agreement with OIG. The settlement agreement resolves allegation that Shawano submitted claims to Medicare 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 Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
Nevada Mobile Imaging Provider Settles Case Involving Excluded Individual
On November 12, 2015, Quality Medical Imaging (QMI), Nevada, entered into a $34,187.34 settlement agreement with OIG. The settlement agreement resolves allegations that QMI employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an x-ray technician, provided items and services to QMI patients that were billed to Federal health care programs. Senior Counsel Katie Fink represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
11-10-2015
California Skilled Nursing Facility Settles Case Involving Excluded Individual
On November 10, 2015, Windsor Health Care Golden Palms, LLC d/b/a Golden Hill Subacute and Rehabilitation Center (Golden Hill), California, entered into a $214,303.69 settlement agreement with OIG. The settlement agreement resolves allegations that Golden Hill employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a social services assistant, provided items and services to Golden Hill patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
California Skilled Nursing Facility Settles Case Involving Excluded Individual
On November 10, 2015, S&F Market Street Healthcare, LLC d/b/a Windsor Gardens Convalescent Center of North Long Beach (Windsor North Long Beach), California, entered into a $207,427.34 settlement agreement with OIG. The settlement agreement resolves allegations that Windsor North Long Beach employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a certified nursing assistant, provided items and services to Windsor North Long Beach patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
California Skilled Nursing Facility Settles Case Involving Excluded Individual
On November 10, 2015, Windsor Oakridge Healthcare Center, L.P. d/b/a Windsor Healthcare Center of Oakland (Windsor Oakland), California, entered into a $34,943.48 settlement agreement with OIG. The settlement agreement resolves allegations that Windsor Oakland employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, an activities assistant, provided items and services to Windsor Oakland patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
11-04-2015
Oregon Physical Therapist Settles Case Involving False Claims
On November 4, 2015, Michael Zingg, P.T., Oregon, entered into a $13,307.52 settlement agreement with OIG. The settlement agreement resolves allegations that Zingg submitted claims to Medicare for physical medicine and rehabilitation services that were not provided as claimed or were false or fraudulent. OIG alleged the claims were false or fraudulent because: 1) Zingg failed to personally provide or directly supervise certain physical therapy services; 2) services were billed as one-on-one provider-patient physical therapy services, when, in fact, they were provided in a group setting; and 3) services were rendered by individuals not qualified to provide therapy services under Medicare guidelines. Senior Counsel Lauren E. Marziani represented OIG.
11-03-2015
California and Michigan Laboratories Settle Case Involving Excluded Individuals
On November 3, 2015, Quest Diagnostics Incorporated (Quest), Summit Health, Inc. (Summit), and Unilab Corporation (Unilab) entered into a $126,599.25 settlement agreement with OIG. Summit and Unilab are subsidiaries of Quest. The settlement agreement resolves allegations that a Summit location in Michigan employed an individual to administer vaccinations who was excluded from participation in Federal health care programs, and a Unilab location in California employed a Quality Assurance Specialist who was excluded from participation in Federal health care programs. Senior Counsel Lisa Veigel represented OIG with the assistance of Paralegal Specialist Eula Taylor.
11-02-2015
South Carolina Urgent Care Centers and Owners Excluded for Default
On November 2, 2015, OIG excluded five urgent care centers located in, and around, Charleston, South Carolina, and the urgent care centers' two owners (collectively, urgent care centers), for default on their payment obligations under their Settlement Agreement (Agreement) with the Department of Justice (DOJ) and OIG. The urgent care centers and their owners had previously entered into the Settlement Agreement for allegedly submitting false claims to Federal health care programs for: (1) unnecessary laboratory tests; (2) evaluation and management services; (3) tetanus immunoglobulin injections when tetanus toxoid was given instead; and (4) radiological services that were performed by an unlicensed employee. The terms of the Agreement provided that the urgent care centers would make an initial upfront payment and two additional installment payments within one year of the Agreement. The urgent care centers failed to make the first of the two installment payments, and DOJ issued a Notice of Default to the urgent care centers on October 15, 2015.
10-30-2015
Texas Physician and Practice Settle False and Fraudulent Medicare Claims Case On October 30, 2015, Tajul Chowdhury, MD, and the Center for Pain Management, PLLC (Chowdhury), entered into a $26,587.20 settlement agreement with OIG. The settlement agreement resolves allegations that Chowdhury submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
Texas Physician and Practice Settle False and Fraudulent Medicare Claims Case
On October 30, 2015, Renaud Rodrigue, MD, and Bulger and Rodrigue Southwest Pain Group, PLLC (Rodrigue), entered into a $22,807.06 settlement agreement with OIG. The settlement agreement resolves allegations that Rodrigue submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
Delaware Physician Settles False and Fraudulent Medicare Claims Case
On October 30, 2015, Edwin David Gar-El, MD, entered into a $11,954.86 settlement agreement with OIG. The settlement agreement resolves allegations that Gar-El submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
10-28-2015
Wisconsin Home Health Agency and Owner Agree to Voluntary Exclusion
On October 28, 2015, in connection with the resolution of False Claims Act liability, a Wisconsin Home Health Agency and its owner 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 agency and its owner submitted claims to Wisconsin Medicaid for personal care worker services that were not provided, were not provided pursuant to appropriate supervision by the agency, were not medically necessary, or were referred or ordered in violation of the Anti-Kickback Statute. Senior Counsels Geeta Taylor and Tamara Forys represented OIG.
10-23-2015
Illinois Hospital Corporation Settles Case Involving Excluded Individuals
On October 23, 2015, Advocate Health and Hospitals Corporation (Advocate), Illinois, entered into a $317,660.89 settlement agreement with OIG. The settlement agreement resolves allegations that Advocate employed two individuals who were excluded from participation in any Federal health care program. OIG's investigation revealed that the excluded individuals, both registered nurses, provided items and services to Advocate patients that were billed to Federal health care programs. Senior Counsel Karen Glassman represented OIG with the assistance of Paralegal Specialist Jennifer McKoy.
10-22-2015
Texas Skilled Nursing Facility Settles Case Involving Excluded Individual
On October 22, 2015, Huntington Healthcare & Rehabilitation Center, Ltd. (HHRC), Texas, entered into a $214,016.48 settlement agreement with OIG. The settlement agreement resolves allegations that HHRC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a nurse, provided items and services to HHRC patients that were billed to Federal health care programs. Senior Counsel David Blank represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
10-16-2015
Kansas Fiscal Intermediary Settles Case Involving Excluded Individual
On October 16, 2015, South Kansas Independent Living Resource Center, Inc. (SKIL), Kansas, entered into a $47,520.18 settlement agreement with OIG. The settlement agreement resolves allegations that SKIL employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a home health aide, provided items and services to SKIL patients that were billed to Kansas Medicaid. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
10-07-2015
New Jersey Pharmaceutical Company Settles Case Involving Drug Price Reporting
On October 7, 2015, Ascend Laboratories, LLC (Ascend), New Jersey, entered into a $1,287,000 settlement agreement with OIG. The settlement agreement resolves allegations that Ascend failed to submit monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2013 and 2014. The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
09-30-2015
OIG Excludes Florida Dentist
On September 30, 2015, OIG excluded Howard Sheldon Schneider, DDS, from participation in all Federal health care programs because his license to practice in the State of Florida was revoked, suspended, or otherwise lost for reasons bearing on his professional competence, professional performance, or financial integrity. OIG conducted an investigation of Dr. Schneider which revealed that the State of Florida Board of Dentistry issued a Final Order for a Disciplinary Voluntary Relinquishment of his dental license after the Florida Department of Health opened an investigation into allegations of Dr. Schneider's abuse of his pediatric dental patients. Dr. Schneider cannot apply for reinstatement until his dental license is reissued by the State of Florida. Senior Counsels Geoffrey Hymans and Geeta Taylor represented OIG.
09-29-2015
Former Arizona Hospice CEO Agrees to Voluntary Exclusion
On September 29, 2015, in connection with the resolution of False Claims Act liability, the former CEO of an Arizona hospice 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's investigation revealed that during the tenure of the CEO, the hospice submitted false claims to Medicare for some patients who were provided a higher level of hospice care than was necessary or allowable under Medicare's hospice benefits and/or were completely partially ineligible for Medicare's hospice benefits because, during some or all of the period they received hospice, they did not have a medical prognosis of six months or less if their illnesses ran their normal course. Senior Counsel Gregory Wellins represented OIG.
09-17-2015
Tennessee Physician and Practice Settle False and Fraudulent Medicare Claims Case
On September 17, 2015, Dennis C. Ford, MD, and the Ford Center for Pain Management, PLLC (Ford), entered into a $32,184.74 settlement agreement with OIG. The settlement agreement resolves allegations that Ford submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
New Jersey Physician and Practice Settle False and Fraudulent Medicare Claims Case
On September 17, 2015, Karl T. Chen, MD, and Karl T. Chen, LLC (Chen), entered into a $25,937.72 settlement agreement with OIG. The settlement agreement resolves allegations that Chen submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
New Mexico Physician and Practice Settle False and Fraudulent Medicare Claims Case
On September 17, 2015, Jesus J. Fonseca, MD, and The Medicine Clinic, LLC, entered into a $17,925.24 settlement agreement with OIG. The settlement agreement resolves allegations that they submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
09-03-2015
Massachusetts Physician and his Practice Settle Case Involving False Claims
On September 2, 2015, Dr. Ronald Goldberg and his practice, Haverhill Family Practice, LLC (collectively "Goldberg and Haverhill"), Massachusetts, entered into a $1,000,000 settlement agreement with OIG. The settlement agreement resolves allegations that Goldberg and Haverhill improperly submitted claims under Dr. Goldberg's billing number for services provided to nursing home patients that had been provided by nurse practitioners. Goldberg and Haverhill also entered into an Integrity Agreement with OIG. Senior Counsel Karen Glassman represented OIG.
09-01-2015
Ohio Durable Medical Equipment Fitter Agrees to Voluntary Exclusion
On September 1, 2015, in connection with the resolution of False Claims Act liability, an Ohio fitter of durable medical equipment 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's investigation revealed that the fitter caused the submission of false claims to Medicare and Medicaid for back braces that were not supplied, not medically necessary, resulted in the payment of a kickback, or not fitted by a person qualified to perform such services. Senior Counsel Lauren Marziani and Associate Counsel David Fuchs represented OIG.
Florida Dermatologist Agrees to Voluntary Exclusion
Effective September 1, 2015, in connection with the resolution of False Claims Act liability, a Florida 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's investigation revealed that the dermatologist submitted claims to Medicare for Mohs surgeries that were not medically necessary or not performed, and claims for adjacent tissue transfers (also known as flaps) that were not medically necessary or not performed. Senior Counsel Karen Glassman represented OIG.
08-31-2015
New Jersey Pharmaceutical Company Settles Case Involving Drug Price Reporting
On August 31, 2015, Glenmark Pharmaceuticals, Inc. USA (Glenmark), New Jersey, entered into a $2,887,300 settlement agreement with OIG. The settlement agreement resolves allegations that Glenmark failed to timely submit monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2013 and 2014. The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
08-27-2015
Texas Doctor Settles Case Involving Kickback Allegations
On August 27, 2015, Marco Vargas, D.P.M., Sugar Land, Texas, entered into a $65,000 settlement agreement with OIG. OIG's investigation revealed that Dr. Vargas received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Vargas. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
08-14-2015
Milwaukee Pain Doctor and Medical Practice Settles False and Fraudulent Medicare Claims Case
On August 14, 2015, David Irving Stein, MD (Stein), and Milwaukee Pain Treatment Services (MPTS), a Wisconsin based pain management specialist and his practice, entered into a $374,864.78 settlement agreement with OIG. The settlement agreement resolves allegations that MPTS, through Stein, submitted false or fraudulent claims for payment for multiple units of HCPCS codes G0431 and G0434 when only a single unit may be billed per patient encounter by inappropriately using modifiers 91 and QW. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
08-12-2015
Colorado Dentist Agrees to Voluntary Exclusion
On August 12, 2015, Dr. Robert E. Hackley, Jr., DDS, agreed to be excluded from participation in all Federal health care programs for a period of three years. OIG conducted an investigation of Dr. Hackley for dental care he provided to patients at Small Smiles Dentistry for Children in Colorado Springs, Colorado. OIG's investigation revealed that Dr. Hackley furnished dental services to patients of a quality which failed to meet professionally recognized standards of care, including: performing medically unnecessary dental procedures, failing to treat existing dental conditions, and performing dental procedures that were below professionally recognized standards of care. Senior Counsels Geoffrey Hymans and Tamara Forys represented OIG.
07-29-2015
Owner of a Pennsylvania Durable Medical Equipment Supplier and Her Spouse Agree to Voluntary Exclusions
On July 29, 2015, the owner of a durable medical equipment (DME) supplier and the owner's spouse, who was also an employee, agreed to be excluded from participation in Federal health care programs. The owner agreed to be excluded for a period of fifteen years and the owner's spouse agreed to be excluded for a period of thirty years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the DME company and its owner furnished supplies reimbursed by Federal health care programs through the owner's spouse while the spouse was excluded from participating in Federal health care programs. Senior Counsels Lauren Marziani and Katherine Matos represented OIG.
07-27-2015
OIG Excludes Georgia Laboratory
On July 27, 2015, OIG excluded C.F. Health Management, Inc. d/b/a Gainesville Pain Management (Gainesville), Georgia, for defaulting on payment obligations under a settlement agreement with OIG. The settlement agreement, effective May 17, 2013, required Gainesville to pay $1,577,597 over a period of time. 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. Gainesville's exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates Gainesville's participation in Federal health care programs. Senior Counsels Geoffrey Hymans and Andrea Treese Berlin represented OIG.
07-23-2015
Minnesota Nursing Home Settles Case Involving Excluded Individual
On July 23, 2015, Itasca County, Minnesota, and its nursing home, the Itasca Nursing Home d/b/a Grand Village (Itasca), a county-owned nursing home in Grand Rapids, Minnesota, entered into a $179,484.98 settlement agreement with OIG. The settlement agreement resolves allegations that Itasca employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a housekeeper and health information specialist, provided items and services to Itasca patients that were billed to Federal health care programs. Senior Counsel Patrick Garcia represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
07-20-2015
Indiana Lab Settles Case Involving False and Fraudulent Claims
On July 20, 2015 American Institute of Technology (AIT), Indiana, entered into a settlement agreement with OIG and agreed to pay $229,924.74 for allegedly violating the Civil Monetary Penalties Law. The settlement agreement resolves conduct that was investigated by OIG as well as conduct that was self-disclosed by AIT. OIG's investigation revealed that AIT inappropriately used Modifiers 59 and 91 to submit claims for payment for multiple units of HCPCS code G0431 when only a single unit may be billed per patient encounter. Also, AIT self-disclosed to OIG that it had employed an individual that it knew or should have known was excluded from participation in Federal health care programs. The excluded individual, a clinical technician, provided items and services to AIT patients that were billed to Federal health care programs. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
07-17-2015
Indiana Dialysis Provider Settles Case Involving Excluded Individual
On July 17, 2015, Fresenius Medical Care (Fresenius), Indiana, entered into a $120,447.23 settlement agreement with OIG. The settlement agreement resolves allegations that Fresenius employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that an Indiana Fresenius location employed an excluded nurse who provided items and services to Fresenius patients that were billed to Federal health care programs. Senior Counsel Henry Green represented OIG.
07-13-2015
OIG Issues Cease and Desist Letter to BankRate Insurance
On July 13, 2015, OIG notified BankRate Insurance (BankRate) that BankRate's unauthorized and inappropriate use of the word "Medicare" and other information in the name and webpages found at http://www.louisiana-medicare.com/ was potentially in violation of section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and Departmental emblems. Before OIG initiated litigation, BankRate agreed to: (1) increase the prominence of BankRate's consumer notices, including usage of 12-16-point font in disclaimers and notices; (2) expand significantly BankRate's disclosure of its non-governmental affiliation in its consumer notices; and (3) provide each Medicare Plan (on which BankRate offers consumer information) a copy of or a link to BankRate's webpages.
06-30-2015
Dental Practice Settles Case Involving Excluded Individual
On June 30, 2015, Adam Diasti, D.D.S., P.C. (Diasti), a dental services provider, entered into a $22,319.26 settlement agreement with OIG. The settlement agreement with OIG resolves allegations that Diasti employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that in two Diasti-affiliated California dental offices, the excluded registered dental assistant provided items and services to patients that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Jennifer McKoy and Program Support Assistant Tynishia Gardner.
06-29-2015
New York Doctor Agrees to Voluntary Exclusion
On June 29, 2015, a New York physician agreed to be excluded from participating in Federal health care programs for a period of two years under 42 U.S.C. § 1320a-7(b)(16). OIG's investigation revealed that the physician filed a Medicaid provider enrollment application with the New York State Department of Health containing false statements of material fact as to the physician's prior restriction from the Medicaid program and prior enrollment denials. Associate Counsel Kaitlyn Dunn represented OIG.
06-19-2015
Midwest Home Health Agency Settles Case Involving Excluded Individual
On June 19, 2015, Accurate Home Care, LLC (Accurate), an Otsego, Minnesota-based, provider of nursing and personal care services, entered into a $334,651.82 settlement agreement with OIG. The settlement agreement resolves allegations that Accurate employed an excluded individual to provide services to Medicaid beneficiaries. Associate Counsel Kaitlyn Dunn represented OIG.
06-08-2015
Texas Skilled Nursing Facility Settles Case Involving Excluded Individual
On June 8, 2015, Meridian Williamsburg Acquisition Partners, LP d/b/a Williamsburg Village Healthcare Campus (Williamsburg) entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services. Williamsburg agreed to pay $77,772.08 to settle allegations that it employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a certified nurse aide, provided items and services to Williamsburg patients that were billed to Federal health care programs. Senior Counsel Ellen Slavin and Paralegal Specialist Mariel Filtz represented OIG.
06-01-2015
Texas Skilled Nursing Facilities Settle Case Involving Excluded Individuals
On June 1, 2015, P & S Healthcare Management, LLC the former general partner of Woodland Springs Healthcare, LP (Woodland Springs) and P & S Healthcare, LP (P & S) agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law (CMPL). OIG alleged that Woodland Springs employed an individual who was excluded from participating in any Federal health care programs. OIG also alleged that P & S employed two individuals who were excluded from participating in any Federal health care programs. OIG's investigation revealed that these excluded individuals provided items and services to Federal health care programs beneficiaries. Senior Counsel Karen Glassman represented OIG.
05-31-2015
OIG Excludes District of Columbia Nuclear Cardiologist
On March 31, 2015, a District of Columbia nuclear cardiologist was excluded from participation in all Federal health care programs for a period of seventeen years under 42 U.S.C. § 1320a-7(b)(7). The cardiologist rendered and billed Federal health care programs for nuclear cardiology services, including myocardial perfusion imaging single-photon emission computed tomography (MPI SPECT) procedures (commonly known as nuclear stress tests). OIG's investigation revealed the claims billed for MPI SPECT procedures and related services that did not comply with applicable Federal health care program rules and regulations. The cardiologist also unbundled and separately billed for services that were contemplated as being part of the reimbursement for the MPI SPECT studies and double-billed for multi-study MPI SPECT procedures. Senior Counsels Kaitlyn Dunn and Jill Wright represented OIG.
05-29-2015
Michigan Physician Agrees to Voluntary Exclusion
On May 29, 2015, in connection with the resolution of False Claims Act liability, a Michigan physician specializing in physical medicine and pain management 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's investigation revealed that the physician caused the submission of false claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care services that the physician referred in exchange for illegal remuneration or kickbacks. Senior Counsel Patrick Garcia represented OIG.
05-27-2015
South Florida Business Owner Agrees to Voluntary Exclusion and Divestiture
Tracy Nemerofsky - a Palm Beach Gardens, Florida private business owner - agreed to be excluded from participation in all Federal health care programs for a period of five years. OIG conducted an investigation of Nemerofsky for knowingly submitting or causing to be submitted to Medicare false claims in violation of the Anti-Kickback Statute. Based upon that investigation, OIG alleged that Nemerofsky violated the Anti-Kickback Statute through her company A Plus Home Healthcare, Inc. (A Plus), when she directed and managed A Plus' payments to eight different physicians' spouses, in exchange for the physicians' Medicare referrals. OIG alleged that the eight spouses were not bona fide employees of A Plus and that these arrangements did not fit within the exception to the Anti-Kickback Statute payment prohibition. OIG alleged that Nemerofsky offered and paid the remuneration described above and this conduct forms a basis for her exclusion.

