Provider Self-Disclosure Settlements

Information on the Provider Self-Disclosure Protocol can be found on the Provider Self-Disclosure Protocol page.

2020

12-30-2020 University Medical Associates of The Medical University of South Carolina Agreed to Pay $81,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Upcoded Anesthesiology Services: After it self-disclosed conduct to OIG, University Medical Associates of The Medical University of South Carolina (UMSC), South Carolina, agreed to pay $81,861.43 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UMSC submitted claims for anesthesia services performed by a certified registered nurse anesthetist claiming medical "direction" by anesthesiologists when the services rendered should have been billed under medical "supervision," a lower paying service.
12-21-2020 Palomar Health Agreed to Pay $3 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Therapy Services that Lacked Medical Necessity: After it self-disclosed conduct to OIG, Palomar Health, California, agreed to pay $3,084,315.48 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Palomar Health submitted claims to Federal health care programs through its Intensive Outpatient Psychiatric program for outpatient therapy services that lacked medical necessity and were not supported by the medical records.
St. Joseph's Hospital Agreed to Pay $729,000 for Allegedly Violating the Civil Monetary Penalties Law by Paying Remuneration in the Form of Free or Below Market Value Space, Equipment, and Services: After it self-disclosed conduct to OIG, Carondelet Health Network d/b/a St. Joseph's Hospital (St. Joseph's), Arizona, agreed to pay $729,629.82 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to physician self-referrals and kickbacks. OIG alleged that St. Joseph's paid remuneration to five physicians in the form of free or below market value space, equipment, and services.
Sweetwater Hospital Association Agreed to Pay $141,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services that Misidentified the Rendering Providers: After it self-disclosed conduct to OIG, Sweetwater Hospital Association (Sweetwater), Tennessee, agreed to pay $141,444.60 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Sweetwater, through Sweetwater Hospital Association - ER Group, submitted claims to Federal health care programs under a physician's name instead of a mid-level provider (physician's assistant or nurse practitioner) when the physicians did not meet the criteria to bill under the physician's names.
12-16-2020 Suncoast Dermatology and Skin Surgery Center, Dr. Ralph Massullo, Jr., and Dr. William Welton III Agreed to Pay $2.3 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting False Claims Associated with Lesions: After they self-disclosed conduct to OIG, Suncoast Dermatology and Skin Surgery Center, P.A., Dr. Ralph Massullo, Jr., M.D., and Dr. William Welton III, M.D. (collectively "Suncoast"), Florida, agreed to pay $2,320,118.88 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Suncoast's shareholder employee falsified patient records and examination findings, including falsified size and type of excised lesions (e.g., benign or malignant), misclassified lesions in size and type leading to unnecessary follow-up procedures on the lesions in which sizes were grossly overstated, and upcoded procedures. Consequently, Suncoast submitted claims for payment to Federal health care programs based on these falsified patient records and examination findings.
Trevose Ambulatory Surgery Care Agreed to Pay $88,000 for Allegedly Violating the Civil Monetary Penalties Law by Paying Remuneration in the Form of Free or Below Fair Market Value Leased Space: After it self-disclosed conduct to OIG, Trevose Ambulatory Surgery Care (Trevose ASC), Pennsylvania, agreed to pay $88,328.58 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that Trevose ASC paid remuneration to a professional corporation in the form of leased space that was free or below fair market value.
12-10-2020 Maple Knoll Communities Agreed to Pay $29,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services by an Unlicensed Nurse: After it self-disclosed conduct to OIG, Maple Knoll Communities, Inc. (Maple Knoll), Ohio, agreed to pay $29,372.58 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Maple Knoll employed an unlicensed individual to provide nursing services that were paid for by Federal health care programs.
11-08-2020 Avantara Evergreen Park, Grove of Berwyn, and Grove of LaGrange Agreed to Pay $10,000 f or Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual: After they self-disclosed conduct to OIG, Avantara Evergreen Park, Grove of Berwyn, and Grove of LaGrange (collectively, "Avantara, Berwyn, and LaGrange"), Illinois, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Avantara, Berwyn, and LaGrange employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
11-06-2020 Southern Maryland Medical Group Agreed to Pay $198,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Automatic Nervous System Testing That Were Not Medically Necessary: After it self-disclosed conduct to OIG, Southern Maryland Medical Group, LLC (SMMG), Maryland, agreed to pay $198,396.83 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SMMG submitted claims to Medicare for automatic nervous system testing that were not medically necessary.
10-27-2020 Kroger Agreed to Pay $346,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Prescriptions Filled by Unlicensed Pharmacists and Paying Remuneration in the Form of Price Reductions on Prescriptions: After they self-disclosed conduct to OIG, The Kroger Co., Kroger Limited Partnership I, Fred Meyer Stores, Inc., Kroger Texas, L.P., and Dillon Companies, LLC (collectively, "Kroger"), headquartered in Ohio, agreed to pay $346,558.94 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Kroger: (1) paid remuneration to physicians their family members in the form of price reductions on prescription drugs that these individuals filled at Kroger pharmacies and paid for with cash; (2) paid remuneration to non-physician healthcare practitioners in the form of price reductions on prescription drugs that these individuals filled at Kroger pharmacies and paid for with cash; and (3) submitted false claims to Federal health care programs for prescriptions filled by pharmacists who were unlicensed.
Ingalls Memorial Hospital Agreed to Pay $10,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual: After it self-disclosed conduct to OIG, Ingalls Memorial Hospital (Ingalls), Illinois, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Ingalls employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-20-2020 Saint Peter's University Hospital and New Brunswick Cardiac Cath Lab Agreed to Pay $3 Million for Allegedly Violating the Civil Monetary Penalties Law by Paying Remuneration in the Form of Lease Payments Made on a Per-Procedure Basis: After they self-disclosed conduct to OIG, Saint Peter's University Hospital (Saint Peter's) and New Brunswick Cardiac Cath Lab, LLC (NBCC), New Jersey, agreed to pay $3,040,205.37 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Saint Peter's paid remuneration to NBCC in the form of lease payments made on a per-procedure basis, from which NBCC paid its physician investors.
10-13-2020 Nashoba Valley Medical Center Agreed to Pay $1.4 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Inpatient Psychiatry Services Without Proper Certifications and Treatment Plans: After it self-disclosed conduct to OIG, Nashoba Valley Medical Center (Nashoba), a Steward Family Hospital, Inc., Massachusetts, agreed to pay $1,424,884.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Nashoba failed to maintain physician certifications, recertifications, and treatment plans for inpatient psychiatry services in violation of Medicare billing requirements. Nashoba retained a third-party contractor who was responsible for managing Nashoba's inpatient psychiatric unit including maintaining proper medical records for the patients in the unit.
Steward Holy Family Hospital Agreed to Pay $6.9 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Inpatient Psychiatry Services Without Proper Certifications and Treatment Plans: After it self-disclosed conduct to OIG, Steward Holy Family Hospital, Inc. (Steward), Massachusetts, agreed to pay $6,952,847 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Steward failed to maintain physician certifications, recertifications, and treatment plans for inpatient psychiatry services in violation of Medicare billing requirements. Steward retained a third-party contractor who was responsible for managing Steward's inpatient psychiatric unit including maintaining proper medical records for the patients in the unit.
10-05-2020 OSF Little Company of Mary Medical Center Agreed to Pay $271,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual: After it self-disclosed conduct to OIG, OSF Healthcare System d/b/a OSF Little Company of Mary Medical Center (Little Company of Mary), Illinois, agreed to pay $271,010.42 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Little Company of Mary employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-02-2020 RehabCare Agreed to Pay $266,000 for Allegedly Violating the Civil Monetary Penalties Law by Paying Remuneration in the Form of Free Wellness Classes: After it self-disclosed conduct to OIG, RehabCare Group, LLC (RehabCare), Kentucky, agreed to pay $266,760 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that RehabCare paid remuneration to an assisted living facility in the form of free wellness classes in exchange for being the exclusive provider of on-site therapy services for the assisted living facility.
09-14-2020: Evergreen Home Healthcare Agreed to Pay $36,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Home Health Services that Were Not Rendered After it self-disclosed conduct to OIG, Evergreen Home Healthcare, LLC (Evergreen), Colorado, agreed to pay $36,105.44 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Evergreen submitted claims for reimbursement to the Colorado Medicaid program for home health services furnished by one of its employed certified nursing assistants, to her minor child, that were not rendered.
08-19-2020: After they self-disclosed conduct to OIG, St. Vincent Hospital (SVH) and MetroWest Medical Center (MetroWest), Massachusetts, agreed to pay $41,495.36 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SVH and MetroWest, through a contractor, employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
08-11-2020: After it self-disclosed conduct to OIG, VHS San Antonio Partners, LLC, d/b/a St. Luke's Baptist Hospital (St. Luke's), Texas, agreed to pay $232,200 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that St. Luke's paid remuneration to two physicians in the form of a disproportionate amount of compensated orthopedic surgery emergency on-call coverage.; After they self-disclosed conduct to OIG, Providence Health & Services-Oregon, Providence Portland Medical Center (PPMC) and Providence Office Park (POP), Oregon, agreed to pay $217,732.53 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PPMC and POP employed an individual that they knew or should have known was excluded from participation in Federal health care programs.; After they self-disclosed conduct to OIG, Providence Health & Services-Oregon, Providence Health Assurance (PHA) and Providence Health Plan (PHP), Oregon, agreed to pay $201,477 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PHA and PHP employed an individual that they knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Providence Health & Services-Oregon d/b/a Providence Medical Group (PMG), Oregon, agreed to pay $108,655.44 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PMG employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-04-2020: After it self-disclosed conduct to OIG, Roundup Memorial Healthcare (RMH), Montana, agreed to pay $62,524 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that RMH employed an individual who was excluded from participation in the State of Montana's Medicaid program. OIG further contended that the individual's Medicare enrollment was revoked and that no Medicare payments could be made for items or services furnished by the individual.
08-03-2020: After it self-disclosed conduct to OIG, American Medical Center, LLC (AMC), Guam, agreed to pay $21,182 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AMC submitted claims that misidentified the provider of the claims in order to obscure the fact that the rendering provider was not certified as a Medicare provider.
07-23-2020: After it self-disclosed conduct to OIG, MHC Healthcare d/b/a Marana Health Center (Marana), Arizona, agreed to pay $47,610.92 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Marana employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-17-2020: After it self-disclosed conduct to OIG, Medical Faculty Associates d/b/a GW Medical Faculty Associates (GW Medical Faculty), Washington, D.C., agreed to pay $14,899.20 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-07-2020: After it self-disclosed conduct to OIG, 6932 W. Sunrise Boulevard Operations, LLC d/b/a NSpire Healthcare Plantation (NSpire), Florida, agreed to pay $51,252.71 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NSpire employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-29-2020: After it self-disclosed conduct to OIG, St. Mary's Passaic, LLC d/b/a St. Mary's General Hospital (St. Mary's), New Jersey, agreed to pay $32,192.43 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. Mary's employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-22-2020: After it self-disclosed conduct to OIG, Green County Human Services (GCHS), Wisconsin, agreed to pay $128,797.89 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that GCHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-12-2020: After it self-disclosed conduct to OIG, St. Vincent's Medical Center, Inc. d/b/a St. Vincent's Medical Center - Riverside (St. Vincent's Riverside), Florida, agreed to pay $63,420.92 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that St. Vincent's Riverside paid remuneration to an independent oncology practice in the form of diagnostic testing services to the oncology practice's patients under a research study arrangement, for which St. Vincent's Riverside did not invoice the oncology practice, bill third-party payors, or otherwise seek payment for the diagnostic testing services.
06-09-2020: After it self-disclosed conduct to OIG, Providence Health System-Southern California (PHSSC), California, agreed to pay $362,342.73 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PHSSC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Providence Health System-Southern California d/b/a Providence Little Company of Mary (Little Company of Mary), California, agreed to pay $141,562.02 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Little Company of Mary employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, St. Joseph Health Personal Care Services d/b/a Nurse Next Door (Nurse Next Door), California, agreed to pay $32,244.15 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Nurse Next Door employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Memorial Hospital Association, d/b/a Beartooth Billings Clinic (Beartooth Billings), Montana, agreed to pay $13,110.10 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Beartooth Billings submitted claims to Medicare and Medicaid for Intensive Behavioral Therapy for Obesity provided by a dietician at the full physician rate as "incident to" the services of a physician, when the services did not satisfy certain "incident to" billing requirements.
05-27-2020: After it self-disclosed conduct to OIG, the City of Beaver Dam, et al. d/b/a Beaver Dam Fire Department (Beaver Dam), Wisconsin, agreed to pay $29,935.10 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Beaver Dam submitted claims for ambulance transportation services provided by an improperly licensed paramedic.
05-21-2020: After they self-disclosed conduct to OIG, Lubbock County Hospital District d/b/a UMC Health System and d/b/a University Medical Center (UMC) and UMC Physicians, Texas, agreed to pay $437,950.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that UMC Physicians paid remuneration to a physician in the form of excess compensation for neurosurgery services. Additionally, OIG contended that UMC paid remuneration to UMC Physicians in the form of excessive compensation for neurosurgery services performed by the physician.
05-19-2020: After they self-disclosed conduct to OIG, Bluestone Physician Services Florida, LLC, and Bluestone National, LLC (collectively, "Bluestone"), Florida, agreed to pay $31,021.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bluestone submitted false or fraudulent claims to Medicare. Specifically, Bluestone became aware that a member of its nursing professional staff had submitted false claims to Medicare consisting of claims for patients who had, in fact, not been seen as documented, and claims not supported by the underlying documentation.
05-18-2020: After it self-disclosed conduct to OIG, NOVA Southeastern University Health Care Centers (NOVA), Florida, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NOVA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-12-2020: After it self-disclosed conduct to OIG, Infusion4Health, Inc. (Infusion), California, agreed to pay $245,366.03 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that: (1) Infusion submitted claims for evaluation and management services and non-chemotherapy therapeutic and diagnostic injection, intravenous fluid infusion for hydration, and infusion services provided by its employed nurse practitioners as if a physician had provided them, when the physician did not provide the appropriate level of supervision of the nurse practitioners when they provided the services; and (2) Infusion employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-06-2020: After it self-disclosed conduct to OIG, New Century Hospice of Richmond, LLC d/b/a New Century Hospice-Farmville (New Century), Virginia, agreed to pay $27,408.47 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that New Century submitted claims to Medicare and Virginia Medicaid for home health services that included services provided by an individual that did not meet the Medicare requirements for a qualified social worker.; After it self-disclosed conduct to OIG, Centerstone of Kentucky, Inc. (Centerstone), Kentucky, agreed to pay $10,551.53 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Centerstone employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-30-2020: After it self-disclosed conduct to OIG, Morehouse Community Medical Centers, Inc. (MCMC), Louisiana, agreed to pay $102,245.46 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MCMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-24-2020: After it self-disclosed conduct to OIG, the City and Borough of Sitka, formerly doing business as Sitka Community Hospital, a Department of the City and Borough of Sitka (Sitka), Alaska, agreed to pay $4,125,552 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that Sitka paid remuneration to providers in the form of (1) excessive compensation under Emergency Department call coverage arrangements; and (2) excessive compensation under advance practice providers arrangements.
04-22-2020: After it self-disclosed conduct to OIG, St. Vincent's Medical Center (St. Vincent's), Connecticut, agreed to pay $747,973.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that St. Vincent's paid remuneration to certain physicians under advance practice provider staffing arrangements in the form of providing clinical staff without cost, or at reduced cost, to the physicians to assist them in treating inpatients at the hospital St. Vincent's formerly owned and operated until October 1, 2019.
04-20-2020: After it self-disclosed conduct to OIG, Triangle Health Alliance, LLC (Triangle), Maryland, agreed to pay $177,864 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that Triangle: (1) provided a surgery practice pre-authorization services for surgical procedures that were inconsistent with the terms of its contractual arrangement and below fair market value; (2) provided a family practice diagnosis and current procedural terminology coding services for professional claims that were inconsistent with the terms of its contractual arrangement and below fair market value; (3) provided a family practice free diagnosis and coding services for claims related to the practice's services to a skilled nursing facility; and (4) provided a primary care provider free diagnosis coding services for claims related to the provider's referrals to a hospital.
04-06-2020: After they self-disclosed conduct to OIG, Southern Illinois Healthcare; Southern Illinois Medical Services NFP, d/b/a SIH Medical Group; and Southern Illinois Hospital Services d/b/a Memorial Hospital of Carbondale, Herring Hospital, and St. Joseph Memorial Hospital, (collectively, "SIH"), Illinois, agreed to pay $208,306.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that SIH provided remuneration to two physicians in the form of patient referrals from SIH Medical Group.
