Civil Monetary Penalties and Affirmative Exclusions
The Office of Inspector General (OIG) has the authority to seek civil monetary penalties (CMPs), assessments, and exclusion against an individual or entity based on a wide variety of prohibited conduct. In each CMP case resolved through a settlement agreement, the settling party has contested the OIG's allegations and denied any liability. No CMP judgment or finding of liability has been made against the settling party.
OIG Enforcement Cases
The cases listed below represent recently-closed cases initiated by the OIG's Office of Counsel to the Inspector General. To view additional cases, including those resolved through the provider self-disclosure protocol, click on the specific categories to the right.
- 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.