Nemerofsky agreed to enter a voluntary exclusion with OIG for a period of five years after she resolved the above mentioned conduct through a False Claims Act monetary settlement with the United States, a settlement in which OIG expressly reserved its exclusion authority. In order to resolve her companies' exclusion liability as well, Nemerofsky also agreed to divest herself of five health care businesses: A Plus; A Plus Private Care Services; Ocean Therapy Group, Inc.; Professional Touch Rehab, Inc.; and RockHill Rehab Services Inc. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
05-15-2015
Michigan Nurse Practitioner Agrees to Voluntary Exclusion
On May 15, 2015, a Michigan Nurse Practitioner (NP) 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's investigation revealed that the NP knowingly and willfully referred patients for physical therapy and home health care services billed to Federal health care programs in exchange for illegal kickbacks. Senior Counsel Patrick Garcia represented OIG.
05-08-2015
Kansas Pharmaceutical Company Settles Case Involving Drug Price Reporting
On May 8, 2015, B.F. Ascher & Company, Inc. (B.F. Ascher), a Kansas pharmaceutical manufacturer, entered into a $178,000 settlement agreement with OIG. The settlement agreement resolves allegations that B.F. Ascher failed to timely submit certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters from 2012 to 2014. The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsels Geeta W. Kaveti and Nicole Caucci represented OIG.
05-06-2015
New Jersey Pharmaceutical Company Settles Case Involving Drug Price Reporting
On May 6, 2015, Seton Pharmaceuticals (Seton), a Manasquan, New Jersey, specialty generic pharmaceutical company, entered into a $91,800 settlement agreement with OIG. The settlement agreement resolves allegations that Seton failed to timely submit certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2012 and 2013. The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsels Geeta W. Kaveti and Nicole Caucci represented OIG.
04-27-2015
Texas Nursing Facility Settles Case Involving Excluded Individual
On April 27, 2015, Town Hall Estates- Arlington, Inc. (Town Hall), an Arlington, Texas, nursing home, entered into a $70,000 settlement agreement with OIG. The settlement agreement with OIG resolves allegations that Town Hall employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a licensed vocational nurse, provided items and services to Town Hall patients that were billed to Federal health care programs. Senior Counsel Karen Glassman represented OIG.
04-15-2015
Georgia Ophthalmologist Agrees to Voluntary Exclusion
On April 15, 2015, a Georgia ophthalmologist 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's investigation revealed that the ophthalmologist submitted claims to Georgia Medicaid for services that were not medically necessary and overstated the level of service provided. Associate Counsel David Fuchs represented OIG.
04-10-2015
Florida Mental Health Counselor Settles Case Involving False Claims
On April 10, 2015, Timothy Fennell, a Florida licensed mental health counselor, entered into a settlement agreement with OIG under which Fennell would pay $120,000 and be excluded for twelve years. The settlement agreement with OIG resolves allegations that Fennell submitted false claims to Medicare for psychotherapy and other services allegedly rendered at Fennell's former company, Lakemont Clinic. Fennell used the provider information of an Orlando-area physician to submit claims for services that were not rendered or supervised by a physician. Senior Counsels Lauren Marziani and Katherine Matos represented OIG.
04-06-2015
Pennsylvania Home Care Agency Settles Case Involving Excluded Individual
On April 6, 2015, YCB, Inc. d/b/a Home Helpers (Home Helpers), a Drexel, Pennsylvania, provider of non-medical and personal in-home care, entered into a $69,130 settlement agreement with OIG. The settlement agreement resolves allegations that from July 1, 2010, to December 12, 2011, Home Helpers employed an excluded individual. OIG alleged that the excluded individual provided services to Medicaid recipients. Senior Counsel Lauren Marziani represented OIG.
03-23-2015
Indiana Health Systems Settles Case Involving Excluded Laboratory Technician
On March 23, 2015, Parkview Health System, Inc. (Parkview), a not-for-profit, community-based health system that serves northeast Indiana and northwest Ohio, entered into a $129,216.80 settlement agreement with OIG. The settlement agreement resolves allegations that Parkview employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a laboratory technician, provided items and services to Parkview patients that were billed to Federal health care programs. Senior Counsel Henry Green represented OIG.
03-19-2015
OIG Excludes Illinois Home Health Agency
Ambulatory Health Care Services, LTD. - a Skokie, Illinois home health agency was excluded from participation in all Federal health programs for a period of three years as a result of its employment of an excluded nurse. OIG's investigation revealed that Ambulatory Health Care Services, LTD, billed the Federal health care programs for services provided by the excluded nurse to Medicare and Medicaid beneficiaries. The exclusion became effective March 19, 2015, and prohibits Ambulatory Health Care Services, LTD, from participating in the Federal health care programs. Ambulatory Health Care Services, LTD is no longer in operation. Senior Counsels David M. Blank and Lauren Marziani, along with Paralegal Specialist Eula Taylor, represented OIG.
03-18-2015
Oklahoma Prosthetics Suppliers Settles Case Involving False Claims
On March 18, 2015, La Fuente Ocular Prosthetics, LLC (La Fuente), an Oklahoma City, Oklahoma, prosthetics supplier, entered into a $90,000 settlement agreement with OIG. The settlement agreement resolves allegations that La Fuente submitted false or fraudulent claims to Medicare and created false records material to a false claim. OIG contends that La Fuente submitted claims for services (1) where the treating physician had not provided La Fuente with an order or other required documentation prior to billing the Medicare program and (2) provided patients with prosthetics that were higher functional level products than necessary. OIG's Office of Audit Services, Office of Investigations and Office of Counsel to the Inspector General, represented by Associate Counsel Paul Westfall and Senior Counsel Geoffrey Hymans, collaborated to achieve this settlement.
03-17-2015
Newton Medical Center in Kansas Settles EMTALA Case
A Newton, Kansas hospital that failed to provide an adequate medical screening examination for a pregnant woman who was later admitted to another hospital and gave birth to a stillborn baby has agreed to pay $45,000 to settle allegations by the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services that those actions violated the Emergency Medical Treatment & Labor Act (EMTALA). The OIG alleged that Newton Medical Center failed to provide an adequate medical screening examination for a patient who presented to Newton's emergency department 38-weeks pregnant and complaining of abdominal and lower back pain. Newton did not take the patient's medical history, take any vitals, conduct fetal monitoring, test for fetal movement, or perform any exam on the patient. Instead, Newton instructed the patient to see her personal physician. The patient left Newton by private vehicle and presented at the emergency department of another hospital where she was admitted and delivered a stillborn baby.