03-30-2020: After they self-disclosed conduct to OIG, Northwell Health Inc. (Northwell) and North Shore Long Island Jewish Medical P.C. (North Shore), New York, agreed to pay $981,679 for allegedly violating the Civil Monetary Penalties Law. The disclosed conduct concerned professional claims that Northwell's professional corporate affiliate, North Shore, submitted to Medicare and Medicaid for evaluation and management services performed at certain hospitals and facilities. Northwell and North Shore disclosed that North Shore's Revenue Cycle Unit had undertaken a focused coding initiative that results in upcoding in the following subsets of claims: (1) claims for level 3, 4, and 5 emergency department evaluation and management services; (2) claims for level 4 and 5 internal medicine evaluation and management services; (3) claims for level 4 and 5 radiation oncology evaluation and management services; and (4) claims for level 4 and 5 urology evaluation and management services. OIG alleged that these subsets of claims were false or fraudulent because the claims furnished were not consistent with the level of evaluation and management service coded.
03-25-2020: After it self-disclosed conduct to OIG, The Trustees of Dartmouth College (Dartmouth College), New Hampshire, agreed to pay $53,940.35 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that during the time period from July 1, 2011, to June 30, 2016, physicians and other practitioners at Hanover Psychiatry, which was at that time, a clinical practice of the Geisel School of Medicine at Dartmouth College, provided psychotherapy and counseling services to Medicare beneficiaries and charged those beneficiaries for these services without billing Medicare for these services on their behalf, without adhering to the applicable limiting charges, without accepting assignment, and without properly documenting to the Medicare program and beneficiaries a decision to "opt out" of the Medicare program.; After it self-disclosed conduct to OIG, Dartmouth-Hitchcock Clinic (Dartmouth-Hitchcock), New Hampshire, agreed to pay $22,947 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that during the time period from July 1, 2016, to June 30, 2017, physicians and other practitioners of Hanover Psychiatry, which is a private practice operated by Dartmouth-Hitchcock, provided psychotherapy and counseling services to Medicare beneficiaries and charged those beneficiaries for these services without billing Medicare for these services on their behalf, without adhering to the applicable limiting charges, without accepting assignment, and without properly documenting to the Medicare program and beneficiaries a decision to "opt out" of the Medicare program.
03-23-2020: After it self-disclosed conduct to OIG, Harbour Manor Health and Living Community (Harbour Manor), Indiana, agreed to pay $57,851.11 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Harbour Manor submitted claims for skilled nursing services provided by an individual without a valid nursing license.
03-17-2020: After it self-disclosed conduct to OIG, Klair Medicose, PLLC (Klair Medicose), agreed to pay $1,495,002.51 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Klair Medicose submitted claims for Pulsed Stimulated Treatment, which is not a covered item or service under the Medicare Program.
03-10-2020: After it self-disclosed conduct to OIG, The Maui Medical Group, Inc. (MMG), Hawaii, agreed to pay $240,471 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MMG submitted claims for evaluation and management services provided by a physician that were not supported by the medical record.
02-26-2020: After it self-disclosed conduct to OIG, The Regents of the University of California on behalf of the University of California Los Angeles Health System (UCLA Health), California, agreed to pay $241,033.41 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UCLA Health submitted claims for services provided by a physician when the services were actually provided by international fellows or Accreditation Council for Graduate Medical Education residents and domestic fellows, outside the physician's physical presence and without his supervision.
02-19-2020: After it self-disclosed conduct to OIG, Interim HealthCare of Southeastern Colorado (Interim), Colorado, agreed to pay $308,312.38 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Interim submitted claims for payment to Medicare and Colorado Medicaid that were based on falsified physician orders.
02-18-2020: After it self-disclosed conduct to OIG, the City of Lincoln, Nebraska d/b/a Lincoln Fire & Rescue (LF&R), agreed to pay $49,122.27 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LF&R employed an unlicensed individual to provide paramedic services that were paid for by Federal health care programs.
02-10-2020: After it self-disclosed conduct to OIG, Smartbox Assistive Technology, Inc. (Smartbox), Pennsylvania, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that Smartbox paid remuneration to independent contractors in the form of sales commissions in exchange for the independent contractors' referrals of durable medical equipment, prosthetics, orthotics, and supplies to Smartbox that were payable under the Medicare and Medicaid programs.
02-07-2020: After it self-disclosed conduct to OIG, INTEGRIS Miami Hospital d/b/a INTEGRIS Miami EMS (INTEGRIS), Oklahoma, agreed to pay $109,943.43 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that INTEGRIS employed an Emergency Medical Technician (EMT) while his EMT license with the Oklahoma State Department of Health was expired. During this period, INTEGRIS submitted claims to Medicare and Medicaid for emergency medical services that did not meet applicable federal and state regulatory requirements.
02-06-2020: After it self-disclosed conduct to OIG, Professional Sleep Analysis, Inc. (PSA), Florida, agreed to pay $114,868.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PSA did not have a medical director or supervising physician and its former president utilized its former medical director's electronic stamp to sign off on polysomnography titration reports, prescriptions for durable medical equipment, and office notes, resulting in inaccurate documentation in patient records to support claims submitted to Medicare and Tricare.
02-03-2020: After it self-disclosed conduct to OIG, VHS Harlingen Hospital Company, LLC d/b/a Valley Baptist Medical Center (VBMC), Texas, agreed to pay $159,084.25 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that VBMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-22-2020: After it self-disclosed conduct to OIG, University of Miami (UM), Florida, agreed to pay $325,150.76 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UM submitted claims to Federal health care programs under CPT codes 65875, 66982, 66984, 67010, and V2788 for cataract and corneal procedures performed using a laser that could not be paid because they were tainted by alleged violations of the anti-kickback statute stemming from an agreement between a medical device company and an employee of UM.; After it self-disclosed conduct to OIG, Windsor Hospital Corporation d/b/a Mt. Ascutney Hospital and Health Center (Mt. Ascutney), Vermont, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mt. Ascutney employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-10-2020: After it self-disclosed conduct to OIG, Avail Home Health Services, LLC (Avail), Texas, agreed to pay $57,315 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Avail improperly submitted claims to Texas Medicaid for home health services provided by an unlicensed nurse.
01-09-2020: After they self-disclosed conduct to OIG, Paul Fallon, M.D. and Portsmouth Psychiatrics Associates (collectively, "Portsmouth"), New Hampshire, agreed to pay $112,533.43 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Portsmouth submitted claims to Medicare for services rendered by an unlicensed provider, as "incident to" when the "incident to" requirements under Medicare were not met.
01-08-2020: After it self-disclosed conduct to OIG, Jeffrey K. Chaulk, M.D., P.C. d/b/a Alpine Eye Care (AEC), Michigan, agreed to pay $23,601.11 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AEC submitted claims to Medicare for services that were medically unnecessary or improperly coded.

2019

12-20-2019: After it self-disclosed conduct to OIG, St. Charles Health System d/b/a St. Charles Bend (St. Charles), Oregon, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. Charles employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-17-2019: After it self-disclosed conduct to OIG, A1 Pharmacy & Surgical Supply, LLC (A1 Pharmacy), North Carolina, agreed to pay $515,060.68 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that A1 Pharmacy submitted claims for brand name diabetes monitoring and treatment supplies when, in fact, A1 Pharmacy had dispensed a less expensive brand or generic supplies.
12-16-2019: After it self-disclosed conduct to OIG, The Center for Orthotic and Prosthetic Care of Kentucky, L.L.C., (COPCK), Kentucky, agreed to pay $335,838 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that COPCK paid remuneration to an individual in the form of compensation based on their marketing of and referral generation for orthotics and prosthetics supplies purchased or ordered from COPCK's Paducah office.
11-26-2019: After it self-disclosed conduct to OIG, Amsterdam Medical Practice, PLLC (AMP), New York, agreed to pay $433,602.53 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AMP submitted claims for services for vestibular autorotation testing and elctronystagmogram testing that did not meet Medicare guidelines.
11-22-2019: After it self-disclosed conduct to OIG, The Rehabilitation Hospital of the Pacific Hilo Clinic (Rehab-Hilo), Hawaii, agreed to pay $231,510.58 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that Rehab-Hilo paid remuneration to a physician in the form of hand therapy services and splinting supplies provided by a certified hand therapist employed by Rehab-Hilo.
11-12-2019: After it self-disclosed conduct to OIG, Central Coast In-Patient Consultants, Inc. (CCIC), California, agreed to pay $750,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CCIC submitted claims for services provided to Medicare beneficiaries at a hospital when those physicians were not properly enrolled as Medicare Part B providers and when the names and National Provider Identifier numbers of physicians who did not furnish the services were used on claims submitted to and paid by the Medicare program for the services furnished by those non-enrolled physician.
10-31-2019: After it self-disclosed conduct to OIG, Clara City Care Center (CCCC), Minnesota, agreed to pay $75,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CCCC employed an unlicensed registered nurse and that no Federal health care program payments could be made for times or services she furnished when she was not licensed.
10-11-2019: After they self-disclosed conduct to OIG, Opti-Vision, LLC (Opti-Vision) and Grene Vision Group, L.L.C. (Grene), (collectively, "Opti-Vision and Grene"), Kansas, agreed to pay $916,145.39 for allegedly violating the Civil Monetary Penalties Law provision applicable to kickbacks. OIG alleged that Opti-Vision and Grene received remuneration from an optical laboratory for the purchase of membership interests in a group purchasing organization owned, in part, by Opti-Vision in the form of installment payments made to Opti-Vision that were conditioned on Opti-Vision, through Grene, purchasing a certain amount of items from the optical laboratory through the group purchasing organization.
10-08-2019: After they self-disclosed conduct to OIG, Joint Medical Equipment, Inc., Hans Wittig, and Maximillian Wittig (collectively, "Joint Medical"), Florida, agreed to pay $143,559.20 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to kickbacks. OIG alleged that Joint Medical submitted claims for medically unnecessary durable medical equipment, which were also tainted by violations of the anti-kickback statute.
10-01-2019: After it self-disclosed conduct to OIG, Atrium South Haven, Inc. d/b/a South Haven Nursing and Rehabilitation Community (South Haven), Michigan, agreed to pay $446,400.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that South Haven employed and individual for the provision of items or services when it knew or should have know that individual was not appropriately licensed as a nursing home administrator as required under Michigan Law, and that no Federal health care program payments could be made for items or services furnished by the individual.
09-30-2019: After it self-disclosed conduct to OIG, Kroger Specialty Pharmacy Holdings, Inc. (Kroger), agreed to pay $4,461,995.24 for allegedly violating the Civil Monetary Penalties Law. On September 2, 2016, Kroger acquired Modern HC Holdings, Inc. (Modern). OIG alleged that: (1) from July 8, 2010, through April 4, 2014, Modern pharmacies improperly submitted claims for prescription drugs and supplies without the requisite state-issued, non-residential pharmacy license; and (2) from December 29, 2014, through August 23, 2017, Kroger retained overpayments when pharmacies failed to reverse test claims for prescription drugs that were not dispensed.
09-25-2019: After it self-disclosed conduct to OIG, Array Skin Therapy (AST), California, agreed to pay $35,281.71 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AST improperly submitted claims for dermatological procedures provided by registered nurses and billed under the National Provider Identifier numbers of its three employed nurse practitioners, using Current Procedural Terminology codes 96900, 96910, 96920, 96921, and 96922, when the three nurse practitioners did not provide the appropriate supervision of the registered nurses for those procedures.
09-17-2019: After they self-disclosed conduct to OIG, MioTech Orthopedic Group, Michigan and DJO LLC, California, (collectively, "MioTech and DJO") agreed to pay $1,247,753.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that employees and representatives of MioTech and DJO altered or falsified supporting documentation for durable medical equipment claims and submitted those claims for payment.
09-10-2019: After it self-disclosed conduct to OIG, Prosthetic Artists, Inc. (PA), California, agreed to pay $54,002.30 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PA submitted claims for construction of a custom plastic piece, commonly referred to as a "model", using CPT code V2628 for fabrication and fitting of an ocular conformer.
09-06-2019: After it self-disclosed conduct to OIG, Memorial Herman Health System (MHHS), Texas, agreed to pay $6,413,851.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MHHS improperly submitted claims where MHHS: (1) automatically appended a 99201 or G0453 facility Evaluation and Management (E/M) Current Procedural Terminology code to preoperative assessments performed by nurses in a hospital setting; and/or (2) automatically appended a modifier 25 to certain E/M services billed on the same day as a surgical procedure.; After it self-disclosed conduct to OIG, Oak Park Place Nursing and Rehabilitation, LLC (Oak Park), Wisconsin, agreed to pay $194,354.75 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Oak Park employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After they self-disclosed conduct to OIG, Greater Hartford Orthopedic Group, P.C. (GHOG), Connecticut, and Daryle A. Ruark, M.D. Orthopedic Surgeon, P.C. (Ruark), Massachusetts, agreed to pay $102,483.08 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that GHOG and Ruark employed an individual that they knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Hazelden Betty Ford Foundation (HBFF), California, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HBFF employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-03-2019: After it self-disclosed conduct to OIG, Grant Memorial Hospital (GMH), West Virginia, agreed to pay $661,386.57 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that GMH paid remuneration to a physician in the form of bonus payments that were neither consistent with the terms of the physician's employment agreement with GMH nor fair market value for the obstetrics and gynecology services the physician provided to GMH.
08-27-2019: After they self-disclosed conduct to OIG, Wellmont Health System and its wholly owned subsidiaries Wellmont Medical Associates and WPS Poviders, Inc. (collectively, "Wellmont") and Medical Education Assistance Corporation (MEAC), Tennessee, agreed to pay $851,061 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Wellmont and MEAC submitted false or fraudulent claims for the professional services of a trauma surgeon that did not comply with teaching physician requirements because the medical record did not support that he was personally present during the key portion of the procedure or service.; After it self-disclosed conduct to OIG, Leominster Dermatology, LLP (Leominster), Massachusetts, agreed to pay $149,447.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Leominster sought reimbursement for phototherapy services that were not provided as claimed. Specifically, Leominster submitted claims for phototherapy services using Current Procedural Terminology (CPT) code 96910, where CPT code 96900 was appropriate, resulting in a higher payment from Medicare.
08-23-2019: After it self-disclosed conduct to OIG, Quest Diagnostics Incorporated (Quest), on behalf of its wholly-owned subsidiary, Quest Diagnostics TB, LLC formerly known as Oxford Immunotec, Inc. (OI), agreed to pay $88,780.74 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that from June 1, 2011, through December 31, 2016, OI, a clinical laboratory, paid remuneration in the form of collection, processing, and handling payments related to the collection of blood to physicians and physician groups. Quest acquired OI on November 6, 2018.
08-22-2019: After it self-disclosed conduct to OIG, U.S. Renal Care, Inc. (USRC), Texas, agreed to pay $13,171.62 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that USRC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-13-2019: After it self-disclosed conduct to OIG, The Regents of the University of California on behalf of the University of California San Diego Health System (UCSD), California, agreed to pay $5,315,927.49 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UCSD submitted claims to Federal health care programs for hospital inpatient services that should have been billed as hospital outpatient or observation services. OIG further alleged that UCSD submitted claims to Federal health care programs for critical care management services where the documentation did not support billing under Current Procedural Terminology codes 99291 or 99292.; After it self-disclosed conduct to OIG, Granite State Independent Living Center (GSILC), New Hampshire, agreed to pay $47,062.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that GSILC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Oklahoma State University Medical Trust d/b/a Oklahoma State University Medical Center (OSUMC), Oklahoma, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OSUMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-01-2019: After it self-disclosed conduct to OIG, Community Physicians of Indiana, Inc. (CPI), Indiana, agreed to pay $765,181.95 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CPI improperly submitted claims to Federal health care programs: (1) for professional evaluation and management services using Current Procedural Terminology (CPT) codes 99212, 99213, 99214, and 99215 ("the E&M Services"); and (2) for oncology infusing services purportedly provided to the same patient on the same day as the E&M Services, where medical record documentation did not support submission of claims for both the E&M Services and oncology infusion services.; After it self-disclosed conduct to OIG, Clarity Child Guidance Center (CCGC), Texas, agreed to pay $19,670.97 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CCGC improperly submitted claims to Federal health care programs for pediatric psychotherapy services performed by a Licensed Professional Counselor that did not meet the applicable time rules for the time-based Current Procedure Terminology (CPT) code reported.
07-31-2019: After it self-disclosed conduct to OIG, Garfield Park Behavioral Hospital (GPBH), Illinois, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that GPBH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-26-2019: After it self-disclosed conduct to OIG, United Scripts LTC, LLC (United Scripts), Missouri, agreed to pay $1,258,146.24 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that United Scripts submitted unauthorized prior authorization forms to Federal health care program payors, which were subsequently relied upon by United Scripts when seeking payment for prescription drug claims.
07-25-2019: After it self-disclosed conduct to OIG, General Physician, P.C. (GP), New York, agreed to pay $10,957.86 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that GP employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-23-2019: After it self-disclosed conduct to OIG, Mercy Medical Center (MMC), Ohio, agreed to pay $210,739.53 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MMC billed for the professional services of physician assistants under the supervising physician's provider number as a shared/split, when the documentation did not meet the requirements for a shared/split visit.