The settlement, effective March 17, 2015, resolves Newton's civil monetary penalties liability under EMTALA. The maximum penalty under EMTALA for a large hospital is $50,000. Senior Counsel Geeta Taylor and Associate Counsel David Fuchs represented OIG.
03-17-2015
Pennsylvania Staffing Agency Settles Case Involving Excluded Individual
On March 17, 2015, Flexible Staffing Solutions, Inc. d/b/a OneSource Medical Staffing (OneSource), a Wilkes-Barre, Pennsylvania, healthcare staffing agency, entered into a $24,775.56 settlement agreement with OIG. The settlement agreement resolves allegations that OneSource employed an individual who was excluded from participating in any Federal health care programs. The excluded individual provided items and services as a Licensed Practical Nurse (LPN) at nursing facilities that billed Federal health care programs. Senior Counsel Nicole Caucci represented OIG.
03-11-2015
New Jersey Pharmaceutical Company Settles Case Involving Misrepresenting Drug Pricing Data to Medicare
On March 11, 2015, Sandoz, Inc. (Sandoz), a New Jersey generic pharmaceutical manufacturer, entered into a $12,640,000 settlement agreement with OIG. The settlement agreement resolves allegations that Sandoz misrepresented drug pricing data to the Medicare program. Federal law requires drug makers to report both accurate and timely "Average Sales Price" information to the Centers for Medicare & Medicaid Services (CMS). CMS uses this information to set payment amounts for most drugs covered under Medicare Part B. Inaccurate pricing information can cause Medicare to overpay for these drugs. Senior Counsels Geeta W. Kaveti and Nicole Caucci represented OIG. News Release
02-27-2015
Texas Physician Agreed to Voluntary Exclusion
On February 27, 2015, in connection with the resolution of False Claims Act liability, a Texas physician and two companies he operated, a research firm and consulting business, 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's investigation revealed that the physician and his business received kickbacks in exchange for recommending or promoting the use of a surgical product. Senior Counsel Sandra Sands represented OIG.
02-25-2015
Denver Skilled Nursing Facility Settles CMP Case
A Denver, Colorado, skilled nursing facility that employed an individual who had been excluded from participation in all Federal health programs and provided items and services to residents who were Medicare and Medicaid beneficiaries has agreed to pay a civil monetary penalty of $242,434.92, the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services has announced. OIG's investigation revealed that the Denver North Care Center had employed an excluded nurse that provided items and services to Denver North Care Center patients that were paid for by Medicare and Medicaid. The effect of an OIG exclusion is that no payment may be made by any Federal health care program for any items or services furnished by an excluded individual. The settlement agreement, effective February 25, 2015, was entered into with both the OIG and the State of Colorado. Senior Counsels David M. Blank and Patrick Garcia, along with Paralegal Specialist Eula Taylor, represented OIG.
02-24-2015
Alabama Physician and Medical Practice Settles False and Fraudulent Medicare Claims Case
Stevenson Medical Center and Alan J. Wayne, M.D. (collectively, Stevenson), a Stevenson, Alabama physician and his practice that performed in-office urine drug testing, entered into a $225,000 Settlement Agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services effective February 24, 2015. The Agreement resolves allegations Stevenson submitted false or fraudulent claims to Medicare. Specifically, OIG contends Stevenson submitted claims to Medicare for high and low/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. The OIG also contends that Stevenson submitted claims for high complexity drug tests when it performed less-expensive low/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.
02-24-2015
California Pharmacy Settles False and Fraudulent Medicare Claims Case
On February 24, 2015, a Los Angeles, California pharmacy and its owner agreed to pay $1,342,295.50 to settle allegations by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services under the Civil Monetary Penalties Law. The agreement with OIG resolves allegations that Hyundai Drugs and its owner Sang Kim submitted claims to Medicare Part D for brand name prescription drugs that it could not have dispensed based on inventory records. The case was investigated as part of Operation Pharm Fury, a joint effort between OIG's Office of Investigations, Office of Evaluation and Inspections, and Office of Counsel to the Inspector General. Senior Counsel Tamara Forys represented OIG.
02-09-2015
Loxahatchee, Florida Hospital Settles EMTALA Case
On February 9, 2015, Palms West Hospital (Palms), a Loxahatchee, Florida hospital, agreed to pay a maximum penalty of $50,000 in a settlement agreement with OIG. The agreement resolves allegations that Palms refused to accept the transfer of a toddler who had ingested Drano. The mother of an 18-month old toddler brought her daughter to a hospital emergency department (ED) for ingestion of an unknown quantity of Drano. Poison control recommended that the toddler be treated by a pediatric gastroenterologist (GI), which that hospital did not have. The ED physician contacted the Hospital Corporation of America's Transfer Center (TC) to arrange a transfer of the patient. As protocols required, TC had a copy of Palms' on-call list. TC called Palms to confirm that pediatric GI services were available and to arrange for the transfer of the toddler. The ED physician at Palms accepted the transfer, but later rescinded the acceptance believing that she had made a mistake about on-call coverage. As a result, the toddler was transferred to another hospital. Palms, however, did have a pediatric GI available on call when the request was made to transfer the toddler. TC failed to check on the transfer request in a timely manner and learned of the refusal after the patient had been transferred to another facility. Senior Counsel Sandra Sands represented OIG.
02-06-2015
Arizona Behavioral and Developmental Services Provider Settles Case Involved Excluded Nurses
On February 6, 2015, Community Provider of Enrichment Services (CPES), a Tucson, Arizona, provider of adult day programs, adult residential services, and other behavioral and developmental services for behaviorally and mentally challenged adults and children, entered into a $250,000 settlement agreement with the OIG. The settlement agreement resolves allegations that CPES employed two individuals who were excluded from participating in any Federal health care programs. The excluded nurses provided items and services to CPES patients that were billed to Federal health care programs. Senior Counsel Nancy Brown and represented OIG, with the assistance of Paralegal Specialist Eula Taylor.
02-04-2015
Group Home in Arizona Settles Excluded Provider Case
A group home providing services to disabled individuals has settled with the HHS Office of the Inspector General allegations that it employed a nurse who has been excluded from participation in Federal health care programs and allowed that person to care for residents. The facility, Agape Homes, LLC, of Avondale, Arizona also offers day treatment services. Under federal law, a provider who has been excluded from federal health care programs can neither provide services to Medicare or Medicaid beneficiaries nor have those services paid for by Medicare or Medicaid. Agape agreed to pay $41,995.30 to settle these allegations. Senior Counsel Nancy W. Brown represented OIG.
01-30-2015
Alabama Hospital Settles Case Involving Excluded Individual
Affinity Medical Center, LLC, - a community hospital in Birmingham, Alabama that operates under the name Trinity Medical Center - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective December 15, 2014. The $111,969.11 settlement resolves the allegation that the hospital employed an individual who was excluded from participating in any Federal health care programs and then billed Federal health care programs for items and services provided by the excluded individual.

The excluded individual was identified through a data analysis project initiated by the OIG's Office of Evaluation and Inspections. OIG's Office Evaluation and Inspections and the Office of Counsel to the Inspector General, represented by Senior Counsel Kenneth D. Kraft, collaborated to reach this settlement.
01-23-2015
Ownership of Minnesota Pharmacy While Excluded Results in Settlement With OIG
Minnesota pharmacist Joseph C. Moon entered into a $96,259.57 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective January 20, 2015. The settlement resolves allegations that from March 10, 2006 to July 17, 2013, Moon owned and managed a pharmacy that participated in Federal health care programs while he was excluded from participating in these programs. Senior Counsel David M. Blank and Paralegal Specialist Mariel Filtz represented OIG.
01-20-2015
Georgia Physician Settles False and Fraudulent Medicare Claims Case
Dennis Conrad Harper, M.D. (Harper), a Georgia physician who overbilled for in-office urine drug testing, agreed to enter into a $305,168.54 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services effective January 20, 2015. The settlement resolves allegations Harper submitted false or fraudulent claims to Medicare. Specifically, OIG contends Harper 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. OIG also contends that he 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.
01-20-2015
Tristar Summit Medical Center in Tennessee Settles Patient Dumping Allegations
A hospital in Tennessee that allegedly transferred an unstable patient for insurance reasons will pay $40,000 in a settlement with the Office of the Inspector General (OIG) of the Department of Health and Human Services, it was announced today. Tristar Summit Medical Center in Hermitage, TN is settling allegations by the OIG that it broke the law when it transferred a patient that had come to its emergency department after consuming a bottle of antifreeze without first stabilizing the patient's medical condition. Emergency room personnel, it is alleged, determined the patient should be admitted to an intensive care unit and, despite the availability of a bed in the Tristar Summit ICU, the patient was sent elsewhere because the hospital did not accept the patient's insurance. The Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986—often referred to as the patient anti-dumping law—requires a hospital to stabilize a patient's emergency condition within its capabilities prior to transfer, and a hospital may not transfer an unstable patient unless the patient requests transfer or a physician certifies that the benefits of transfer outweigh the risks. Under EMTALA hospitals can be fined up to $50,000 per violation.