07-18-2019: After it self-disclosed conduct to OIG, the City of Jacksonville (COJ), Florida, agreed to pay $337,601.12 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that COJ submitted claims to Federal health care programs for ambulance transportation services provided to beneficiaries which were improper because COJ failed to obtain necessary beneficiary authorization for ambulance transports.
07-12-2019: After it self-disclosed conduct to OIG, Mary Washington Hospital, Inc. (MWH), Virginia, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that MWH paid remuneration to a medical practice by not recouping certain amounts it paid to a physician, through the medical practice, pursuant to a physician recruitment arrangement.
07-01-2019: After it self-disclosed conduct to OIG, Histopathology Services LLC d/b/a Pathline Emerge (Pathline), New Jersey, agreed to pay $310,978.11 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Pathline paid remuneration to physician offices in the form of free medical specimen collection supplies.
06-28-2019: After it self-disclosed conduct to OIG, Five Star Quality Care-CA, LLC d/b/a Van Nuys Healthcare Center (VNHC), California, agreed to pay $1,138,807.29 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that VNHC's Director of Nursing and Minimum Data Set (MDS) Coordinator reported false Assessment Reference Dates on MDS reports required under Medicare rules.
06-27-2019: After it self-disclosed conduct to OIG, Riverside Healthcare Association, Inc. t/a Riverside Health System (Riverside), Virginia, agreed to pay $788,535 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Riverside submitted false or fraudulent claims to TRICARE for: (1) professional services provided by active duty military physicians; (2) services provided by Physical Therapy Assistants and Certified Occupational Therapy Assistants in the Acute Care Division, and (3) services provided by Physical Therapy Assistants and Certified Occupational Therapy Assistants in the Lifelong Health Division.
06-24-2019: After it self-disclosed conduct to OIG, Shands Teaching Hospital and Clinics, Inc. d/b/a UF Health Shands (Shands), Florida, agreed to pay $16,483.10 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Shands employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-07-2019: After it self-disclosed conduct to OIG, LifeSkills, Inc. (LifeSkills), Kentucky, agreed to pay $36,868.59 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LifeSkills employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-06-2019: After it self-disclosed conduct to OIG, Community Health Centers of Burlington (CHCB), Vermont, agreed to pay $26,061.75 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHCB employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-22-2019: After they self-disclosed conduct to OIG, Kali Nagabalaji, LLC formerly d/b/a Saginaw Pharmacy; Deepak Arsid; Ravi Chandra Gudla; Shiva Peddireddy; Matthew W. Cerniglia, DPM, P.A. d/b/a Ankle and Foot Institute of Texas; Matthew W. Cerniglia, DPM; Absolute Foot Care Specialist; Noah Levine, DPM; HAI IL Corporation; Arshad Khan; Bedolla Enterprises, LLC d/b/a Madera Medical Distributors d/b/a MMD Management & Consulting Services; Alfredo Bedolla; Damien M. Dauphine, DPM; Complete Foot and Ankle Care of North Texas, PA; and Irish Kidd Partners, LTD, Texas, agreed to pay $543,664.28 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to kickbacks. OIG alleged that Kali Nagabalaji, LLC, which was then doing business as Saginaw Pharmacy (Saginaw Pharmacy) knowingly paid remuneration in the form of commissions for the first fill of certain prescriptions filled as Saginaw Pharmacy to Bedolla Enterprises, LLC d/b/a Madera Medical Distributions d/b/a MMD Management & Consulting Services (Bedolla Enterprises), a portion of which Bedolla Enterprises paid to certain practitioners in exchange for their referrals of such prescriptions. OIG further contends that Saginaw Pharmacy knowingly paid remuneration to a marketer in the form of commissions in exchange for arranging for the filling of prescriptions at Saginaw Pharmacy for patients of two practitioners.
04-26-2019: After it self-disclosed conduct to OIG, The Traveling Nurse Practitioner, LLC d/b/a At Home Medical Professionals (TTNP), Ohio, agreed to pay $46,981.62 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that TTNP submitted claims to Medicare and Ohio Medicaid that indicated the incorrect rendering provider.
04-12-2019: After it self-disclosed conduct to OIG, Atrius Health, Inc. (Atrius), Massachusetts, agreed to pay $222,535.47 62 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Atrius billed for certain injections of the drug Neulasta under Medicare's Part B "incident to" conditions of coverage. OIG alleged that in the case of these certain injections at issue, the drug was not being administered by a physician or their auxiliary personnel but rather was being administered by patients, caregivers, or visiting nurses at the home of the patient.
04-10-2019: After it self-disclosed conduct to OIG, Carolina Eye Center, P.A. (CEC), South Carolina, agreed to pay $15,040.25 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CEC billed Medicare for two physicians' services claiming they were rendered incident to the services of a third physician when such services did not meet Medicare's incident to billing requirements and were not furnished by providers properly enrolled in Medicare.
04-09-2019: After it self-disclosed conduct to OIG, Winchester Radiologists, PC (Winchester), Virginia, agreed to pay $1,673,415 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Winchester submitted claims to Medicare, Medicaid, Tricare and Veteran's Administration for non-diagnostic surgical and invasive procedures that were performed by a radiologist practitioner assistant at two hospitals and their outpatient centers and not eligible for reimbursement.
04-04-2019: After they self-disclosed conduct to OIG, Great River Health System, Inc. (GRHS), Great River Foundation (GRF), Riverview System, Inc. (RSI), Great River Medical Center (GRMC), and Great River Physicians and Clinics, Inc. (GRPC), Iowa, agreed to pay $3,008,326.50 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to kickbacks. OIG alleged that GRHS, GRF, RSI, and GRPC paid remuneration to a physician in the form of excessive compensation. OIG also alleged that GRHS, GRMC, and GRPC submitted or caused to be submitted false claims to Medicare, Medicaid, and Tricare for medically unnecessary and improperly coded hyperbaric oxygen therapy and wound care services provided by the physician.
04-03-2019: After it self-disclosed conduct to OIG, The Vicksburg Clinic, LLC d/b/a Merit Health Medical Group (Merit), Mississippi, agreed to pay $2,022,904.96 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Merit submitted claims for inpatient behavioral health services provided by a physician in an affiliated hospital's adolescent psychiatric, geriatric psychiatric, adult detoxification, and adult psychiatric units, and the affiliated hospital's adolescent children's day unit, when the medical record did not support medical necessity or the level of care billed and there was cloning of documentation for multiple dates of treatment for the same patients and for multiple patients on the same dates of treatment.
04-02-2019: After it self-disclosed conduct to OIG, Vanderbilt Stallworth Rehabilitation Hospital, L.P. (Vanderbilt), Tennessee, agreed to pay $25,912.53 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Vanderbilt employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-01-2019: After it self-disclosed conduct to OIG, Orlando Foot & Ankle Clinic, Inc. (OFAC), Florida, agreed to pay $418,256.66 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that OFAC received remuneration from Mid-Florida Pathology, LLC and Laboratory Services of Central Florida, LLC pursuant to arrangements for the provision of laboratory services.
04-01-2019: After they self-disclosed conduct to OIG, Mid-Florida Pathology, LLC (MFP) and Laboratory Services of Central Florida, LLC (LSCF), Florida, agreed to pay $314,497.41 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that MFP and LSCF paid remuneration to Orlando Foot & Ankle Clinic, Inc. pursuant to arrangements for the provision of laboratory services.
03-21-2019: After it self-disclosed conduct to OIG, Redstone Presbyterian SeniorCare (Redstone), Pennsylvania, agreed to pay $25,878.91 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Redstone presented claims to Medicare for services performed by a physical therapy assistant without direct supervision as required by the Pennsylvania State Practice Act for Physical Therapy and by the Medicare program.
02-19-2019: After it self-disclosed conduct to OIG, Union Hospital of Cecil County, Inc. (Union), Maryland, agreed to pay $457,213.07 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Union: (1) paid remuneration to physicians in the form of free support services provided by three physician assistants; and (2) paid remuneration to cardiologists in the form of free support services provided by a nurse practitioner.
02-06-2019: After he self-disclosed conduct to OIG, Omenihu Oluikpe (Oluikpe), New York, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Oluikpe submitted or caused a pharmacy he owned to submit claims to Medicare and Medicaid for only the base of compounded medications when he actually dispensed compounded medications made with bulk powder.
01-25-2019: After it self-disclosed conduct to OIG, IHC Health Services, Inc. d/b/a Intermountain Medical Center (IMC), Utah, agreed to pay $68,204.85 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that IMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs. OIG further alleged that two additional excluded individuals provided items or services to IMC's patients that were billed to Federal health care programs.
01-23-2019: After it self-disclosed conduct to OIG, Personalized Therapy, LLC (Personalized Therapy), Maryland, agreed to pay $334,519.37 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Personalized Therapy improperly billed Tricare for services provided by one Occupational Therapist Assistant when those services were not reimbursable.
01-17-2019: After it self-disclosed conduct to OIG, Ironton-Lawrence County Community Action Organization, Inc. (Ironton-Lawrence), Ohio, agreed to pay $99,683.77 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Ironton-Lawrence submitted claims to Medicaid for telepsychiatry services from a service site that was not approved under Ironton-Lawrence's scope of project.
01-09-2019: After it self-disclosed conduct to OIG, Fort Bend County, Texas, agreed to pay $4,526,740.26 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fort Bend County submitted claims for ambulance transportation services provided to beneficiaries which were improper because Fort Bend County failed to obtain the necessary beneficiary authorization for ambulance transports.
01-08-2019: After it self-disclosed conduct to OIG, PHI Air Medical, L.L.C. (PHI Air), Arizona), agreed to pay $13,259.99 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PHI Air employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-04-2019: After it self-disclosed conduct to OIG, Valley's Best Hospice (VBH), California, agreed to pay $27,420.23 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that VBH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2018

12-31-2018: After it self-disclosed conduct to OIG, Gastroenterology Associates of Piedmont, P.A. (GAP), North Carolina, agreed to pay $188,900.89 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that GAP and its predecessor received remuneration from two anesthesia practices in the form of rent and free anesthesia-related drugs and supplies when the anesthesia practices provided anesthesia services through their employed and contracted anesthesiologists or certified registered nurse anesthetists at GAP's endoscopy centers.
12-28-2018: After they self-disclosed conduct to OIG, WellDyneRx, LLC (WellDyneRx) and HillCour, Inc. (HillCour), Florida, agreed to pay $7,053,650 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that WellDyneRx and HillCour paid remuneration to an entity consisting of a percentage of the compensation WellDyneRx and HillCour received from a Florida Medicaid managed care plan for their provision of pharmacy benefit management services, mail order pharmacy services, and specialty pharmacy services to the Florida Medicaid managed care plan and its Medicaid managed care members that were paid for by the Florida Medicaid program.
12-27-2018: After it self-disclosed conduct to OIG, Williamson Medical, PLLC (Williamson), New York, agreed to pay $20,274.78 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Williamson submitted claims to Medicare and Tricare for incident-to services provided by a physician assistant under a physician's National Provider Identifier when Medicare and Tricare supervision requirements had not been met.
12-21-2018: After they self-disclosed conduct to OIG, St. Paul Place Specialists, Inc. (SPPS) and its affiliate, Mercy Medical Center, Inc. (MMC), Maryland, agreed to pay $687,484.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SPPS and MMC billed for services provided by graduates of foreign medical schools who came to SPPS and MMC to participate in an international visitors program. OIG alleged the services provided by these doctors were not reimbursable by Medicare or Medicaid.; After it self-disclosed conduct to OIG, Falcon Lake Health Care Ltd. d/b/a Falcon Lake Nursing Home (Falcon Lake), Texas, agreed to pay $25,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Falcon Lake submitted minimum data set (MDS) forms that were not appropriately reviewed for completeness and attested to by a Registered Nurse, as required under Medicare and Medicaid payment rules. OIG contended that the MDS forms were completed and submitted by a Licensed Vocational Nurse who improperly used the electronic signature of a former employee.
12-20-2018: After he self-disclosed conduct to OIG, David Hagan, M.D. (Dr. Hagan), Illinois, agreed to pay $24,027.10 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Hagan submitted claims to Medicare for incident-to services provided by nurse practitioners under his National Provider Identifier when the Medicare supervision requirements had not been met.; After it self-disclosed conduct to OIG, Gibson Community Hospital Association d/b/a Gibson Community Hospital, on behalf of itself and its wholly owned clinic (collectively, "GCH"), Illinois, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that GCH submitted claims to Medicare for incident-to services provided by nurse practitioners under a physician's National Provider Identifier when Medicare supervision requirements had not been met.
12-18-2018: After they self-disclosed conduct to OIG, Cancer Treatment Centers of America Global, Inc., Eastern Regional Medical Center, Inc., Southeastern Regional Medical Center, Inc., Midwestern Regional Medical Center, Inc., Southwestern Regional Medical Center, Inc., Cancer Treatment Centers of America Professional Corporation of Pennsylvania, P.C., Cancer Treatment Centers of America Professional Corporation of Georgia, P.C., Patient First, S.C., and Cancer Treatment Centers of America Professional Corporation of Oklahoma, Inc. (collectively, "CTCA"), headquartered in Florida, agreed to pay $8,220,814.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that CTCA paid improper remuneration to physicians in exchange for their referrals to CTCA's hospitals.; After it self-disclosed conduct to OIG, UMass Memorial Health Alliance - Clinton Hospital, Inc. (UMass HA-Clinton), Massachusetts, agreed to pay $2,331,641.67 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UMass HA-Clinton admitted Medicare beneficiaries and submitted claims for payment without properly documenting that an impatient psychiatric hospitalization was a reasonable and medically necessary treatment for the patient's condition. OIG also alleged that the medical records did not consistently contain the appropriate documentation to satisfy Medicare requirements for continued treatment.; After it self-disclosed conduct to OIG, Quest Diagnostics Incorporated, on behalf of its wholly-owned subsidiary, Cleveland HeartLab (CHL), agreed to pay $2,275,094.25 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. Quest acquired CHL, an Ohio based clinical laboratory, on December 1, 2017. OIG alleged that, during the period August 12, 2010 through June 30, 2014, CHL paid remuneration to physicians and physician groups in the form of collection, processing, and handling payments related to the collection of blood.
11-19-2018: After it self-disclosed conduct to OIG, Milton S. Hershey Medical Center (MHMC), Pennsylvania, agreed to pay $382,074.60 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MHMC provided outpatient radiology imaging services to Federal health care program patients when MHMC's employed radiologists did not provide personal supervision of MHMC's employed radiology assistants.
11-08-2018: After it self-disclosed conduct to OIG, Fox Rehabilitation Services, P.C. (Fox), agreed to pay $261,003 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fox, at a Fox location in New Jersey, employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Odyssey HealthCare Operating A, LP d/b/a Kindred Hospice (Kindred), agreed to pay $32,224.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kindred, at a Kindred hospice in Arkansas, submitted claims to Federal health care programs for services provided by an unlicensed nurse.
11-01-2018: After it self-disclosed conduct to OIG, McBride Clinic Orthopedic Hospital, LLC d/b/a McBride Orthopedic Hospital (McBride), Oklahoma, agreed to pay $414,649.91 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that McBride improperly submitted claims to Federal health care programs for: (1) professional services related to surgeries performed by two employee-physicians improperly appended by Modifier 51, 58, and/or 59; (2) professional and facility fees related to post-surgical patient visits performed by a licensed practical nurse without physician supervision; and (3) evaluation and management services performed by an employee-physician during office visits improperly appended by Modifier 25 and/or billed as split/shared. OIG further alleged that McBride knew of overpayments and did not report and return those overpayments in accordance with Medicare rules. Specifically, OIG alleged that McBride allowed the accrual of overpayments owed to Medicare and, when McBride became aware of these overpayments through educational audits, it failed to return those overpayments to Medicare.
10-30-2018: After they self-disclosed conduct to OIG, Riverside Spine & Pain Physicians, LLC d/b/a Riverside Spine & Pain Physicians, PL and Riverside Surgical Center, LLC (collectively, "Riverside"), Florida, agreed to pay $1,765,080.48 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Riverside billed for triamcinolone acetonide injections under Healthcare Common Procedure Coding System (HCPCS) Code J3300, but was actually using triamcinolone diacetate, which should have been billed under HCPCS Code J3302.
10-25-2018: After it self-disclosed conduct to OIG, San Luis Obispo County Health Agency (San Luis Obispo), California, agreed to pay $11,885.25 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that San Luis Obispo employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-24-2018: After they self-disclosed conduct to OIG, Presence Care Transformation Corporation, Presence Chicago Hospitals Network, and Presence Central and Suburban Hospitals Network (collectively, "Presence"), Illinois, agreed to pay $461,130.66 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Presence paid remuneration to physicians in the form of: (1) cash equivalent gift cards; (2) excessive compensation for electroencephalography and electromyography interpretation services performed by Presence Resurrection Medical Center; and (3) excessive compensation for medical director services performed for Presence Saints Mary and Elizabeth Medical Center.