2014

12-29-2014
Atmore Community Hospital Settles EMTALA Case
A small hospital in Atmore, Alabama, settled claims that it refused to provide pain medication to a man who had been shot in the arm. The 65-year old man was sent to Atmore Community Hospital via ambulance to be air lifted to a hospital that was capable of treating his injury. However, it was too foggy for the helicopter to land, so the paramedics needed to drive him to the hospital, which was one hour away. The patient did not think he could make the trip without pain medication, so he requested pain relief for his severe pain - something Atmore had the capability to provide. As the paramedics unloaded the patient from the ambulance, Atmore's emergency department doctor and a nurse came out to the ambulance and refused to let the patient enter the hospital because they did not have a trauma surgeon on staff. Both the paramedic and the patient explained that the patient wanted pain relief for the long trip, but the doctor and nurse returned inside, with locked doors closing behind them.

The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services alleged this conduct violates the Emergency Medical Treatment & Labor Act, which requires hospitals to provide stabilizing treatment to patients with emergency medical conditions, including severe pain. On December 29, 2014, Atmore agreed to pay $25,000 - the maximum penalty for a small hospital - to resolve these allegations. Senior Counsel Sandra Sands represented OIG.
12-29-2014
Memorial Health Care System Settles EMTALA Case
A small hospital in Hixson, Tennessee, that failed to provide stabilizing treatment to an 18 year-old with severe pain and multiple broken bones, has settled allegations by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services that it violated the Emergency Medical Treatment & Labor Act. EMTALA requires hospitals to provide stabilizing treatment to anyone with an emergency medical condition. The patient came to the emergency room of Memorial North Park, one of Memorial Health Care System's satellite hospitals, with severe pain in his feet, ankles, and right shin after jumping from a twenty foot wall and landing on concrete. Although Memorial had an orthopedic surgeon on call, the emergency room staff did not consult with him nor did they provide treatment for the patient's pain or splint his legs before transferring him to the trauma center. The trauma center ultimately did not consider the patient a trauma case.

The hospital agreed to pay $20,000 in a settlement agreement with the OIG, effective December 29, 2014. Under EMTALA , the maximum penalty for hospitals with fewer than 100 beds is $25,000. Senior Counsel Sandra Sands represented OIG.
12-29-2014
Baptist Medical Center - Princeton Settles EMTALA Case
A Birmingham, Alabama, medical center that refused to accept the appropriate transfer of a 61-year-old woman, has agreed to settle allegations that it violated the Emergency Medical Treatment & Labor Act. EMTALA requires hospitals with specialized capabilities-in this case a neurosurgeon-to accept transfers of patients who require those services.

The patient, who was found to be unresponsive in her home, was initially taken to a facility that did not have the capability to treat her condition. The hospital diagnosed her with altered mental status caused by a change in brain function: she had a subdural hematoma and needed emergency surgery, which that hospital could not provide. When the ED physician called Baptist to make arrangements to transfer the patient to Baptist, Baptist transferred the call to its ED and the transferring physician was told that he needed to talk to the on-call neurosurgeon. The call was then forwarded to the Hospitalist, who repeated that he had to speak with the on-call neurosurgeon. The transferring ED physician was then connected to the neurosurgeon and explained the patient's condition. The neurosurgeon responded that it sounded like the patient was brain dead. The ED physician explained that she was not and that he had paralyzed her to intubate her for medical purposes. The neurosurgeon repeated that she sounded brain dead and refused the transfer. Before hanging up, the neurosurgeon said he would be willing to consult on the case, but not accept transfer of the patient to Baptist. The ED physician then transferred the patient to another hospital where she successfully underwent surgery and was released to a rehabilitation facility five days later. Baptist, after finding out about its refusal to accept this patient, ordered the neurosurgeon to call Baptist back and to accept the patient, which he did, but the patient had already been sent to another hospital.

Baptist, on December 29, 2014, agreed to pay $40,000 to resolve allegations of an EMTALA violation investigated by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services. The maximum penalty for violating the so-called "patient dumping" law is $50,000 for a large hospital. Senior Counsel Sandra Sands represented OIG.
12-29-2014
Caldwell Medical Center Settles EMTALA Case
Caldwell Medical Center, a small hospital in Princeton, Kentucky, has settled allegations that it failed to evaluate a patient's head pain or provide stabilizing treatment. A 72-year old woman lost consciousness and fell face-first onto a concrete floor. She regained consciousness about five hours later, called an ambulance, and was taken to Caldwell's Emergency Department (ED). She had bruising and abrasions on her nose, two black eyes and a skin tear on her right arm. She complained of severe pain in her face and head. Her abrasions and skin tear were cleaned and she was discharged home a little over one hour after she arrived in the ED. She did not receive any diagnostic tests, including a CAT Scan, and she received no treatment for her head pain.

The patient continued to have pain: she could not chew and she vomited blood. The next morning she called an ambulance again and returned to Caldwell's ED. This time she received an appropriate medical screening exam, which revealed multiple head fractures. She was then transferred to a hospital with neurosurgery capabilities and she underwent several surgeries and was discharged thirteen days later.

Caldwell agreed to pay $10,000 in a settlement with the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services effective December 29, 2014. Senior Counsel Sandra Sands represented OIG.
12-19-2014
Denver Hospital System Settles False Claims Allegations
Effective December 19, 2014, Denver Health and Hospital Authority entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services. The $51,803.86 settlement resolves allegations that Denver Health submitted claims to Medicare for services provided to individuals it knew, or should have known, were incarcerated or in custody. In most circumstances, Medicare does not pay for health care services for individuals who are incarcerated or in custody. Senior Counsels Tamara Forys and Geeta Taylor represented OIG.
12-18-2014
Hospice Owners Settle False and Fraudulent Medicare Claims Case
The current and former owners of Premier Hospice and Palliative Care, LLC and Premier Hospice & Palliative Care - Indiana, LLC jointly entered into a $2,674,895.79 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective December 18, 2014. The settlement resolves allegations that from October 1, 2009 to April 30, 2013, Premier submitted hospice claims to Medicare for patients whose health records indicated they were ineligible for such services. SP Management, Inc. and Jeff L. Smith owned the hospices when the alleged conduct began. They sold the hospices to Abode Healthcare, Inc. on December 31, 2012, and shortly after, Abode self-disclosed potential violations of the Civil Monetary Penalties Law to OIG. This settlement resolves allegations for all parties: SP Management, Jeff L. Smith, and Abode. Senior Counsel Tamara Forys represented OIG.
12-18-2014
A Medical Practice, Doctor in New York Settle False and Fraudulent Claims Case
Jennan Comprehensive Medical, P.C. (Jennan) - a medical group practice in New York - and its owner, Henry Chen, M.D., entered into a $694,887.02 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective December 18, 2014. The settlement resolves allegations that from May 15, 2008 to December 31, 2013, Jennan and Dr. Chen knowingly submitted or caused to be submitted false and/or fraudulent claims to Medicare for physical therapy services. Specifically, OIG alleged that these claims were false and/or fraudulent for one or more of the following reasons: 1) physical therapy services were not provided or supervised by the rendering provider; 2) group services were billed as one-on-one provider-patient physical therapy services; 3) services were performed by unqualified individuals; and/or 4) claims for time-based physical therapy services did not accurately reflect the actual time spent performing the services. Senior Counsels David M. Blank, Tamara T. Forys, and Lauren E. Marziani, along with Paralegal Specialist Mariel Filtz, represented OIG.