10-23-2018: After it self-disclosed conduct to OIG, St. Francis Health, LLC (St. Francis), Georgia, agreed to pay $3,273,181 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that St. Francis paid remuneration to a management company in the form of incentive payments for performance metrics that were not met and were not materially updated to incentivize performance. OIG further contended that St. Francis paid remuneration to a cardiology practice in the form of a forgiven or uncollected debt owed as a result of the practice exceeding the tenant improvement allowances of their lease agreement.
10-04-2018: After it self-disclosed conduct to OIG, HVL Corp., d/b/a The Whittier Pavilion (Whittier), Massachusetts, agreed to pay $87,493.65 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Whittier improperly billed the Medicare and Medicaid programs for outpatient psychotherapy treatment sessions that were not provided as claimed.
10-02-2018: After it self-disclosed conduct to OIG, Detroit Area Agency on Aging (DAAA), Michigan, agreed to pay $583,084.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DAAA contracted with a vendor for the provision of items or services and DAAA knew or should have known the vendor was excluded from participation in Federal health care programs.
09-27-2018: After it self-disclosed conduct to OIG, Orlando Regional Medical Center (ORMC), Florida, agreed to pay $130,158.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ORMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Eye Care Associates, Inc. (ECA), Alabama, agreed to pay $19,934.66 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ECA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-26-2018: After it self-disclosed conduct to OIG, Care Inn of Sequin d/b/a San Gabriel Rehabilitation and Care Center (San Gabriel), Texas, agreed to pay $129,589.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that San Gabriel employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Surgery Partners, Inc. (SPI) agreed to pay $55,252.32 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SPI, at a SPI location in Beverly Hills, California, employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Beacon Medical Group, Inc. (Beacon), Indiana, agreed to pay $25,302.96 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Beacon employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Roots Community Health Center (Roots), California, agreed to pay $13,450.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Roots employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-25-2018: After it self-disclosed conduct to OIG, Froedtert Memorial Lutheran Hospital (Froedtert), Wisconsin, agreed to pay $1,972,729.90 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Froedtert submitted false claims for services rendered in its Wound Care Clinic by registered nurses, where the services were not provided pursuant to appropriate physician or non-physician practitioner supervision.
09-24-2018: After it self-disclosed conduct to OIG, Rex Hospital, Inc. d/b/a UNC Rex Healthcare (Rex), North Carolina, agreed to pay $2,277,762 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. Rex disclosed that it leased an employed physician from a community hospital for the provision of cardiology services at the community hospital. OIG contends that during this time the community hospital paid Rex a fee for the lease of the physician and Rex paid the physician salary and bonus payments for the cardiology services performed by the physician at the community hospital. OIG alleged that Rex offered and paid remuneration in the form of salary and bonus payments to the physician that were in excess of the community hospital's lease fee to Rex and that should have been paid by the community hospital.; After it self-disclosed conduct to OIG, Southern Cancer Center, P.C. (SCC), Alabama, agreed to pay $538,545.67 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SCC allowed the accrual of overpayments owed to the Medicare and Medicaid programs and, when it became aware of these overpayments, it failed to return these overpayments to the Medicare and Medicaid programs.; After they self-disclosed conduct to OIG, Mountain West Derm - Blackhart, PLLC d/b/a Skin Cancer Dermatology Institute and MWD Management, LLC d/b/a United Derm Partners (collectively, "MWD"), Nevada, agreed to pay $105,538.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MWD billed for phototherapy services using CPT Code 96910, which requires the use of a topical agent, when such services should have been billed using CPT Code 96900, which does not involve use of a topical agent.
09-20-2018: After it self-disclosed conduct to OIG, the University of Nevada School of Medicine, Multispecialty Group Practice South, Inc. (UNSOM) agreed to pay $12,194.66 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UNSOM submitted claims to Medicare and Medicaid for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG alleged that UNSOM: (1) billed for hand replantation surgeries that were not provided; (2) billed for a fasciocutaneous advancement flap that was not performed; (3) submitted a claim for a left hand crush injury but the operative report did not support billing for that procedure; and (4) billed for replacement of a breast expander without documentation supporting billing for the CPT code associated with that procedure.
09-14-2018: After it self-disclosed conduct to OIG, The General Hospital Corporation d/b/a Massachusetts General Hospital (Massachusetts General) agreed to pay $35,327.09 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Massachusetts General employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-13-2018: After it self-disclosed conduct to OIG, Via Christi Manhattan Hospital, Inc. (VCMH), Kansas, agreed to pay $3,796,703.97 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that VCMH submitted claims to Federal health care programs for medically unnecessary bronchoscopies that lacked medical documentation.
09-07-2018: After it self-disclosed conduct to OIG, St. Joseph Hospital (St. Joseph), Maine, agreed to pay $14,232.65 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. Joseph employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Washington Health System Orthopedics and Sports Medicine (WHS), Pennsylvania, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged WHS improperly submitted claims to Medicare for film X-rays without using the FX modifier as required by the Centers for Medicare and Medicaid Services.
08-31-2018: After they self-disclosed conduct to OIG, Daniel Umberger, D.O. and Osteopathic Treatment and Diagnostic Services, P.C. (collectively, "Osteopathic"), New York, agreed to pay $45,843.03 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Osteopathic submitted claims for physical therapy services provided by physical therapists "incident to" physician services when a physician was not present on the premises. OIG also alleged that Osteopathic submitted claims for physical therapy services provided by physical therapy assistants "incident to" physician services that were actually supervised by a physical therapist, not a physician.
08-30-2018: After it self-disclosed conduct to OIG, San Juan Regional Medical Center, Inc. (SJRMC), New Mexico, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that SJRMC paid remuneration that was above fair market value to a physician and his wife for land that was leased pursuant to a ground lease.
08-28-2018: After it self-disclosed conduct to OIG, Adventist Health System Sunbelt Healthcare Corporation (Adventist), Florida, agreed to pay $21,219.17 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Adventist employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-22-2018: After it self-disclosed conduct to OIG, DeWitt Hospital and Nursing Home (DHNH), Arkansas, agreed to pay $123,935.30 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DHNH failed to perform quarterly utilization review audits of patient charts and also failed to obtain consent for care for certain patients as required by Medicare in order to receive an all inclusive rate for covered services provided by rural health care practitioners.
08-21-2018: After it self-disclosed conduct to OIG, Prospect CharterCare RWMC, LLC (Prospect), Rhode Island, agreed to pay $78,525.25 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Prospect submitted claims to Medicare for services provided at free-standing clinics but billed as if they were provided at a provider-based location.
08-07-2018: After it self-disclosed conduct to OIG, Digestive Health Specialists, P.A. (DHS), North Carolina, agreed to pay $478,668 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that DHS received remuneration from two anesthesia practices in the form of free CO2 nasal cannulas and anesthesia-related drugs when the anesthesia practices provided anesthesia services through its employed and contracted anesthesiologists or certified nurse anesthetists at DHS's endoscopy centers.
08-06-2018: After they self-disclosed conduct to OIG, Wahiawa Hospital Association and Wahiawa General Hospital (collectively, "Wahiawa"), agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Wahiawa provided remuneration to a family health center by leasing office space at below fair market value.
08-02-2018: After it self-disclosed conduct to OIG, Monadnock Community Hospital (MCH), New Hampshire, agreed to pay $76,555.18 for alleged violating the Civil Monetary Penalties Law. OIG alleged that MCH submitted false or fraudulent claims to Medicare for intravenous iron therapy for non-End Stage Renal Disease patients with a single diagnosis of iron deficiency.; After it self-disclosed conduct to OIG, Heart of America Medical Center (HAMC), North Dakota, agreed to pay $76,262.06 for alleged violating the Civil Monetary Penalties Law. OIG alleged that HAMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-23-2018: After it self-disclosed conduct to OIG, Steuben County EMS (Steuben County), Indiana, agreed to pay $251,267.19 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Steuben County submitted claims for inter-hospital transports that were improperly billed at the emergency level instead of the non-emergency level.
07-20-2018: After it self-disclosed conduct to OIG, St. Agnes Healthcare, Inc. d/b/a St. Agnes Hospital (St. Agnes), Maryland, agreed to pay $257,594.16 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. Agnes submitted improper claims for a combination of CPT codes 93965 (noninvasive physiologic studies of extremity veins, complete bilateral study) and 93970/93971 (duplex scan of extremity veins, complete bilateral study/unilateral or limited study) for the same patient on the same date of service when the codes represent technologies that serve the same diagnostic purpose.
07-19-2018: After it self-disclosed conduct to OIG, Central City Community Health Center, Inc. (CCCHC), California, agreed to pay $112,335.57 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CCCHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-17-2018: After it self-disclosed conduct to OIG, Digestive Health Specialists, P.A. (DHS), North Carolina, agreed to pay $91,910.01 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DHS submitted claims to Federal health care programs for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG alleged that: (1) DHS submitted claims to Federal health care programs for ultrasound examinations performed at its medical office in Winston-Salem, using Current Procedural Terminology (CPT) Code 76775, when the type of ultrasound procedure performed did not support use of that code; and (2) DHS submitted claims to Federal health care programs for Remicade infusion treatments performed at its medical offices in Winston-Salem and Thomasville, using CPT Code 96415 when the duration of the infusion in certain instances did not support billing under that code.
07-16-2018: After they self-disclosed conduct to OIG, Community Dialysis Center, and its affiliates Center for Dialysis Care, Inc., Nephrology Associates of Cleveland, Ltd., ARC/CDC, Ltd., ARM/CDC, Ltd., Nephrology Associates Oakwood, Ltd., Center for Dialysis Care Home Care, and The Center for Dialysis Care at Heather Hill (collectively, "CDCI"), Ohio, agreed to pay $307,609.80 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CDCI employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-09-2018: After it self-disclosed conduct to OIG, West End Fire Company No. 3 of Phoenixville (West End), Pennsylvania, agreed to pay $24,231.69 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that West End staffed its ambulance transportation services with an individual who had not maintained registration of his Emergency Medical Technician certification with the appropriate state authority. West End then submitted claims and received payments from Federal health care programs for those transport services.
07-02-2018: After it self-disclosed conduct to OIG, Midwest Regional Medical Center, LLC d/b/a Alliance Health Midwest (Midwest), Oklahoma, agreed to pay $111,927.85 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Midwest employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-26-2018: After it self-disclosed conduct to OIG, United Family Practice Health Center (UFPHC), Minnesota, agreed to pay $518,710 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UFPHC submitted claims for services to Medicare patients that did not have proper documentation. Specifically, OIG alleged that UFPHC knew or should have known that the claims it presented for reimbursement for HCPCS codes G0402, G0438, G0439 were not properly supported by the medical record.
06-25-2018: After it self-disclosed conduct to OIG, Steward Medical Group, (SMG), Massachusetts, agreed to pay OIG $196,677 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SMG presented improper claims to federal health care programs for: (1) physician office visits by established patients of an employed physician; and (2) intraoperative ultrasounds during partial nephrectomies under CPT code 76998-26. OIG alleged these claims were improper because they were not supported by accurate medical record documentation.; After it self-disclosed conduct to OIG, Schryver Medical, LLC (Schryver), Colorado, agreed to pay $35,837.75 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Schryver employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-21-2018: After it self-disclosed conduct to OIG, NorthStar Services (NorthStar), Nebraska, agreed to pay $74,615.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NorthStar employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-11-2018: After it self-disclosed conduct to OIG, Magee Benevolent Association d/b/a Magee General Hospital (Magee), Mississippi, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Magee provided remuneration to physicians and physician practices in the form of office space, transcription services, and/or personnel services at rates that were below fair market value. OIG further alleged that the remuneration described above created financial relationships and that Magee presented claims for designated health services that resulted from the prohibited referrals.
06-08-2018: After it self-disclosed conduct to OIG, LSU Health Sciences Center Shreveport (LSU Health Shreveport), Louisiana, agreed to pay $732,854.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LSU Health Shreveport, in certain cases of three or more concurrent neurosurgical procedures performed at its partner hospital, submitted claims for physician services by teaching surgeons when those services were supervisory services to the hospital rather than a physician service to individual patients.; After it self-disclosed conduct to OIG, Tremont Rehabilitation and Skilled Care Center (TRSCC), Massachusetts, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Tremont employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-01-2018: After it self-disclosed conduct to OIG, Adventist Health System Sunbelt Healthcare Corporation (Adventist), Florida, agreed to pay $671,461.17 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Adventist employed two individuals that it knew or should have known were excluded from participation in Federal health care programs; After it self-disclosed conduct to OIG, Join Implant Surgeons, Inc. (JIS), Ohio, agreed to pay $11,491.55 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that JIS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-23-2018: After it self-disclosed conduct to OIG, Millennium Healthcare Management, Inc. (MHM), with locations in Louisiana, agreed to pay $321,411 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MHM submitted claims at twelve urgent care centers that were not supported by sufficient documentation to justify the assigned code level, primarily because: (1) there was insufficient detail on the Patient Family and Social History component in the patient's record, and/or (2) there was insufficient detail to support the inclusion of Medical Decision Making as a component in determining the code level.
05-21-2018: After it self-disclosed conduct to OIG, Aspen Trace Health and Living Community (ATHLC), Indiana, agreed to pay $16,115.25 717 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ATHLC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-15-2018: After they self-disclosed conduct to OIG, HVHC LLC; Visionworks of America, Inc., formerly known as Eye Care Centers of America, Inc.; Visionary Properties, Inc.; Visionworks, Inc., formerly known as Eyemasters, Inc.; and Empire Vision Center, Inc. (collectively, "Visionworks"), headquartered in Texas, agreed to pay $3,668,961 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Visionworks paid excess remuneration to certain optometrists in the form of space and equipment leases that were below fair market value and/or by failing to collect one or more rental amounts under space and equipment leases.; After it self-disclosed conduct to OIG, Cheyenne Regional Medical Center (CRMC), Wyoming, agreed to pay $2,099,462.30 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that CRMC paid remuneration to a physician practice pursuant to a Practice Lease Agreement, where the remuneration was greater than fair market value or was for costs that the physician practice should have borne.; After it self-disclosed conduct to OIG, Monadnock Community Hospital (MCH), New Hampshire, agreed to pay $498,717 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MCH submitted claims to Medicare for technical services associated with Transthoracic Echocrdiograms performed by two non-credentialed individuals.; After they self-disclosed conduct to OIG, the Count of Sullivan and Sullivan County Ambulance Services (Sullivan County), Indiana, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Sullivan County submitted claims for reimbursement to Medicare for ambulance services provided by an employee crew member who lacked a current EMT certification for the State of Indiana.
05-14-2018: After it self-disclosed conduct to OIG, Kettering Medical Center d/b/a Kettering Behavioral Medicine Center (Kettering), Ohio, agreed to pay $1,298,249 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kettering submitted claims for group psychotherapy services provided by unlicensed mental health technicians.; After it self-disclosed conduct to OIG, Chesapeake Eye Care and Laser Center, P.C. (Chesapeake), Maryland, agreed to pay $613,617.39 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Chesapeake improperly billed for services rendered by new providers under already-credentialed provider's Medicare Provider Transaction Access Numbers or National Provider Numbers.; After it self-disclosed conduct to OIG, Bronx Physical Therapy and Rehabilitation (Bronx PT), New York, agreed to pay $13,587 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bronx PT submitted claims for services provided by an unlicensed physical therapist.
05-09-2018: After it self-disclosed conduct to OIG, Advanced Urology Institute, LLC (AUI), Florida, agreed to pay $716,518.89 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AUI submitted claims to Medicare and Medicaid for radiation oncology services without providing the requisite level of physician supervision for those services.
04-27-2018: After it self-disclosed conduct to OIG, Tuscarawas County General Health District (Tuscarawas), Ohio, agreed to pay $55,203.42 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Tuscarawas employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-24-2018: After it self-disclosed conduct to OIG, Hartford Hospital, Connecticut, agreed to pay $423,017.45 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Hartford Hospital provided remuneration to a medical practice in the form of office space, where Hartford Hospital charged the practice rent at less than fair market value. The remuneration created a financial relationship between Hartford Hospital and the practice that caused Hartford Hospital to present claims for health services that resulted from prohibited referrals in violation of the Stark law.
04-19-2018: After it self-disclosed conduct to OIG, Pecos County Memorial Hospital (Pecos), Texas, agreed to pay $136,436.94 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pecos billed for services by an employed physician who included incomplete or inappropriate documentation for the level of visit billed, submitted documentation of re-occurring or frequency of visits not meeting medical necessity guidelines, or who duplicated progress notes on multiple visits.
04-12-2018: After it self-disclosed conduct to OIG, DLP Marquette General Hospital, LLC for Marquette General Hospital (Marquette), Michigan, agreed to pay $545,663.69 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Marquette presented claims for reimbursement on behalf of a physician for hyperbaric oxygen therapy which were excessive.
04-05-2018: After it self-disclosed conduct to OIG, Shands Teaching Hospital and Clinics, Inc. d/b/a UF Health Shands (Shands), Florida, agreed to pay $249,413 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Shands employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-02-2018: After they self-disclosed conduct to OIG, BenchMark Rehabilitation Partners, LLC, BenchMark Growth Partners, LLC, BenchMark Premier Partners, LLC, BenchMark East Partners, LLC, BenchMark Development Partners, LLC and BenchMark West Partners, LLC (collectively, "BenchMark"), with locations in Tennessee, Georgia, Alabama, South Carolina, North Carolina, Texas and Kansas, agreed to pay $3,157,771.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BenchMark submitted claims to Medicare and Tricare for time-based outpatient rehabilitation therapy services provided when Benchmark's therapists did not provide constant attendance or direct one-on-one contact because the therapy services were provided concurrently with another Medicare or Tricare beneficiary.; After it self-disclosed conduct to OIG, The Mary Lanning Memorial Hospital Association d/b/a Mary Lanning HealthCare (Mary Lanning HealthCare), Nebraska, agreed to pay $677,239.56 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mary Lanning HealthCare contracted with a hospital for one of its employed physician to provide professional medical services, on a part-time bases to patients at Mary Lanning HealthCare's Blue Hill Clinic, a rural health clinic owned and operated by Mary Lanning HealthCare. The physician reassigned his billing rights for services performed under the agreement to Mary Lanning HealthCare, which then billed for his services. OIG alleged the physician documented and billed E&M codes for services performed in nursing homes that were not medically necessary and did not meet the requirements of the E&M code billed and Mary Lanning HealthCare billed for these codes.
03-29-2018: After it self-disclosed conduct to OIG, Tri-Med Ambulance, LLC (Tri-Med), Washington, agreed to pay $71,880.66 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Tri-Med filed duplicate claims for ambulance transportation services provided to Medicare beneficiaries. Additionally, OIG alleged that Tri-Med identified the overpayments related to the submission of these duplicate claims, but Tri-Med failed to timely return those overpayments.
03-28-2018: After it self-disclosed conduct to OIG, Allen's Nursing Home, d/b/a South Kingstown Nursing and Rehabilitation Center (SKNRC), Rhode Island, agreed to pay $42,734.62 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SKNRC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-25-2018: After it self-disclosed conduct to OIG, Copiah Community Care Center, LLC d/b/a Copiah Living Center (Copiah), Mississippi, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Copiah employed an unlicensed individual to provide nursing services as a Licensed Practical Nurse that were paid for by Federal health care programs.
03-12-2018: After it self-disclosed conduct to OIG, Christian Living Neighborhoods (CLN), Colorado, agreed to pay $42,775.78 or allegedly violating the Civil Monetary Penalties Law. OIG alleged that CLN submitted claims for services provided by an unlicensed nurse at one of its skilled nursing facilities.
03-08-2018: After it self-disclosed conduct to OIG, AGA Home Health, Inc. (AGA), Utah, agreed to pay $77,817.56 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AGA submitted claims to Medicare for unnecessary home health services that lacked medical documentation.
03-07-2018: After it self-disclosed conduct to OIG, City of Hammond (Hammond), Indiana, agreed to pay $247,752.17 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Hammond submitted claims for ambulance transports by crew members that lacked a current EMT-Basic certification.
03-05-2018: After it self-disclosed conduct to OIG, Florida Hospital Medical Group, Inc. (FHMG), Florida, agreed to pay $298,242 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that FHMG submitted claims for outpatient and inpatient hospital visits by an employed physician when those outpatient and inpatient visits were not performed.
02-23-2018: After it self-disclosed conduct to OIG, Nazareth Hall d/b/a Nazareth Living Care Center (Nazareth), Texas, agreed to pay $3,910,846.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Nazareth did not follow Medicare requirements when submitting Change of Therapy forms for rehabilitative therapy services.
02-20-2018: After it self-disclosed conduct to OIG, Scotland Memorial Hospital, Inc. (Scotland), North Carolina, agreed to pay $252,455.56 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Scotland submitted claims in violation of the provider-based billing requirements for sleep diagnostic and treatment services provided at Scotland Sleep Center and as a result was paid more than it should have been by Medicare and TRICARE.
02-13-2018: After it self-disclosed conduct to OIG, Northwell Health Inc. (Northwell), New York, agreed to pay $12,736,087 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Northwell hospitals submitted claims to Medicare that they knew or should have known did not meet the requirements of Medicare Local Coverage Determination, "Veterbroplasty and Vertebral Augmentation - Percutaneous, L26439," because the supporting documentation for those claims failed to demonstrate: (1) that non-surgical medical treatment typically lasting at least six weeks had failed, or (2) the existence of pathological fracture (including osteoporotic fracture), and not simply a fracture attributable to traumatic causes.
02-09-2018: After they self-disclosed conduct to OIG, CHRISTUS Health and CHRISTUS Santa Rosa Health Care Corporation, d/b/a Santa Rosa Hospital (collectively, "CHRISTUS"), agreed to pay $148,095 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to physician self-referrals and kickbacks. OIG alleged that CHRISTUS paid remuneration that was above fair market value to a medical distributorship owned by a physician in exchange for the physician's referrals of Federal healthcare beneficiaries to two hospitals owned and operated by CHRSITUS hospitals.; After they self-disclosed conduct to OIG, Fennis Bledsoe and Atlanta Dental Clinic, Inc. (collectively, "Atlanta Dental"), Indiana, agreed to pay $125,446 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Atlanta Dental submitted claims to Indiana Medicaid for dental services provided by non-credentialed dentists under the names of dentists who were credentialed with Indiana Medicaid.
02-08-2018: After it self-disclosed conduct to OIG, Highland Rivers Community Service Board, d/b/a Highland Rivers Health (Highland Rivers), Georgia, agreed to pay $133,067.26 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Highland Rivers submitted or caused the submission of claims for psychiatric telehealth services provided to Medicare beneficiaries at certain Highland Rivers locations when the locations were not eligible for Medicare telehealth reimbursement because they were not "originating sites".
01-31-2018: After they self-disclosed conduct to OIG, Central Virginia Pharmacy Consultants, PC d/b/a Rustburg Family Pharmacy and James V. Ettare II (collectively, "Rustburg"), Virginia, agreed to pay $60,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rustburg submitted false and fraudulent claims to Medicare Part D for compounded drugs that used bulk pharmaceutical powder, instead of crushed tablets of Food and Drug Administration approved drugs.
01-30-2018: After they self-disclosed conduct to OIG, Shands Jacksonville Medical Center, Inc. d/b/a UF Health Jacksonville (Medical Center) and University of Florida Jacksonville Physicians, Inc. (UFJPI), Florida, agreed to pay $4,476,123.63 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the Medical Center and UFJPI presented claims to Medicare and Medicaid for hospital and professional services associated with surgical procedures performed by an ophthalmologist, at the Medical Center, when the record did not support medical necessity for the procedures performed.
01-23-2018: After it self-disclosed conduct to OIG, Miller Holdings Sunrise, Inc. d/b/a Sunrise Homes (Sunrise Homes), Ohio, agreed to pay $15,815.88 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Sunrise Homes employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-17-2018: After it self-disclosed conduct to OIG, Wahiawa General Hospital (Wahiawa), Hawaii, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Wahiawa employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-05-2018: After it self-disclosed conduct to OIG, St. Agnes Healthcare, Inc. (St. Agnes), Maryland, agreed to pay $2,231,722.50 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that St. Agnes paid remuneration to a physician in the form of excessive compensation that included an inflated salary and improper incentive and administrative payments.
01-03-2018: After it self-disclosed conduct to OIG, East Tennessee Personal Care Services, LLC (ETPCS), Tennessee, agreed to pay $85,131.56 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ETPCS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2017

12-22-2017: After it self-disclosed conduct to OIG, Cavalier County Memorial Hospital Association (CCMHA), North Dakota, agreed to pay $750,000 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that CCMHA paid improper remuneration to two physicians and a nurse practitioner in the form of excessive compensation. OIG also contended that such remuneration created prohibited financial relationships with the two physicians and that CCMHA presented claims for designated health services that resulted from prohibited referrals made by the physicians.
12-20-2017: After it self-disclosed conduct to OIG, Seton Medical Center (Seton), California, agreed to pay $27,225 for alleged violating the Civil Monetary Penalties Law. OIG alleged that Seton submitted claims to Medicare for cataract extraction procedures when it did not supply the specialized Intraocular Lens (IOL) and should not have been reimbursed for the IOL supply.
12-19-2017: After it self-disclosed conduct to OIG, Heart Center of Philadelphia, P.C. (Heart Center), Pennsylvania, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Heart Center received remuneration from a laboratory company in the form of "process, handling, and collection" payments related to the collection of blood. OIG also contended that Heart Center received remuneration from the laboratory company in the form of "consulting" fees. OIG contended that Heart Center received the remuneration from the laboratory company in exchange for Heart Center referring patients for laboratory testing services, which were paid by Federal health care programs.
12-12-2017: After they self-disclosed conduct to OIG, Meriwether Healthcare, LLC d/b/a Warm Springs Medical Center and Warm Springs Nursing Home (collectively, "Warm Springs"), Georgia, agreed to pay $253,398.32 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Warm Springs employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Friendly Medical Transportation, LLC (FMT), North Carolina, agreed to pay $54,812.25 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that FMT employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-06-2017: After it self-disclosed conduct to OIG, HVL Corp d/b/a The Whittier Pavilion (Whittier), Massachusetts, agreed to pay $51,021 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Whittier employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Keystone Behavioral Pediatrics, LLC (Keystone), Florida, agreed to pay $26,245.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Keystone presented claims to TRICARE for behavioral health supervision services that were not actually provided.
12-01-2017: After they self-disclosed conduct to OIG, Kennon Stuart Legacy Trusts and the QTIP Trust, through its companies Victoria Special Care Center, Inc. d/b/a Shea Family Care Victoria and Magnolia Special Care Center, Inc. d/b/a Shea Family Care Magnolia (collectively, "Shea Family Care"), California, agreed to pay $399,700.45 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Shea Family Care employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
11-09-2017: After it self-disclosed conduct to OIG, Fisher & Paykel Healthcare, Inc. (Fisher & Paykel), California, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Fisher & Paykel paid remuneration to durable medical equipment suppliers that took the form of credits of amounts the suppliers owed for resupply services provided when continuous positive airway pressure masks, nasal interfaces, and headgear manufactured by affiliated entities of Fisher & Paykel were resupplied.
11-06-2017: After they self-disclosed conduct to OIG, Arkansas Family Care Network, P.A., Michael Beard, M.D., and Michael Kittell, M.D. (collectively, "AFCN"), agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that AFCN solicited and received remuneration from a laboratory company in the form of "process and handling" payments related to the collection of blood. OIG contended that AFCN solicited and received the remuneration in exchange for AFCN referring patients for laboratory testing services, which were paid by Medicare.
11-03-2017: After it self-disclosed conduct to OIG, EyeCare Associates of East Texas (ECA), Texas, agreed to pay $13,562.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ECA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-26-2017: After it self-disclosed conduct to OIG, St. Vincent Frankfurt Hospital, Inc. (SVFH), Indiana, agreed to pay $120,066.17 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that SVFH provided remuneration to a physician practice and a physician in the form of medical office spaces, where SVFH charged the practice and the physician rent at less than fair market value.
10-25-2017: After it self-disclosed conduct to OIG, DaVita Medical Management Services Nevada, LLC (DaVita), Nevada, agreed to pay $3,320,483.34 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DaVita submitted claims to Federal health care programs for Routine Home Care and General Inpatient services, provided by a hospice company DaVita acquired, when the medical record did not support the patient's eligibility for those hospice services or the level of care provided.
10-10-2017: After it self-disclosed conduct to OIG, MAS Medical Staffing Corporation (MAS), Rhode Island, agreed to pay $93,703.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MAS employed an individual, on a per diem basis on behalf of healthcare providers, that it knew or should have known was excluded from participation in Federal health care programs.
10-06-2017: After it self-disclosed conduct to OIG, OSF Healthcare System, d/b/a OSF Home Care Services (OSF), Illinois, agreed to pay $188,620.79 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OSF submitted claims to Medicare and Medicaid for skilled nursing services provided by a nurse whose license was suspended and therefore was ineligible to provide such nursing services.
09-28-2017: After it self-disclosed conduct to OIG, Humana Inc. (Humana), headquartered in Kentucky, agreed to pay $411,600 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Humana knowingly made or used false records or statements material to false or fraudulent claims for payment for items and services furnished under a Federal health care program. Specifically, OIG alleged that Humana knowingly made "meaningful use" attestations as part of its participation in the Centers for Medicare & Medicaid Services Electronic Health Records Incentive Program.
09-06-2017: After it self-disclosed conduct to OIG, Adventist Health System Sunbelt Healthcare Corporation d/b/a AHS Information Services (AHS), Florida, agreed to pay $101,435.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Adventist Health System Sunbelt Healthcare Corporation d/b/a Rx Plus Pharmacy (Rx Plus), Florida, agreed to pay $15,437.12 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rx Plus employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-01-2017: After it self-disclosed conduct to OIG, Leroy R. Polite, D.M.D., P.A., d/b/a Economy Dentures and Economy Dentistry (Economy Dentures), Florida, agreed to pay $279,135 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Economy Dentures employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-24-2017: After it self-disclosed conduct to OIG, Apex Dermatology and Skin Surgery Center, LLC (Apex), Ohio, agreed to pay $125,070.71 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Apex employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-14-2017: After it self-disclosed conduct to OIG, OSF Healthcare System, d/b/a OSF St. Francis Hospital & Medical Group (OSF), Michigan, agreed to pay $1,143,152.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OSF submitted claims for physical therapy services provided by personnel who were not eligible to bill Federal health care programs for those services.
08-01-2017: After it self-disclosed conduct to OIG, Nurse Practitioner Health Services, LLC (NPHS), Ohio, agreed to pay $22,846.38 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NPHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-27-2017: After it self-disclosed conduct to OIG, UMC Physicians, formerly known as UMC Physician Network Services (UMCP), Texas, agreed to pay $3,364,079 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UMCP improperly filed claims with Federal health care programs for: (1) evaluation and management services; and (2) Doppler and Ultrasound testing services that were upcoded, not rendered, or otherwise not supported by the record.
07-11-2017: After it self-disclosed conduct to OIG, Volunteer Medical Services Corps of Lansdale (VMSCL), Pennsylvania, agreed to pay $26,795.70 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that VMSCL staffed its ambulance transport services with an individual who had not maintained registrations of his Emergency Medical Technician certification with the appropriate state authority and then submitted claims and received payment from Federal health care programs for those transport services.
07-06-2017: After it self-disclosed conduct to OIG, Arvada, Colorado Fire Protection District (AFPD), Colorado, agreed to pay $30,494.36 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AFPD staffed its ambulance transport services with two individuals whose paramedic certifications were expired and then submitted claims and received payment from Federal health care programs for these improperly staffed ambulance transport services.
06-23-2017: After it self-disclosed conduct to OIG, Calvert Physical Therapy and Sports Fitness Center (Calvert), Maryland, agreed to pay $368,740.59 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that: (1) Calvert submitted claims to Medicare, Medicaid and TRICARE for therapeutic services that required direct one-to-one patient contact when the physical therapist was treating more than one patient at the same time: and (2) submitted claims to Medicare for patient re-evaluations when the physical therapist was recertifying Medicare patients' existing plans of care. OIG further alleged that Calvert improperly submitted claims to Medicare, Medicaid, and TRICARE for physical therapy services that failed to meet documentation requirements for time spent with patients and modalities used to treat patients.
06-16-2017: After it self-disclosed conduct to OIG, Laboratory Corporation of America (LabCorp), agreed to pay $45,466.13 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LabCorp, at a lab in Florida, employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-13-2017: After it self-disclosed conduct to OIG, Children's National Medical Center (CNMC), Washington, D.C., agreed to pay $615,263.42 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CNMC knowingly presented to Federal health care programs claims for services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, CNMC submitted claims for outpatient pediatric primary care services that it knew or should have known were furnished by medical students without required supervision.
06-12-2017: After they self-disclosed conduct to OIG, Central Maine Medical Center and Central Maine Health Care Corporation (collectively, "CMMC"), and Comprehensive Pharmacy Services, Inc. (CPS), Maine, agreed to pay $196,929 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CMMC, who had a contract with CPS to staff and manage its hospital pharmacies, employed an individual that CMMC and CPS knew or should have known was excluded from participation in MaineCare and that no MaineCare program payments could be made for items or services furnished by the individual.
06-02-2017: After it self-disclosed conduct to OIG, Tobii Dynavox, LLC (Tobii), Pennsylvania, agreed to pay $163,952.01 for allegedly violating the Civil Monetary Penalties Law provisions applicable to beneficiary inducements and kickbacks. OIG alleged that Tobii improperly induced Medicare and TRICARE beneficiaries to buy Tobii's products by waiving cost-sharing amounts without conducting an individualized determination of financial need.