This case developed as a result of OIG's prior investigation of Joseph A. Raia, M.D., a former Jennan employee. Dr. Raia entered into a settlement with OIG on February 11, 2014 for $1.5 million and agreed to be excluded from participating in Federal health care program for a minimum of 15 years.
12-03-2014
Texas Otolaryngology Practice Settles False and Fraudulent Medicare and Medicaid Claims Case
Ear Nose and Throat Associates of Corpus Christi, LLC - a physician practice providing otolaryngology services in Corpus Christi, TX - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective December 3, 2014. The $200,630 settlement resolves allegations that for nearly three years the practice improperly submitted claims to Medicare and Texas Medicaid for hearing assessment services performed by unqualified technicians. Senior Counsel Ellen Slavin represented OIG.
11-26-2014
Ohio Chiropractor Agrees to Voluntary Exclusion
On November 26, 2014, an Ohio chiropractor 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's investigation revealed that the chiropractor billed Medicare for custom orthotics and related add-on codes when he actually provided standard equipment that was: (1) not billable to Medicare; (2) billed at a higher rate of reimbursement than appropriate; (3) provided to patients who were not eligible for such equipment; and (4) not medically necessary. OIG also alleged that the chiropractor inappropriately solicited potential clients at nursing homes, ordered equipment without proper clinical evaluations, ordered orthotics for both feet without medical necessity, advised patients that there would be not cost for the equipment, and any co-payments would be waived. Senior Counsel Geeta W. Kaveti represented OIG.
11-17-2014
South Carolina's Trident Health System Settles EMTALA Case Involving Patient Dumping Allegations
Effective November 17, 2014, Trident Health System (Trident) in South Carolina entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services to resolve claims that it failed to provide stabilizing treatment to a patient in one of its emergency rooms. Specifically, OIG alleged that on February 12, 2012, a 58-year-old male patient, who was incarcerated at the time, was transported by an Emergency Medical Services (EMS) ambulance to Moncks Corner Medical Center, a Trident facility. EMS contacted emergency room personnel to inform them of the patient's transport but, when the patient arrived at the emergency room, a nurse informed EMS personnel that the medical center could not treat the patient because Trident had a "no trespass" order on him. EMS then took the patient to a nearby hospital, and Trident never provided a medical screening examination of the patient. This $40,000 settlement resolves Trident's civil monetary penalties liability under the patient dumping statute.
10-30-2014
DCH Regional Medical Center Settles EMTALA Case
Effective October 30, 2014, DCH Regional Medical Center-a 583-bed hospital located in Tuscaloosa, Alabama-entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services to resolve its civil monetary penalties liability under the Emergency Medical Treatment and Labor Act (EMTALA). DCH paid $40,000 to settle allegations that it violated EMTALA by failing to conduct an appropriate medical screening examination and provide stabilizing treatment to a patient who came to the DCH emergency department with an emergency medical condition.

Specifically, the patient came to the DCH emergency department with a gunshot wound in his abdomen region. The emergency department physician determined that the on-call general surgeon needed to evaluate and treat the patient and the staff contacted the on-call general surgeon multiple times. The on-call general surgeon indicated that he was performing a previously scheduled elective surgery in the operating room. DCH's emergency department was unable to find another general surgeon to evaluate and provide stabilizing treatment to the patient. The on-call general surgeon then performed a second previously scheduled elective surgery in the operating room without first evaluating and providing stabilizing treatment to the patient in the emergency department. After waiting approximately two hours at DCH, the patient died, never having received an evaluation or stabilizing treatment from a general surgeon.
10-24-2014
Texas Company Settles Case Involving Excluded Individuals
Daybreak Venture, LLC, the general partner of 74 skilled nursing and long-term-care facilities throughout Texas, entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 24, 2014. The $357,341.96 settlement resolves allegations that seven facilities operated by Daybreak each employed an individual who was excluded from participating in any Federal health care programs. These facilities then billed Federal health care programs for items or services provided by the excluded individuals.

Five of the seven individuals were identified through a data analysis project initiated by the OIG's Office of Audit Services. During OIG's investigation, Daybreak identified two additional employees who were excluded as well. OIG's Office of Investigations, Office of Audit Services, and Office of Counsel to the Inspector General, represented by Senior Counsel Karen Glassman, collaborated to reach this settlement.
10-24-2014
New Jersey Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Rajan Shah - a Newark, NJ gastroenterologist - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 24, 2014. The $104,950.00 settlement resolves allegations that Dr. Shah received remuneration from Orange Community MRI, LLC, an imaging facility in Orange, NJ, in exchange for patient referrals. Senior Counsel David M. Blank and Lauren E. Marziani represented OIG in this case.
10-17-2014
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Jimmy Dung Doan - a Houston, TX family practice physician - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 17, 2014. The $50,000 settlement resolves allegations that Dr. Doan received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form services received under a Referral Coordinator contract. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Doan. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Dan Kelly Eidman - a Houston, TX orthopedic surgeon - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 17, 2014. The $50,000 settlement resolves allegations that Dr. Eidman received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of monthly payments made under a Medical Director contract. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Eidman. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
10-16-2014
Utah Skilled Nursing Facility Settles Case Involving Excluded Nursing Assistant
Manor Care of South Ogden UT, LLC d/b/a ManorCare Health Services - South Ogden (MCHS - South Ogden), a skilled nursing facility located in Utah, entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 16, 2014. The $41,129.76 settlement resolves allegations that MCHS - South Ogden employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a certified nursing assistant, provided items and services to MCHS - South Ogden patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci and Associate Counsel Kaitlyn L. Dunn represented OIG in this case.
10-02-2014
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Robert L. Burke - a Houston, TX orthopedic surgeon - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 2, 2014. The $99,000 settlement resolves allegations that Dr. Burke received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of money paid above a compensation rate negotiated in a Medical Director Agreement. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Burke. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
09-29-2014
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.
09-12-2014
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
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
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
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Thanh A. Nguyen - a Houston, TX urologist - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective September 9, 2014. The $60,000 settlement resolves allegations that Dr. Nguyen received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Nguyen. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
09-03-2014
Springfield Hospital (Springfield), Vermont, agreed to pay $50,000 resolve its liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that: (1) Springfield failed to provide stabilizing treatment to a patient with an emergency psychiatric condition before having him criminally charged and transferred to jail; and (2) Springfield failed to provide an appropriate medical screening examination to a second patient before having him criminally charged and sent to jail.
08-24-2014
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.
Florida Respiratory Therapist and His Sleep Clinic Agree to Voluntary Exclusion
On August 24, 2014, in connection with the resolution of False Claims Act liability, a Florida respiratory therapist and his sleep clinic agreed to be excluded from participating in Federal health care programs for a period of eight years under U.S.C. § 1320a-7(b)(7). OIG's revealed the respiratory therapist and his sleep clinic submitted claims for polysomnographic sleep studies and psychological testing that was not medically necessary, was not conducted by the appropriately licensed individuals, or was not actually performed. Senior Counsel Kristen Schwendinger represented OIG.
08-21-2014
Florida-based Distributor Enters Settlement Agreement with OIG on Kickback Allegations
Zimmer-Deptula, Inc. (ZDI) - a former Florida-based distributor for Zimmer, Inc. - entered into a $123,000 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective August 21, 2014. This settlement resolves allegations that ZDI violated the Civil Monetary Penalties Law by paying kickbacks. Specifically, OIG alleges that two ZDI independent contractors paid third parties to recommend Zimmer, Inc. products to Florida-based physicians. OIG contends that ZDI knowingly and willfully offered and paid the kickbacks to the third parties to induce them to recommend and arrange for the purchase of Zimmer, Inc. products which were paid for by Federal health care programs. Senior Counsel David M. Blank, Robert M. Penezic, and Lauren E. Marziani represented OIG in this case.
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.
08-11-2014
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Gary Stephen Hurwitz - a Houston, TX urologist - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective August 11, 2014. The $170,000 settlement resolves allegations that Dr. Hurwitz received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Hurwitz. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Dilipkumar Chotabhai Patel - a LaPorte, TX primary care doctor and internist - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective August 11, 2014. The $146,000 settlement resolves allegations that Dr. Patel received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Patel. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
08-11-2014
A Florida laboratory agreed to pay $50,000 to resolve its liability for violating the select agent regulations. OIG alleged that the laboratory violated the select agent regulations by: (1) its Responsible Official failing to ensure compliance with the Select Agent regulations; (2) failing to ensure an accurate and current inventory of each select agent in long term storage; and (3) failing to notify CDC and appropriate Federal, State, or local law enforcement agencies upon discovery of a missing select agent.
08-05-2014
Saint Joseph's Medical Center in New York Settles Case Involving a Patient Dumping Allegation
Effective August 5, 2014, Saint Joseph's Medical Center (SJMC), a 332 bed hospital located in Yonkers, NY, entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services. In the settlement agreement, SJMC agreed to pay $50,000 to resolve its civil monetary penalties liability under the patient dumping statute. Specifically, OIG alleged that SJMC violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide an appropriate medical screening examination to a patient that came to SJMC's emergency department with an emergency medical condition. Associate Counsel Patrick Garcia and Paralegal Specialist Mariel Filtz represented OIG in this matter.
08-05-2014
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
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
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
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.
07-11-2014
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
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.
06-26-2014
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Steven A. Fein - a Houston, TX gastroenterologist - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective June 26, 2014. The $118,944 settlement resolves allegations that Dr. Fein received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement and from the benefit of referral coordinator whose compensation was paid by Fairmont. OIG alleged that these financial arrangements took into account the value and volume of referrals made to Fairmont by Dr. Fein. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Jerry McShane - a Houston, TX occupational health specialist- entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective June 26, 2014. The $134,200 settlement resolves allegations that Dr. McShane received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement and from the benefit of a referral coordinator whose compensation was paid by Fairmont. OIG alleged that these financial arrangements took into account the value and volume of referrals made to Fairmont by Dr. McShane. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
06-20-2014
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.
06-09-2014
Winter Haven Hospital (Winter Haven), Florida, agreed to pay $75,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that Winter Haven: (1) failed to accept the transfer of two patients who needed specialized capabilities or facilities available at Winter Haven; and (2) failed to provide medical examination and treatment to a third patient as required to stabilize his condition, within the capabilities of the staff and facilities available at Winter Haven.
06-06-2014
Trinity Medical Center d/b/a Trinity Bettendorf (Trinity), Iowa, agreed to pay $40,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that Trinity failed to provide appropriate screening or stabilizing treatment for an individual who came to Trinity's emergency department with emergency medical and psychiatric conditions.
06-05-2014
Indiana Hospital Settles EMTALA Case Involving Allegations of Patient Dumping
Effective June 5, 2014, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services entered into a settlement agreement with St. Vincent Jennings Hospital (SVJH). SVJH agreed to pay $25,000 to resolve its liability for civil monetary penalties under the patient dumping statute. Specifically, OIG alleged that SVJH violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide an appropriate medical screening examination to a patient who arrived via ambulance to SVJH's emergency department with an emergency medical condition. OIG was represented in this matter by Associate Counsel Patrick Garcia and Eula Taylor.
06-05-2014
California Hospital Settles EMTALA Case Involving Patient Dumping Allegations
Olive View - UCLA Medical Center - a county hospital in Sylmar, CA - entered into a settlement agreement with the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, effective May 23, 2014. The $40,750 settlement resolves allegations that Olive View violated the Emergency Medical Treatment and Labor Act, (EMTALA), by failing to provide an individual with an appropriate medical screening examination (MSE) within the capability of the hospital's emergency department in order to determine whether he had an emergency medical condition.