05-16-2017: After it self-disclosed conduct to OIG, UnityPoint at Home (UnityPoint), Iowa, agreed to pay $18,562.95 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UnityPoint employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-11-2017: After it self-disclosed conduct to OIG, BrightView, LLC (BrightView), Ohio, agreed to pay $19,935.59 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BrightView employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-10-2017: After it self-disclosed conduct to OIG, Abingdon Convalescent Ambulance Service, Inc. (Abingdon), Pennsylvania, agreed to pay $20,087.98 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Abingdon submitted claims to Federal health care programs for ambulance transportation services provided an employee as if that employee had the EMT-Intermediate certification when, in fact, the employee had the EMT-Basic certification.
04-28-2017: After it self-disclosed conduct to OIG, Madison Parish Hospital Service District d/b/a Madison Parish Hospital (MPH), Louisiana, agreed to pay $1,800,000 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that MPH: (1) improperly submitted claims to Medicare related to certain inpatient admissions; (2) received remuneration in the form of inpatient Computed Tomography equipment and services provided below fair market value (FMV) from an independent diagnostic testing facility (IDTF) and paid remuneration to the IDTF in the form of below FMV medical office space and support services; and (3) improperly reported illegal remuneration from hospital vendors paid to a former CEO on MPH cost reports then used by the Medicare and Medicaid program to calculate reimbursement rates to MPH, resulting in overpayments.
04-24-2017: After it self-disclosed conduct to OIG, Ambulance Service of Fulton County, Inc. (Fulton), New York, agreed to pay $150,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fulton submitted claims to Federal health care programs for ambulance transportation services provided to beneficiaries which were improper because Fulton did not obtain the required beneficiary signatures.
04-21-2017: After it self-disclosed conduct to OIG, Samaritan Pacific Health Services, Inc. (Samaritan Pacific), Oregon, agreed to pay $263,700 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Samaritan Pacific paid remuneration to a medical practice in the form of office space use without a written lease or payment of rent.; After it self-disclosed conduct to OIG, Samaritan North Lincoln Hospital (Samaritan North), Oregon, agreed to pay $60,300 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Samaritan North paid remuneration to a medical practice in the form of office space use without a written lease or payment of rent.
04-20-2017: After they self-disclosed conduct to OIG, David Yoon, M.D., David Yoon, MD PA, and Primary Care Physicians, Inc. (collectively, "Dr. Yoon"), Florida, agreed to pay $379,085 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Yoon submitted false claims to Medicare for: (1) services rendered by providers who were not enrolled in the Medicare program; and (2) services rendered by non-physician providers as "incident to" when the "incident to" requirements under Medicare were not met.
04-18-2017: After it self-disclosed conduct to OIG, Pafford Medical Services, Inc. (Pafford), Arkansas, agreed to pay $390,587.18 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pafford employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Custom Clinic, PA d/b/a Smart Clinic (Smart Clinic), Minnesota, agreed to pay $24,696.18 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Smart Clinic submitted Chronic Care Management services under Current Procedural Terminology (CPT) Code 99490 that were not provided or that were not provided as required by CPT Code 99490.; After it self-disclosed conduct to OIG, Allergy Partners, P.A. (Allergy Partners), North Carolina, agreed to pay $14,638.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Allergy Partners submitted claims to Medicare for allergen immunotherapy injections provided without the requisite physician supervision.
04-06-2017: After it self-disclosed conduct to OIG, the Board of Trustees of the University of Illinois (University of Illinois), Illinois, agreed to pay $39,405.05 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the University of Illinois improperly billed neurosurgical procedures in the name of a physician who was not the appropriate physician to bill for the services.
03-21-2017: After it self-disclosed conduct to OIG, North Central Health Care Facilities (North Central), Wisconsin, agreed to pay $50,612.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that North Central employed an individual for the provision of items or services for which payment may be made under a Federal health care program. OIG alleged that North Central knew or should have known that the individual was not a licensed nurse, as she represented in certain employment related documentation, and that no Federal health care program payments could be made for items or services furnished by the unlicensed individual.
03-17-2017: After it self-disclosed conduct to OIG, Crittenton Hospital Medical Center (CHMC) and Crittenton Cancer Center (CCC), Michigan, agreed to pay $3,274,153.90 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that CHMC and CCC (1) paid more than fair market value compensation for prohibited financial arrangements with a physician and entities owned by that physician and (2) had compensation arrangements with the physician and entities owned by that physician that were at times not set forth in writing and, when a writing existed, did not act in accordance with the terms set forth therein. OIG further alleged that the remuneration described above created an inappropriate financial relationship and that CHMC and CCC presented claims for designated health services that resulted from the prohibited referrals.; After it self-disclosed conduct to OIG, Child and Family Services of New Hampshire (CFS), New Hampshire, agreed to pay $177,000 for allegedly violating the Civil Monetary Penalties Law. CFS administers a Healthy Families Home Visit (HFHV) program for low income, Medicaid eligible, pregnant women, to ensure coordinated social services pre and post birth. OIG alleged that CFS caused claims to be submitted to Medicaid for HFHV services that it knew or should have known were not provided as claimed by one of its case workers.
03-13-2017: After it self-disclosed conduct to OIG, Highland Medical, P.C. (Highland), New York, agreed to pay $403,151 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Highland submitted claims to Federal health care programs for Evaluation and Management Services purportedly provided by an employed physician, which were not rendered.
03-03-2017: After it self-disclosed conduct to OIG, Carroll Manor Nursing and Rehabilitation Center (Caroll Manor), Washington, D.C., agreed to pay $1,962,227.92 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Caroll Manor submitted claims to Medicare for therapy that lacked a physician certification for the plan of care and/or proper documentation for the number of therapy minutes billed.
02-28-2017: After it self-disclosed conduct to OIG, Quest Diagnostics, Incorporated (Quest), New Jersey, agreed to pay $1,151,053.07 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that: (1) phlebotomists employed by Quest performed services at multiple locations in Texas, Maryland, Ohio and New Jersey that were outside the scope of their employment; (2) Quest failed to meet documentation requirements supporting its donation of valuable electronic health records software or information technology and services through donation agreements with individuals or entities from which Quest received referrals of clinical laboratory business; and (3) Quest failed to collect timely second-year payments from physician clients as required in electronic health record donation agreements.
02-16-2017: After it self-disclosed conduct to OIG, Athena Orchard View LLC d/b/a Orchard View Manor (Orchard View), Rhode Island, agreed to pay $61,576.22 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Orchard View employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-08-2017: After it self-disclosed conduct to OIG, Metro Health Corporation and its subsidiary, Metropolitan Hospital d/b/a Metro Health Hospital (Metro Health), Michigan, agreed to pay $2,305,743.39 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Metro Health entered into professional services agreements with two independent contractor physician groups for the provision of neurosurgical and general surgery services and paid the physician groups in excess of fair market value.; After it self-disclosed conduct to OIG, OhioHealth Corporation (OhioHealth), Ohio, agreed to pay $231,277.60 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OhioHealth employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.
02-06-2017: After it self-disclosed conduct to OIG, Health Services, Inc. (Health Services), Alabama, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Health Services employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
02-01-2017: After it self-disclosed conduct to OIG, Ridgeview Institute, Inc. (Ridgeview), Georgia, agreed to pay $29,113.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Ridgeview employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-30-2017: After it self-disclosed conduct to OIG, Ocean Dental of Arkansas, PC (ODA), Arkansas, agreed to pay $17,346 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ODA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-24-2017: After it self-disclosed conduct to OIG, Quest Diagnostics, Incorporated (Quest), agreed to pay $315,093.35 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Quest, at one of its laboratories in New Jersey, paid remuneration in the form of greater than fair market value rent for space, which was related to a medical practice that referred patients to Quest.
01-23-2017: After it self-disclosed conduct to OIG, Staten Island University Hospital (SIUH), New York, agreed to pay $1,132,489.61 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SIUH knowingly submitted claims to Medicare for walk-in and home-drawn lab services that were performed at one of SIUH's outpatient lab facilities that it knew or should have know were false because they lacked sufficient documentation in one or more of the following areas: (1) the claims at issue lacked a signature or adequate medical documentation supporting the physician's intent to have the lab test performed, (2) the claims at issue lacked a date of request for lab services to be performed, or (3) the claims at issue for home-drawn lab services lacked a physician's order directing collection of the specimen in a patient's home.
01-13-2017: After it self-disclosed conduct to OIG, Planned Parenthood Great Plains and Comprehensive Health of Planned Parenthood Great Plains (collectively, "PGP"), Kansas, agreed to pay $18,808.92 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PGP submitted claims to Medicaid where the services were (1) provided by advanced registered nurse practitioners (ARNPs) but were billed improperly under a supervisory physician's name and national provider identifier, and (2) provided by ARNPs who were not properly enrolled or credentialed under the Medicaid program and were billed improperly under a supervisory physician's name and national provider identifier.
01-06-2017: After it self-disclosed conduct to OIG, St. Joseph Hospital, Breese, of the Hospital Sisters of the Third Order of St. Francis (SJHB), Illinois, agreed to pay $421,692.35 for allegedly violating the Civil Monetary Penalties. OIG alleged that SJHB knowingly presented to Federal health care programs claims 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 two independent contractor physicians affiliated with SJHB improperly permitted clinical staff to use: (1) signature stamps on physician order forms; (2) pre-signed physician orders; and (3) physician orders signed by clinical staff on their behalf with their knowledge.

2016

12-28-2016: After it self-disclosed conduct to OIG, New LifeCare Hospitals of Northern Nevada, LLC d/b/a Tahoe Pacific Hospitals (New Life Care), Nevada, agreed to pay $57,425.51 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that New LifeCare employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, KaleidAScope, Inc. (KaleidAScope), Pennsylvania, agreed to pay $18,468.30 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that KaleidAScope submitted claims for individual/intake therapy sessions that were billed as four units of service in fifteen-minute increments, instead of one unit of service.; After it self-disclosed conduct to OIG, Wexner Heritage Village (Wexner), Ohio, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Wexner employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-23-2016: After it self-disclosed conduct to OIG, Dr. Henry Tripp, Oldtown Immediate Care, P.A d/b/a Old Town Immediate and Family Care, and Ameri-Care Family Practice, P.A. (collectively, Dr. Tripp), North Carolina, agreed to pay $133,880.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Tripp submitted claims to Medicare for nurse practitioner services as if Dr. Tripp personally performed the services. These claims should have been submitted to Medicare using the nurse practitioner's National Provider Identifier at the nurse practitioner rate.
12-22-2016: After it self-disclosed conduct to OIG, Alternative Consulting Enterprises, Inc. (ACE), Pennsylvania, agreed to pay $126,102.38 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ACE employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-21-2016: After it self-disclosed conduct to OIG, the City of Grand Junction, Colorado (Grand Junction), agreed to pay $25,288.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Grand Junction staffed its ambulance transport services with two individuals whose Emergency Medical Technician (EMT) Basic or EMT Paramedic certifications were expired. Grand Junction then submitted claims and received payment from Federal health care programs for these improperly staff ambulance transport services.
11-30-2016: After it self-disclosed conduct to OIG, Antelope Valley Hospital (AVH), California, agreed to pay $190,087.90 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AVH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-21-2016: After it self-disclosed conduct to OIG, San Luis Obispo Count (San Luis), California, agreed to pay $56,583.68 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that San Luis excused clients from their drug and alcohol group counseling sessions prior to the scheduled end of the sessions, but billed the Medicaid program as if the sessions had been completed.
11-18-2016: After it self-disclosed conduct to OIG, Dignity Health (Dignity), agreed to pay $368,364.69 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to beneficiary inducements, physician self-referrals and kickbacks. OIG alleged that at one of Dignity's facilities in California, Dignity offered and paid the following remuneration in connection with an arrangement to induce referrals from physician specialists at a community physician practice: (a) medical equipment provided without charge and without a written agreement; (b) payments made to the physician practice for teaching physician supervision services that were not provided as claimed; (c) payments to a physician for services that were not provided as claimed; (d) payment for medical waste disposal services provided to the physician practice by a third party; (e) free medical supplies provided to the physician practice; (f) free taxi vouchers provided to patients of the physician practice; (g) food, drinks and baby shower gifts provided to patients of the physician practice; and (h) payments to two physicians for liaison marketing services that were not provided.
11-17-2016: After it self-disclosed conduct to OIG, Scheurer Hospital, Michigan, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Scheurer Hospital paid remuneration to a physician in the form of lodging costs.
11-10-2016: After it self-disclosed conduct to OIG, Ridgewood Medical Health, PLLC (Ridgewood), New York, agreed to pay $29,744 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Ridgewood submitted claims to Medicare for services provided by physician assistants at the rate payable for physician services instead of at the lower rate payable for physician assistant services.
10-26-2016: After it self-disclosed conduct to OIG, Our Lady of Lourdes (Lourdes), Washington, agreed to pay $55,575.00 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Lourdes paid remuneration to various members of its medical staff including physicians in the form of gift cards to local restaurants.
10-19-2016: After it self-disclosed conduct to OIG, Miller EMS, LLC (Miller), Oklahoma, agreed to pay $64,921.67 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Miller submitted claims to Federal health care programs for ambulance transportation services provided by an Emergency Medical Technician (EMT) as if she was properly licensed as an EMT, when, in fact she was not properly licensed. OIG alleged that Miller did not meet the staffing requirements and, therefore, the services were not provided as claimed and the claims were false or fraudulent.
10-18-2016: After it self-disclosed conduct to OIG, Memorial Hermann Health System (MHHS), Texas, agreed to pay $5,652,628.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MHHS improperly submitted claims to Federal health care programs for certain outpatient services that automatically appended modifiers 59 or 91 to Current Procedural Terminology codes.
10-11-2016: After they self-disclosed conduct to OIG, Muscogee (Creek) Nation Department of Health, acting on behalf of its subsidiary Creek Nation Hospital and Clinics d/b/a Creek Nation EMS (collectively, "Creek"), Oklahoma, agreed to pay $171,767.52 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Creek submitted claims to Federal health care programs for services provided by an unlicensed emergency medical technician.; After it self-disclosed conduct to OIG, Affinity Health System, a wholly owned subsidiary of Ministry Health Care (Affinity), Wisconsin, agreed to pay $50,000.00 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Affinity, as the parent company of two hospitals, entered into an improper financial relationship with a medical group practice involving an arrangement for the two hospitals to provide ultrasound equipment, space, and staff to the medical group practice for less than fair market value.
09-30-2016: After it self-disclosed conduct to OIG, Orthopedic Center of Vero Beach, P.A. (OCVB), Florida, agreed to pay $46,904.95 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OCVB billed for services provided by a physician using previously recorded consultation notes written by other physicians as his initial admitting history and physician examination and failing to generate his own patient encounter notes.
09-28-2016: After it self-disclosed conduct to OIG, Drug Abuse Comprehensive Coordinating Office, Inc. (DACCO), Florida, agreed to pay $32,189.76 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DACCO employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-27-2016: After it self-disclosed conduct to OIG, Pediatric Plus Home Healthcare Services, LLC (Pediatric Plus), Indiana, agreed to pay $68,353.34 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pediatric Plus employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-26-2016: After it self-disclosed conduct to OIG, Costco Wholesale Corporation (Costco), agreed to pay $340,157.25 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Costco's pharmacy manager at its pharmacy located in Waltham, Massachusetts improperly altered prescription drug claims to Medicare Part D and the Massachusetts Medicaid program that resulted in high reimbursement from these programs than was appropriate.
09-21-2016: After they self-disclosed conduct to OIG, Consulate Health Care and Vero Beach Facility Operations, LLC d/b/a Consulate Health Care of Vero Beach (collectively, "Consulate Vero Beach"), Florida, agreed to pay $30,978.42 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Consulate Vero Beach employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-19-2016: After they self-disclosed conduct to OIG, American Professional Associates, LLC and Atlanta Oncology Associates, LLC (collectively, "APA/AOA"), Georgia, agreed to pay $125,905.45 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that APA/AOA submitted claims for radiation oncology and related services without direct physician supervision by a radiation oncologist or similarly qualified person, and/or without timely review by a radiation oncologist.; After they self-disclosed conduct to OIG, Vantage Oncology, LLC, Radiation Oncology Services of America, Inc., and ROSA of Georgia, LLC (collectively, "Vantage"), Georgia, agreed to pay $91,172.91 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Vantage submitted claims for radiation oncology and related services without direct physician supervision by a radiation oncologist or similarly qualified person, and/or without timely review by a radiation oncologist
09-16-2016: After it self-disclosed conduct to OIG, Metroplex Adventist Hospital, Inc. d/b/a Metroplex Hospital (Metroplex), Texas, agreed to pay $115,279.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Metroplex paid remuneration to a physician in the form of: (1) waived late fees for unpaid rent, and (2) office space leasing agreements, which improperly calculated the square footage actually used by the physician, and which did not include any payments for certain shared space.
09-14-2016: After it self-disclosed conduct to OIG, Achievement Center, Inc. (AC), Pennsylvania, agreed to pay $16,523.55 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AC submitted false claims to Medicaid for behavioral specialist services purported to be provided by a Behavioral Specialist Consultant employed by AC, but that were not in fact rendered or were not supported by documentation. OI contends that the Behavioral Specialist Consultant (1) provided insufficient documentation in the progress notes and/or patient charts to justify the time billed, (2) provided recorded/time-stamped signatures that did not match billed times, (3) included non-reimbursable services in the progress notes, and (4) completed/signed progress notes for other individuals while providing services to an identified client.
09-08-2016: After it self-disclosed conduct to OIG, Stony Brook University Hospital (Stony Brook), New York, agreed to pay $3,219,483.45 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Stony Brook failed to timely obtain re-certification statements for inpatient psychiatric services furnished to Medicare Part A beneficiaries with stays of more than 11 days, which resulted in more reimbursement from Medicare than would otherwise have been paid. OIG also contends that Stony Brook failed to properly code daily activities in its New York Medicaid-qualified Continuing Day Treatment Program, which resulted in improper Medicare Part B reimbursement for non-covered services to dual-eligible beneficiaries.
09-07-2016: After it self-disclosed conduct to OIG, CareGivers America Home Health Services, LLC (CareGivers), Pennsylvania, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that CareGivers paid remuneration to an independent contractor for their recommendation of CareGivers' home health services to physicians.
09-01-2016: After it self-disclosed conduct to OIG, Med Solutions, LLC (Med Solutions), New Jersey, agreed to pay $429,683.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Med Solutions double billed Medicare Part B for vials of Remicade, a physician-administered injectable medication used to treat autoimmune diseases. Med Solutions was permitted to administer partial vials of Remicade to avoid product waste, but was not permitted to bill for the same vial more than once.; After they self-disclosed conduct to OIG, Jason A. Joy, DC (Joy) and Joy Chiropractic, PA d/b/a Joy Family and Sports Chiropractic (JFSC), Kansas, agreed to pay $12,494.27 for allegedly violating the Civil Monetary Penalties Law. OIG contends that Joy and JFSC knowingly presented to Medicare Part B claims for items or services that they knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG alleged that Joy provided chiropractic care in the State of Kansas when he was not actively licensed as a chiropractor in the State because he failed to timely renew his chiropractic license.
08-17-2016: After it self-disclosed conduct to OIG, Rutherford County, North Carolina, Department of Emergency Medical Services (Rutherford), North Carolina, agreed to pay $652,671.53 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rutherford presented claims to Medicare and TRICARE for non-emergency transportation services that Rutherford knew or should have known were not provided as claimed and were false and fraudulent because they did not have valid Physician Certification Statement (PCS) forms as required. Specifically, OIG contended that the documentation for such transports either did not include a PCS form certifying the transport or contained PCS forms with: (1) falsified dates, cut and pasted signatures, and/or forged signatures by Rutherford's former Quality Assurance Specialist; (2) signatures dated after the transport date; or (3) photocopied or inaccurate signatures from providers.; After it self-disclosed conduct to OIG, Richland Memorial Hospital, Inc. (Richland), Illinois, agreed to pay $29,932.86 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Richland employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-12-2016: After it self-disclosed conduct to OIG, Buffalo Heart Group (BHG), New York, agreed to pay $13,084.73 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BHG employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-05-2016: After they self-disclosed conduct to OIG, Beth Israel Deaconess Hospital-Needham and Medical Care of Boston Management, Inc. d/b/a Affiliated Physicians Group (collectively, "BIDMC"), Massachusetts, agreed to pay $154,506.84 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BIDMC employed an individual that BIDMC knew or should have known was excluded from participation in Federal health care programs.
08-03-2016: After it self-disclosed conduct to OIG, Compliance Advantage, LLC (CAL), Kentucky, agreed to pay $32,249.15 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CAL employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-02-2016: After they self-disclosed conduct to OIG, UMass Memorial Health Care, Inc.; UMass Memorial Medical Center, Inc.; and the Clinton Hospital Association (collectively, "UMass"), Massachusetts, agreed to pay $30,299.27 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UMass employed an individual that UMass knew or should have known was excluded from participation in Federal health care programs.
07-29-2016: After they self-disclosed conduct to OIG, Cheshire Medical Center (CMC) and Dartmouth-Hitchcock Clinic (DHC), New Hampshire, agreed to pay $1,424,271 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CMC and DHC submitted claims to Medicare for Level I Evaluation and Management services for its Coumadin Clinic patients that were not performed as billed and/or were not medically necessary.
07-27-2016: After it self-disclosed conduct to OIG, Fort Worth Manor Nursing Center (Fort Worth Manor), Texas, agreed to pay $113,820.91 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fort Worth Manor employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-26-2016: After it self-disclosed conduct to OIG, Greene Memorial Hospital (GMH) and Fort Hamilton Hospital (FHH), Ohio, agreed to pay $748,968.33 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that GMH and FHH submitted claims to Federal health care programs for radiation oncology and related services when the services were provided without direct supervision by a radiation oncologist or similarly qualified person.
07-21-2016: After it self-disclosed conduct to OIG, Mayo Clinic Health System - Franciscan Medical Center, Inc. (Mayo Clinic), Wisconsin, agreed to pay $219,357.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mayo Clinic: (1) submitted claims to Federal health care programs for psychotherapy services allegedly provided by a psychiatrist using blended Current Procedural Terminology (CPT) Code 90805 or 90807, where the services were not billable, or where only Evaluation and Management service CPT Code 99212 or 99213 should have been billed; and (2) submitted claims to Federal health care programs for psychotherapy services allegedly provided by a psychiatrist, and billed each claim using CPT Code 90833, 90836, or 90838, where the services were not billable, or where only CPT Code 99212 or 99213 should have been billed.
07-15-2016: After they self-disclosed conduct to OIG, Buckner Elam Medical (BEM) and Setal Rana, M.D. (Dr. Rana), Texas, agreed to pay $435,481.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BEM and Dr. Rana employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
07-14-2016: After it self-disclosed conduct to OIG, O'Connor Hospital, California, agreed to pay $207,698 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that O'Connor Hospital employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-12-2016: After it self-disclosed conduct to OIG, Carolina Kidney Associates, P.A. (CKA), North Carolina, agreed to pay $11,805.48 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CKA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-11-2016: After it self-disclosed conduct to OIG, Doctors' Anesthesia Associates, Inc. (DAA), West Virginia, agreed to pay $519,058.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DAA submitted claims to Medicare and Medicaid for reimbursement for services personally performed by an anesthesiologist when, in fact, the services had been performed at least in part by licensed and certified registered nurse anesthetists who were not properly credentialed under the Medicare and Medicaid program.
07-07-2016: After it self-disclosed conduct to OIG, Medical Resources Group (MRG), Michigan, agreed to pay $362,515.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that MRG improperly paid remuneration to a surgical center and its owners through a side letter to a professional service agreement, signed by an employee of MRG without express authorization.; After it self-disclosed conduct to OIG, Palisades Health Care Partners, Inc. d/b/a ASAP Services Corporation (ASAP Services), District of Columbia, agreed to pay $66,647.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ASAP Services employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-06-2016: After it self-disclosed conduct to OIG, Gateway Healthcare, Inc. (Gateway), Rhode Island, agreed to pay $400,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Gateway employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.; After they self-disclosed conduct to OIG, New York Physicians LLP (NYP) and Lewis P. Schneider, M.D. (Dr. Schneider), New York, agreed to pay $57,839.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NYP and Dr. Schneider knowingly presented or caused to be presented to Medicare Part B beneficiaries and extra "office fee" ranging from $50 to $2,000 per patient for the convenience of performing colonoscopies and/or endoscopies in-office instead of at a hospital in violation of an assignment agreement.; After it self-disclosed conduct to OIG, Natera, Inc. (Natera), California, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Natera employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-24-2016: After it self-disclosed conduct to OIG, Five Star Quality Care-CA LLC d/b/a Lancaster Healthcare Center (Lancaster), California, agreed to pay $8,601,795 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Lancaster submitted claims for skilled nursing services without proper certifications and recertifications for services, establishment and content of therapy plans, and/or maintenance of clinical records. OIG also alleged that Lancaster paid remuneration to a physician for referrals pursuant to a medical director agreement.; After it self-disclosed conduct to OIG, Planned Parenthood Health System, Inc. (Planned Parenthood), incorporated in North Carolina, agreed to pay $1,572,752.80 for potentially violating the Civil Monetary Penalties Law. Planned Parenthood submitted claims to Medicaid programs in North Carolina, South Carolina, Virginia and West Virginia that included the following billing errors: (1) services billed under a provider number different than the medical professional who provided the service and (2) billed for services of non-physician practitioners who were not properly enrolled in their state Medicaid program.; After it self-disclosed conduct to OIG, Moses H. Cone Memorial Hospital Operating Corporation d/b/a Cone Health System (CHS), North Carolina, agreed to pay $475,220.66 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Boston University Eye Associates, Inc. (BUEA), Massachusetts, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that BUEA provided improper remuneration in the form of holiday gifts, consisting primarily of candy and other small food items, to physicians and physician practices who were referral sources.
06-23-2016: After it self-disclosed conduct to OIG, Community Care Physicians, P.C. (CCP), New York, agreed to pay $60,972.04 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CCP employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
06-20-2016: After it self-disclosed conduct to OIG, Medical Plaza Family and Geriatric Physician, P.A. (Medical Plaza), North Carolina, agreed to pay $109,975.24 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Medical Plaza submitted claims to Medicare for payment under two physicians' National Provider Identification numbers for incident-to services provided to patients at Medical Plaza when the services had been provided by Medical Plaza's nurse practitioners.
06-17-2016: After it self-disclosed conduct to OIG, Radiology Alliance, PC (Radiology Alliance), Tennessee, agreed to pay $355,461.34 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Radiology Alliance submitted claims to Federal health care programs that were false or fraudulent in the following ways: (1) services were performed by two radiology practitioner assistants that were supervised by Radiology Alliance's physicians as if they were personally provided by the physicians; (2) in certain instances Radiology Alliance billed for nursing practitioner and physician assistant services using the supervising physician's billing number at the supervising physician's billing rate; and (2) billed for the insertion of peripherally inserted central catheter lines by hospital nurses and radiology technicians that were supervised by Radiology Alliance's physicians as if those services were directly provided by the physicians.; After it self-disclosed conduct to OIG, UHS of Fairmount, Inc. d/b/a Fairmount Behavioral Health System (Fairmount), Pennsylvania, agreed to pay $58,339.74 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fairmount employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-09-2016: After it self-disclosed conduct to OIG, St. Vincent Medical Group, Inc. (St. Vincent), Indiana, agreed to pay $523,135.76 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. Vincent submitted claims to Federal health care programs for evaluation and management services where the services where upcoded or where the supporting documentation did not support any billable services.; After it self-disclosed conduct to OIG, CNY Women's Healthcare, P.C. (CNY), New York, agreed to pay $123,122.44 65 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CNY submitted claims to Federal health care programs for services provided by a physician that lacked documentation or lacked sufficient documentation.
05-24-2016: After it self-disclosed conduct to OIG, Prime Pharmacy Solutions, LLC (PPS), Louisiana, agreed to pay $613,671.22 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PPS submitted claims for compound drug prescriptions to Federal health care programs that overstated the amount of ingredients actually dispensed, or included more than an amount prescribed by the physician.; After it self-disclosed conduct to OIG, ZMS1 LLC, d/b/a The Medicine Shoppe Pharmacy, in Kissimmee, Florida (ZMS), agreed to pay $35,313.05 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ZMS submitted claims to Federal health care programs for compound drug prescriptions when it knew or should have known the claims overstated the amount of the active ingredient Lipoderm actually dispensed.
05-19-2016: After it self-disclosed conduct to OIG, Regional Medical Laboratory, Inc. (RML), Oklahoma, agreed to pay $1,095,279.69 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that RML paid remuneration to a medical group in the form of a profit-splitting arrangement related to on-site clinical reference laboratory services for non-governmental business which induced the referral of business for which the government was the payer.; After it self-disclosed conduct to OIG, UHS of Westwood Pembroke, Inc. d/b/a Pembroke Hospital (Pembroke Hospital), Massachusetts, agreed to pay $807,856.65 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pembroke Hospital employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Fort Duncan Medical Center, L.P. d/b/a Fort Duncan Regional Medical Center (FDRMC), Texas, agreed to pay $545,995.62 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that FDRMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, BHC Streamwood Hospital, Inc. d/b/a Streamwood Behavioral Health System (SBHS), Illinois, agreed to pay $285,683.03 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SBHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, UHS of Dover, LLC d/b/a Dover Behavioral Health System (DBHS), Delaware, agreed to pay $197,320.85 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DBHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, UHS of Texoma, Inc. d/b/a Texoma Medical Center (TMC), Texas, agreed to pay $127,001.69 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that TMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, TBD Acquisition, LLC d/b/a Brook Hospital-Dupont (BHD), Kentucky, agreed to pay $119,033.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BHD employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, La Amistad Residential Treatment Center, LLC d/b/a Central Florida Behavioral Hospital (CFBH), Florida, agreed to pay $26,744.55 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CFBH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, UHS of Parkwood, Inc. d/b/a Parkwood Behavioral Health System (PBHS), Mississippi, agreed to pay $13,092.48 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PBHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-18-2016: After it self-disclosed conduct to OIG, Health Recovery Services, Inc. (HRS), Ohio, agreed to pay $213,564.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HRS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-06-2016: After it self-disclosed conduct to OIG, Anesthesia and Pain Management Services of Pueblo, LLC and APM Billings, LLC (collectively, "APM"), Colorado, agreed to pay $207,923 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that APM forged physician signatures on Colorado Medical Assistance Program Sterilization Consent Forms and submitted these forms to Colorado Medicaid in order to receive reimbursement for anesthesia services provided during tubal ligation. OIG also alleged that APM improperly submitted claims for reimbursement for services provided by Certified Registered Nurse Anesthetists whose Medicare credentialing forms were forged.; After it self-disclosed conduct to OIG, Where The Heart Is (WTHI), Tennessee, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that WTHI employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-05-2016: After it self-disclosed conduct to OIG, Sheridan Community Hospital (Sheridan), Michigan, agreed to pay $124,800 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Sheridan received improper remuneration from a physician practice and provided improper remuneration to physicians/physician practices and that this conduct violated physician self-referral and kickback prohibitions.; After it self-disclosed conduct to OIG, 125 Alma Boulevard Operations LLC d/b/a Island Health and Rehabilitation Center (IHRC), Florida, agreed to pay $30,924.11 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that IHRC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, AHS Oklahoma Physician Group, LLC d/b/a Utica Park Clinic (UPC), Oklahoma, agreed to pay $13,467.01 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UPC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-12-2016: After it self-disclosed conduct OIG, Diversicare Healthcare Services, Inc. (Diversicare), headquartered in Delaware, agreed to pay $514,424 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Diversicare employed four individuals that it knew or should have known were excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Marias Care Center (Marias), Montana, agreed to pay $85,952.72 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Marias employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-05-2016: After it self-disclosed conduct to OIG, Union County General Hospital (Union County), New Mexico, agreed to pay $45,458.10 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Union County presented false or fraudulent claims to Medicare for services purportedly provided or supervised by a physician when he was not present at Union County and his presence was required.
03-22-2016: After it self-disclosed conduct to OIG, Senior Care Centers and Midland SCC, LLC d/b/a Senior Care Midland (collectively, Senior Care), Texas, agreed to pay $162,171.36 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Senior Care employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-18-2016: After it self-disclosed conduct to OIG, St. John Hospital and Medical Center (St. John), Michigan, agreed to pay $79,167 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that St. John paid remuneration in excess of fair market value to an independent contractor physician oncology group with which it entered into a professional services agreement. OIG alleged that St. John improperly compensated the oncology group based on work relative value units (wRVU) that the oncology group did not personally perform.
03-15-2016: After it self-disclosed conduct to OIG, Samuel U. Rogers Health Center (SURHC), Missouri, agreed to pay $196,013.37 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SURHC submitted claims to Missouri Medicaid for imaging services without pre-authorization, as required under Missouri Medicaid, and resubmitted claims for services that had been denied with a CPT code not reflective of the services rendered, resulting in improper payment.