Specifically, the individual presented to the Olive View emergency department with signs of appendicitis and severe abdominal pain that he rated at a 10 on a 10-point scale. Despite his severe pain and symptoms, he was forced to wait for several hours to receive an MSE. After waiting for 6.5 hours, he left to seek medical screening and treatment at another hospital, where he was diagnosed with acute appendicitis with a large peritoneal abscess and had to undergo an immediate laparoscopic appendectomy. According to EMTALA, if an individual comes to a hospital emergency department and a request is made on his/her behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate MSE within the capability of the emergency department to determine whether or not an emergency medical condition exists. OIG was represented by Associate Counsel Odies Williams, IV. Olive View was represented by Brandi M. Moore of the Los Angeles County Counsel's Office.
06-04-2014
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
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.
05-21-2014
New Jersey Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Ansar Sharif, M.D. - former owner of a Kearny, NJ, medical practice - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective May 20, 2014. The $52,280 settlement resolves allegations that Sharif received kickbacks from Orange Community MRI, LLC, a diagnostic testing facility, in exchange for patient referrals.

To date, the United States Attorney's Office for the District of New Jersey convicted 17 defendants - including 15 physicians - in connection with the government's ongoing investigation of illegal payments made by Orange MRI. The investigation by OIG's Office of Investigations indicated that Sharif received money from Orange MRI for patient referrals. This case marks the first Civil Monetary Penalty Law resolution stemming from the government's investigation of Orange MRI. OIG was represented by Senior Counsel David M. Blank and Lauren E. Marziani. Sharif was represented by Carmine Campanile.
05-15-2014
Mercy Hospital in Miami, FL Settles EMTALA Case
Mercy Hospital - a campus of Plantation General Hospital in Miami, FL - agreed to pay $45,000 to resolve allegations that it failed to provide appropriate medical screening for a 24-day-old baby brought to the hospital's Emergency Department for an emergency medical condition, including persistent low body temperature. The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services alleged that Mercy Hospital violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide adequate evaluation and treatment because it did not address the newborn's low temperature nor did it order any further laboratory tests, such as a blood count, blood chemistry lab, or urinalysis, before telling the parents to take the baby home. Minutes after leaving the hospital, the baby suffered cardiac arrest, kidney injury and potential injury to the brain from lack of oxygen because of an issue with the bowel, known as necrotic bowel. OIG contends that EMTALA is intended to protect vulnerable patients such as newborn babies who cannot articulate their own needs, and medical professionals must consider appropriate diagnostic techniques and adequately listen to family members presenting the baby's chief symptoms.
04-25-2014
Harper's Hospice Care, Inc. (Harper's Hospice), Mississippi, agreed to pay $150,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Harper's Hospice paid remuneration to a physician in the form of medical directorship fees. Specifically, the OIG contends that Harper's Hospice paid the remuneration to the physician in exchange for the physician referring patients to Harper's Hospice for hospice services and pre-singing blank prescription forms for patients treated by Harper's Hospice.
04-25-2014
An Arizona research university agreed to pay $165,000.00 to resolve its liability for violating the select agent regulations by failing to: (1) maintain current and accurate inventory records regarding certain select agents; (2) implement biosafety and containment procedures commensurate with the risks associated with the select agents and toxins in its possession; and (3) failed to ensure compliance with the requirement of 42 C.F.R. Part 73.
04-24-2014
Texas Doctor Agrees to Voluntary Exclusion with OIG on Kickback Allegations
A family practice physician in Houston, TX, agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7a(a)(7), 1320a-7(b)(6)(B) and 1320a-7(b)(7). OIG alleged that the physician received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by the physician. OIG further alleged that the physician admitted to the Texas Medical Board that his medical practice fell below the standard of care in the treatment of eight patients and that he provided controlled substances to the patients without appropriate treatment plans or documentation.
04-15-2014
Gregory Bohn, M.D., Iowa, agreed to pay $35,000 to resolve his liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that Dr. Bohn, the on-call surgeon at Trinity Bettendorf, refused to examine or treat a patient who had an emergency medical condition that required surgery.
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.
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.
03-04-2014
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.
02-21-2014
OIG Issues Case and Desist Letter to CarePoint Medical
On February 21, 2014, OIG notified CarePoint Medical (CarePoint) that CarePoint's unauthorized and inappropriate use of the word "Medicare" and other misleading language in its mailings to beneficiaries was potentially in violation of section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and Departmental emblems. Before OIG initiated litigation, CarePoint agreed to: (1) discontinue using the word "Medicare" or other language in a manner that implies that CarePoint has an association or affiliation with the Medicare program, the Centers for Medicare and Medicaid Services or the United States Department of Health and Human Services; and (2) include in all future mailings promoting CarePoint's products and services a prominent disclaimer that states that neither CarePoint nor its activities are connected with, approved, endorsed, or authorized by the United States Department of Health and Human Services.
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.
02-14-2014
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.
02-11-2014
Physician Agrees to $1.5 Million Payment and 15-Year Exclusion To Settle Civil Monetary Penalty Case
Joseph A. Raia, MD, 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 Dr. Raia had improperly used chiropractors to provide physical therapy services "incident to" his professional services. Further, OIG alleged that Dr. Raia 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. News Release
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.
02-07-2014
Claiborne County Medical Center (CCMC), Mississippi, agreed to pay $25,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that CCMC failed to provide an adequate medical screening examination to a patient who presented to its emergency department.
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.
01-06-2014
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Amir Ghebranious - a Houston, TX family practice physician - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective January 6, 2014. The $195,016 settlement resolves allegations that Dr. Ghebranious received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement and from the benefit of a referral coordinator whose compensation was paid by Fairmont. OIG alleged that these financial arrangements took into account the value and volume of referrals made to Fairmont by Dr. Ghebranious. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Mary Campbell-Fox - a Houston, TX family practice physician - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective January 6, 2014. The $195,016 settlement resolves allegations that Dr. Campbell-Fox received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement and from the benefit of a referral coordinator whose compensation was paid by Fairmont. OIG alleged that these financial arrangements took into account the value and volume of referrals made to Fairmont by Dr. Campbell-Fox. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.

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
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.
12-15-2013
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
A physician assistant (PA) 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 PA knowingly and willfully received illegal remuneration in exchange for referring patients for the furnishing of items or services for which payment may be made in whole or in part under a Federal health care program. OIG further alleged that the PA referred patients to health care entities for physical therapy and home health care services in exchange for illegal kickbacks in violation of the Anti-Kickback Statute.
12-04-2013
Carolinas Medical Center (Carolinas), North Carolina, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that Carolinas failed to provide an appropriate medical screening examination or stabilizing treatment to a patient that needed psychiatric treatment.
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.
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.
11-13-2013
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.
10-25-2013
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.
10-21-2013
In connection with the resolution of False Claims Act liability, two owners of a durable medical equipment company 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 owners, through their company, entered into contracts with marketing companies whereby, in violation of the Anti-Kickback Statute, the company paid for referrals from marketing companies when Medicare beneficiaries ordered diabetic supplies.
10-18-2013
Regional Medical Center at Memphis (RMC), Tennessee, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that RMC failed to provide a medical screening examination to a patient who was refused access to the emergency department and told to go instead to a nearby hospital.
10-17-2013
Henry Schein, Inc. (Henry Schein), New York, agreed to pay $1,140,260 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Henry Schein offered and paid remuneration to customers that are members of its Henry Schein Medical Privileges Program in the form of points redeemable for products and services, which do not qualify as "discounts" or "rebates" under the anti-kickback statute.
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.
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.
09-06-2013
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.
09-03-2013
Northeast Georgia Medical Center (Northeast), Georgia, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Northeast refused to accept an appropriate transfer of a patient who required Northeast's specialized capabilities.
08-28-2013
Texas Doctor and Medical Practice Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Victor Van Phan - a Houston, TX orthopedist, and his orthopedic practice Victor Van Phan, D.O., P.A. - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective August 28, 2013. The $188,000 settlement resolves allegations that Dr. Van Phan and his practice received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from personal services agreements and employment compensation for Dr. Phan to serve as a Medical Director for Fairmont. OIG alleged that these financial arrangements took into account the value and volume of referrals made to Fairmont by Dr. Van Phan and his practice. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
08-15-2013
The Finley Hospital (Finley), Iowa, agreed to pay $30,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Finley violated the requirements of the patient dumping statute when it delayed the provision of stabilizing treatment to a patient when it transferred him to another facility based in part upon his status as an IowaCare patient.
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.
St. Luke's Hospital (St. Luke's), Iowa, agreed to pay $25,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that St. Luke's violated the requirements of the patient dumping statute when it failed to provide an appropriate medical screening examination by transferring the patient to another facility based in part upon his status as an IowaCare patient.
07-26-2013
Bravo Health Pennsylvania, Inc. (Bravo), Pennsylvania, agreed to pay $225,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bravo provided medical records to the OIG's Office of Audit Services (OAS) in connection with an OAS audit that were intentionally altered prior to their submission or resubmission.
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.
07-24-2013
Mahaska Health Partnership (Mahaska), Iowa, agreed to pay $20,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Mahaska failed to provide appropriate medical screening, stabilizing treatment, or an appropriate transfer for an individual who presented to Mahaska with a serious emergency medical condition.
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.
07-15-2013
East Texas Medical Center Carthage (ETMC Carthage), Texas, agreed to pay $20,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that ETMC Carthage violated the requirements of the patient dumping statute when it failed to provide an adequate medical screening examination to a patient who was 24 weeks pregnant. The patient presented to ETMC Carthage with complaints of uterine contractions and abdominal pain. The patient was told to seek care in Henderson Texas because ETMC Carthage did not have obstetrical (OB) service and did not have an OB doctor on staff. The patient then left ETMC Carthage by private vehicle.
07-01-2013
Mercy Hospital of Franciscan Sisters (Mercy), Iowa, agreed to pay $20,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Mercy violated the requirements of the patient dumping statute when it failed to provide an adequate medical screening examination, stabilizing treatment, or an appropriate transfer for a patient who presented to Mercy's emergency department after ingesting window de-icer, a product containing the toxin methanol.
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.
06-21-2013
In connection with the resolution of False Claims Act liability, a physical rehabilitation and pain management clinic (clinic) agreed to be excluded from participating in Federal health care programs for twenty years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the clinic: (1) submitted claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care services that were referred to companies that were owned or operated by the clinic's owner in exchange for illegal remuneration and/or kickbacks and (2) submitted claims to Medicare and Medicaid using medical billing codes that reflected more complex and expensive services than the services that were actually rendered to patients.
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.
06-13-2013
A former pharmaceutical sales representative and sales manager for Sanofi, agreed to be excluded from participating in Federal health care programs for five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the sales representative provided samples of the viscosupplement Hyalgan to physicians with the expectation that the physicians would bill Medicare for the samples. OIG further alleged that the sales representative provided an agreed number of samples with each order of a specified size, that these off-the-books discounts constituted remuneration under the Anti-Kickback statute (42 U.S.C. § 1320a-7b(b)(2)), and that these alleged kickbacks were provided for the purpose of assuring the physicians' continued use of the product.
05-29-2013
OIG Issues Cease and Desist Letter to MedicareWire.com
On May 29, 2013, OIG notified MedicareWire.com (MedicareWire) that MedicareWire was potentially in violation of section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and Departmental emblems. Specifically, MedicareWire inappropriately, and without authorization, used words and symbols belonging to the United States Department of Health and Human Services, and used other misleading language on MedicareWire's "Medicare" webpage located at http://medicarenursing.com (may or may not be functional). Before OIG initiated litigation, MedicareWire agreed to: (1) remove the inappropriate words and symbols from its website; (2) add header and footer disclaimers to its website; and (3) refrain from using any words or names in reference to Social Security or Medicare in a manner that might convey the false impression that MedicareWire or its programs and services are approved, endorsed, connected to or authorized by Medicare, Medicaid, Social Security or the United States Department of Health and Human Services.
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.
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.
05-02-2013
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.
Emory University Hospital (Emory), Georgia, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Emory refused to accept appropriate transfer of a patient who required Emory's specialized capabilities.
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.
04-04-2013
Donalsonville Hospital, Inc. (Donalsonville), Georgia, agreed to pay $25,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Donalsonville failed to provide an adequate medical screening examination to a patient who presented to their emergency department complaining of shortness of breath and chest pain. The patient did not receive any medical examination from a physician and was told he was required to pay a minimum fee of $100 to continue further treatment. The patient chose not to pay the fee and was discharged without receiving an appropriate medical screening examination. The delay in the provision of an appropriate medical screening examination and the imposition of a minimum fee to receive an appropriate medical screening examination were inappropriate.
04-03-2013
Paul Lux, M.D., Missouri, agreed to pay $63,900 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Dr. Lux received remuneration from a medical device manufacturer in the form of payments made under a clinical registry contract.
03-07-2013
OIG Issues Cease and Desist Letter to Policy Issues Institute
On March 7, 2013, OIG notified Policy Issues Institute (PII) that PII's unauthorized and inappropriate use of the word "Medicare" in its "Emergency Committee to Save Medicare" mailings was potentially in violation of section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and Departmental emblems. Before OIG initiated litigation, PII agreed to: (1) discontinue sending the "Emergency Committee to Save Medicare" mailing; and (2) refrain from using any words or names in reference to Social Security or Medicare in a manner that might convey the false impression that PII or its programs and services are approved, endorsed, connected to or authorized by Medicare, Medicaid, Social Security or the United States Department of Health and Human Services.
OIG issues Cease and Desist Letter to The National Center for Public Policy Research
On March 7, 2013, OIG notified The National Center for Public Policy Research (NCPPR) that NCPPR was potentially in violation of section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and Departmental emblems. Specifically, NCPPR inappropriately, and without authorization, used the words "Medicare", "Medicaid", "Social Security", and "Health and Human Services" and other misleading language in its Health Care Reform Task Force mailings to Medicare beneficiaries. Before OIG initiated litigation, NCPPR agreed to: (1) cease mailing the Health Care Reform Task Force letter; and (2) refrain from using any words or names in reference to Social Security or Medicare in a manner that might convey the false impression that NCPPR or its programs and services are approved, endorsed, connected to or authorized by Medicare, Medicaid, Social Security or the United States Department of Health and Human Services.
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.
02-25-2013
Edward Desser (Desser), a Florida resident, agreed to pay OIG $120,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that Desser owned and operated International Orthopedic Solutions (IOS), an orthopedic medical device distributorship that sold Ortho Development Corporation products, and ECM Solutions, LLC (ECM), a medical consulting/business development company. OIG alleged that Desser, by and through ECM, received remuneration from for the purpose of recommending the ordering of Zimmer, Inc. (Zimmer), orthopedic products by a Florida-based physician. OIG also alleged that Desser paid remuneration to two individuals to induce them to recommend the purchasing of medical devices by Florida orthopedic surgeons. OIG contends that Desser knowingly and willfully solicited and received the remuneration described above to induce a person(s) to order Zimmer orthopedic products for which payment was made by Federal health care programs. OIG also contends that Desser knowingly and willfully offered and paid remuneration to two individuals to induce them to recommend the ordering of orthopedic products for which payment may have been made by Federal health care programs.
02-22-2013
Sacred Heart Hospital (SHH), IL, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that SHH failed to provide a medical screening examination for a 63-year old woman who presented to the emergency department and was not breathing. SHH provided no screening and called the Chicago Fire Department who transferred her to another hospital where she was pronounced dead.
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.
01-28-2013
Holmes Regional Medical Center (HRMC), FL, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that HRMC failed to provide a medical screening examination and to adequately stabilize a 30-year old pregnant woman who presented to their emergency department experiencing chest pains, in potential cardiac arrest, and became unresponsive. Both the patient and her baby died.
01-09-2013
Heritage Medical Partners, LLC, Thomas Lenns, M.D., Paul Long, M.D., Michael Mayes, M.D., and William Petty II, M.D. (collectively Heritage), South Carolina, agreed to pay $170,260 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Heritage knowingly presented or caused to be presented to Medicare beneficiaries requests for payment that were in violation of an assignment agreement.

Related Information

CMP Navigation