03-14-2016: After it self-disclosed conduct to OIG, Lahey Health System, Inc. on behalf of its current subsidiaries and affiliates Lahey Clinic Hospital, Inc. (LCH), Northeast Senior Health Corporation, and Visiting Nurse Association of Middlesex-East, Inc. (collectively, Lahey), Massachusetts, agreed to pay $1,923,993 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Lahey received remuneration from home health agencies in the form of free administrative services related to discharge planning provided by the home health agencies staff serving as liaisons for their respective home health agency employers. Specifically, OIG contends that, without any written contract, some of the functions performed by the home health agency employees were functions that ordinarily would have been performed by LCH discharge planners or other LCH staff, and those services constituted improper remuneration. After it self-disclosed conduct to OIG, Northeast Kingdom Human Services, Inc. (NKHS), Vermont, agreed to pay $50,712.27 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NKHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-26-2016: After it self-disclosed conduct to OIG, Consulate Health Care (Consulate), Florida, agreed to pay $359,388.10 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Consulate employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Consulate Health Care and Perry Village Facility Operations, LLC d/b/a The Manor at Perry Village (collectively, Perry Village), Florida, agreed to pay $29,324.36 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Perry Village employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Good Samaritan Society HCBS-Choice, LLC d/b/a Choice Home Health Care (CHHC), Texas, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-22-2016: After it self-disclosed conduct to OIG, Decatur County Memorial Hospital (Decatur), Indiana, agreed to pay $3,757,615.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Decatur improperly submitted claims for home health care where the underlying patient files contained the following deficiencies: (1) venipuncture identified as the only skilled service furnished for purposes of justifying Medicare home health eligibility; (2) missing or incomplete documentation; (3) certifications and orders unsigned or undated by physicians; (4) lack of documentation to support the patient's skilled need or homebound status; and (5) documentation indicating that the requisite physician face-to-face encounter was not timely performed, or the absence of any face-to-face encounter documentation.; After it self-disclosed conduct to OIG, Cedars-Sinai Medical Center (Cedars), California, agreed to pay $872,925 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Cedars submitted claims to Federal health care programs for outpatient and inpatient professional services on behalf of a physician that were not provided as claimed or for which there was insufficient documentation to support the level of professional services claimed.; After it self-disclosed conduct to OIG, Hamilton Medical Group, Inc. (Hamilton), Louisiana, agreed to pay $259,746.37 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Hamilton submitted claims to Medicare and Medicaid for upcoded patient bills to reflect higher levels of services than were actually warranted.
02-05-2016: After it self-disclosed conduct to OIG, Napa County Health & Human Services Agency (Napa), California, agreed to pay $35,064.19 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Napa submitted claims to the Medicaid program, through the California Department of Health Service, for services provided by an employee of Napa's Public Health Division that were not provided as claimed.; After it self-disclosed conduct to OIG, Specialized Physical Therapy, P.C. (SPT), Oklahoma, agreed to pay $22,635.77 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that two SPT employees submitted false and fraudulent physical therapy claims on SPT's behalf to Medicare. OIG contended that the claims submitted on behalf of SPT were false and fraudulent because (1) the services were billed as one-on-one patient/therapist encounters where group therapy services were provided; (2) the services did not accurately reflect the amount of time spent administering therapy for time based CPT codes; (3) the services were provided by a physical therapy assistant who was not properly supervised; and/or (4) some services were provided by unlicensed and unqualified individuals.; After it self-disclosed conduct to OIG, Scott & White Memorial Hospital (S&W), Texas, agreed to pay $19,146.08 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that S&W employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-27-2016: After it self-disclosed conduct to OIG, Liberty Medical Center (Liberty), Montana, agreed to pay $60,649.29 for allegedly violating the civil Monetary Penalties Law. OIG alleged that Liberty submitted claims to Medicare for erroneously billed Hospital Based Ambulatory Care services that were performed by Liberty's clinic as though they were provided in the hospital section of Liberty.
01-21-2016: After it self-disclosed conduct to OIG, Berkeley HeartLab, Inc. (Berkeley) and Celebra Corp. (Celebra), California, agreed to pay $750,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Berkeley and Celebra submitted claims to Medicare for clinical laboratory services performed on blood specimens previously submitted by the ordering physician or other health care professional that lacked indicia of medical necessity.; After they self-disclosed conduct to OIG, Delaware Valley Community Health, Inc. (DVCH) and Fairmount Primary Care Center (FPCC), Pennsylvania, agreed to pay $27,061.58 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DVCH and FPCC employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
01-11-2016: After it self-disclosed conduct to OIG, Claxton-Hepburn Medical Center (CHMC), New York, agreed to pay $23,483.39 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-07-2016: After it self-disclosed conduct to OIG, Somerset Cardiology Group, P.C. (Somerset), New Jersey, agreed to pay $422,741.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Somerset knowingly presented claims to Medicare for items or services that it knew or should have known were not provided as claims and were false and fraudulent. Specifically, OIG contended that Somerset cloned patient progress notes, as well as improperly coded and submitted for payment to Medicare E&M services that used current procedural terminology codes to reflect a higher level of service than the cardiologists actually preformed resulting in higher payments by Medicare to which Somerset was not entitled.; After they self-disclosed conduct to OIG, Trilogy Health Services, LLC (Trilogy) and PCA-Corrections, LLC (PCA), Kentucky, agreed to pay $80,526 for allegedly violating the Civil Monetary Penalties Law provisions applicable to beneficiary inducements and kickbacks. OIG alleged that Trilogy and PCA improperly induced Medicare beneficiaries to fill their drug prescriptions at PCA locations by waiving Medicare Part D prescription drug copayment amounts without conducting an individualized determination of financial need for residents at 50 skilled nursing and assisted living facilities owned and/or serviced by Trilogy or PCA.
01-06-2016: After it self-disclosed conduct to OIG, Precision Toxicology, LLC (Precision), California, agreed to pay $30,137.69 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Precision employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2015

12-30-2015: After it self-disclosed conduct to OIG, The Passavant Memorial Area Hospital Association (Passavant), Illinois, agreed to pay $275,000.22 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Passavant paid remuneration to a clinic in the form of compensation purportedly for the services of two physicians where delivery of the services could not be confirmed with documentation or otherwise.
12-23-2015: After it self-disclosed conduct to OIG, Bradshaw Medical Clinic, PC (Bradshaw), Tennessee, agreed to pay $24,637.76 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bradshaw submitted claims to Federal health care programs for: (1) services provided "incident-to" a physician's services when the services were not provided "incident-to" a physician's services; (2) services not provided as claimed; (3) non-reimbursable services; and (4) services where the Patient Encounter Form was missing and resulted in the correctness of payment not being verifiable.; After it self-disclosed conduct to OIG, Kindred Transitional Care and Rehab-Wyomissing (Kindred), Pennsylvania, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kindred employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-22-2015: After it self-disclosed conduct to OIG, Towson University Speech Language & Hearing Center (Towson), Maryland, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Towson submitted claims for audiology services with a National Provider Identification (NPI) number that did not correctly identify the provider that rendered those audiology services. OIG further alleged that for these services to be paid by Medicare, the audiologist must have been credentialed by Medicare as a provider and that audiologist's NPI number must accompany the claim.; After it self-disclosed conduct to OIG, Our Lady of Lourdes Hospital at Pasco (Lourdes), Texas, agreed to pay $460,173.45 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Lourdes paid remuneration to eight physicians in the form of arrangements for medical office building space and certain support services and supplies.
12-21-2015: After it self-disclosed conduct to OIG, Renown Health (Renown), Nevada, agreed to pay $598,213.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Renown failed to execute a written lease with a physician tenant and had provided for actual use of office space and provision of personnel beyond what the parties initially discussed and agreed. OIG further alleged that Renown paid remuneration to the physician in the form of office space and the services of medical assistant, patient access representative, a clinic dietician and a registered nurse.; After it self-disclosed conduct to OIG, Mercy Health Services, Inc. (Mercy), Maryland, agreed to pay $253,899 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Mercy paid remuneration to a spine center in the form of the services of a physician's assistant. OIG further alleged that the physician's assistant provided on-call services to the spine center without a written agreement in place and without any compensation paid to Mercy.; After it self-disclosed conduct to OIG, Caro Community Hospital (Caro), Michigan, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Caro paid remuneration to two physicians in the form of professional liability insurance premium payments to induce both physicians to continue seeing patients at Caro's hospital facility.; After it self-disclosed conduct to OIG, Dayem Health Services, LLC and its owner, Dr. Michael Dayem (collectively, Dayem), Ohio, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dayem employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-18-2015: After it self-disclosed conduct to OIG, Webster MA SNF, LLC d/b/a Webster Manor Rehabilitation and Health Care Center (Webster), Massachusetts, agreed to pay $18,454.44 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Webster employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-16-2015: After it self-disclosed conduct to OIG, Sports & Orthopedic Rehabilitation, P.L.L.C. d/b/a STAR Spine and Sport (STAR), Colorado, agreed to pay $19,095.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that STAR submitted claims to Medicare for items or services that were preferred by a physician's assistant for "incident-to" services using a STAR physician's provider identification number during times when the physician was not supervising the physician's assistant in accordance with Medicare guidelines.
12-09-2015: After it self-disclosed conduct to OIG, Indianapolis Osteopathic Hospital, Inc. d/b/a Westview Hospital Physicians (Westview), Indiana, agreed to pay $61,755 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Westview submitted claims to Medicare, Medicaid, and TRICARE for evaluation and management services allegedly performed by a physician, where the medical record documentation for the services failed to support the level of services billed and/or lacked physician credentials and signatures.
12-08-2015: After it self-disclosed conduct to OIG, Webster Manor Long Term Care Facility, Inc. (Webster Manor), Massachusetts, agreed to pay $92,881.76 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Webster Manor employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Kroger Co. (Kroger), Ohio, agreed to pay $21,523,047 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kroger: 1) employed 14 excluded individuals who were excluded from participation in Federal health care programs; and 2) filled prescriptions, for which payment was made under a Federal health care program, that were written by 84 excluded prescribers.
12-02-2015: After it self-disclosed conduct to OIG, The Lowell General Hospital (Lowell), Massachusetts, agreed to pay $225,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Lowell paid remuneration to a physician in the form of monthly payments under a written agreement to serve as a medical director of a specialty facility. Although the facility never came into existence, OIG alleged that, nevertheless, Lowell continued to make the monthly payments to the physician under the agreement.
11-23-2015: After it self-disclosed conduct to OIG, Northampton Manor, Inc. d/b/a Northampton Manor Health Care Center, Magnolia Management, Inc., Perini Services, Inc., and the Perini Family Trust (collectively, Northampton), Maryland, agreed to pay $183,450.97 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Northampton employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-12-2015: After it self-disclosed conduct to OIG, Signature Medical Group, Inc. (Signature), Missouri, agreed to pay $158,297.72 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Signature submitted claims to Medicare for pelvic floor electrical stimulation services rendered by a physician that failed to meet applicable coding and documentation requirements.
10-30-2015: After it self-disclosed conduct to OIG, Providence Hospital (Providence), Washington, D.C., agreed to pay $50,665.20 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Providence employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Van Rue, Inc. d/b/a Vancrest Health Care Center (Vancrest), Ohio, agreed to pay $35,117.64 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Vancrest employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-22-2015: After it self-disclosed conduct to OIG, Community Health United Home Care, LLC (CHUHC), Alabama, agreed to pay $9,800,707 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHUHC submitted claims to Medicare for two of its locations without certifications of terminal illness, face-to-face encounters, and/or physician narratives as required by regulations.; After it self-disclosed conduct to OIG, Cardiology Associates of Fredericksburg, Ltd. (CAF), Virginia, agreed to pay $49,578.63 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CAF employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-08-2015: After it self-disclosed conduct to OIG, Baptist Hospitals of Southeast Texas (BHSE), Texas, agreed to pay $116,946.72 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BHSE employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, East Tennessee Children's Hospital Association, Inc. (ETCHA), Tennessee, agreed to pay $221,920.61 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ETCHA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-07-2015: After it self-disclosed conduct to OIG, Jupiter Imaging Associates (JIA), Florida, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that JIA, through one of its employed physicians, paid remuneration to the top 100 referring physicians of JIA in the form of holiday gift cards. OIG alleged that the physician used reports of referring physicians to determine the corresponding value of holiday gifts based on the volume of referrals.
10-01-2015: After it self-disclosed conduct to OIG, COMHAR, Inc. (COMHAR), Pennsylvania, agreed to pay $24,128.07 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that COMHAR employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-22-2015: After it self-disclosed conduct to OIG, Community Hospice, LLC (Community), Mississippi, agreed to pay $87,792.87 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Community employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-17-2015: After it self-disclosed conduct to OIG, Brier Creek Integrated Pain & Spine, PLLC (Brier Creek), North Carolina, agreed to pay $222,348.81 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Brier Creek employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-14-2015: After it self-disclosed conduct to OIG, Spectrum Health Primary Care Partners d/b/a Spectrum Health Medical group (Spectrum), Michigan, agreed to pay $292,225.64 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.; After it self-disclosed conduct to OIG, Sanderling Renal Services-USA, LLC and SRS Ely, LLC d/b/a Sanderling Dialysis of Ely (Sanderling), Tennessee, agreed to pay $39,337.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Sanderling employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-10-2015: After it self-disclosed conduct to OIG, Humphreys Community Care Center, LLC d/b/a Humphreys County Nursing Center (Humphreys), Mississippi, agreed to pay $200,136.77 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Humphreys employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-02-2015: After it self-disclosed conduct to OIG, PHC Las Cruces, Inc. d/b/a Memorial Medical Center of Las Cruces (Las Cruces), New Mexico, agreed to pay $1,107,698 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Las Cruces paid remuneration to a physician in the form of payments for medical director services not performed. OIG contends that such remuneration created prohibited financial relationships and Las Cruces presented claims for designated health services that resulted from prohibited referrals. OIG also alleged that Las Cruces improperly billed certain Intensive Outpatient Psychiatric program claims that were not medically necessary and/or lacked sufficient documentation.
08-31-2015: After it self-disclosed conduct to OIG, Memorial Health Services and Saddleback Memorial Medical Center (collectively, "Saddleback"), California, agreed to pay $1,143,750 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Saddleback paid remuneration to a surgical practice in the form of payment for purported services that were not adequately documented or were beyond the scope of their medical director agreements, including services provided at third-party facilities. OIG contends that such remuneration created prohibited financial relationships and Saddleback presented claims for designated health services that resulted from prohibited referrals.; After it self-disclosed conduct to OIG, Community Medical Associates, Inc. (CMA), Kentucky, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that CMA received remuneration from a hospital in the form of an arrangement for medical office space and certain support services utilized by one of CMA's employees.; After it self-disclosed conduct to OIG, Inlet Physical Medicine (Inlet), Georgia, agreed to pay $11,905.89 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Inlet employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-27-2015: After it self-disclosed conduct to OIG, Laser Spine Institute, LLC and its subsidiaries (collectively, "Laser Spine"), Florida, agreed to pay $145,127.45 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged Laser Spine paid remuneration to Medicare and TRICARE beneficiaries in the form of hotel and travel assistance to induce referrals to Laser Spine.
07-31-2015: After it self-disclosed conduct to OIG, Northeast Medical Consultants, P.C. d/b/a Interventional Spine Medicine (Interventional Spine), New Hampshire, agreed to pay $185,767 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Interventional Spine submitted claims to Medicare for trigger point injections and joint/bursa injections when prolotherapy (which is not covered by Medicare) was being performed.
07-30-2015: After it self-disclosed conduct to OIG, The Health and Hospital Corporation of Marion County d/b/a Eskenazi Health (Eskenazi), Indiana, agreed to pay $5,840,322.54 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Eskenazi: 1) submitted claims to Medicare and Medicaid that were false or fraudulent because Eskenazi maintained a relationship with behavioral health services providers that did not meet applicable provider-based requirements, and 2) paid remuneration to a behavioral health services provider in the form of rent that exceeded fair market value.
07-14-2015: After it self-disclosed conduct to OIG, Theratech, Inc. (Theratech), Tennessee, agreed to pay $6,646,911.72 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Theratech submitted claims to Medicare for transcutaneous electrical nerve stimulators and related supplies without a detailed written physician order, and without adequate clinical documentation from the patient's medical record to support medical necessity and coverage.; After it self-disclosed conduct to OIG, Vantage Oncology, LLC, Radiation Oncology Services of America, Inc., ROSA of South Alabama, LLC, and ROSA of Eastern Shore, LLC (collectively, Vantage), Alabama, agreed to pay $9,561,998.58 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Vantage submitted claims for radiation oncology and related services without direct physician supervision by a radiation oncologist or similarly qualified person, and/or without timely review by a radiation oncologist.; After it self-disclosed conduct to OIG, Monroeville Radiation - Oncology, P.C., South Alabama Radiation Oncology, P.C., Eastern Shore Radiation Oncology, P.C., William Hixson, M.D. and Gulf Coast Cancer Center - Gulf Shores, P.C. (collectively, Gulf Coast), Alabama, agreed to pay $2,557,824.27 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Gulf Coast submitted claims for radiation oncology and related services without direct physician supervision by a radiation oncologist or similarly qualified person, and/or without timely review by a radiation oncologist.
07-08-2015: After it self-disclosed conduct to OIG, PeaceHealth, Washington, agreed to pay $23,407.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PeaceHealth employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-29-2015: After it self-disclosed conduct to OIG, Safe Haven Health Care, LLC (Safe Haven), Idaho, agreed to pay $262,249.44 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Safe Haven employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-09-2015: After it self-disclosed conduct to OIG, Miguel A. Gutierrez, M.D. and Miguel A. Gutierrez, M.D. & Associates, P.A. (Gutierrez), Texas, agreed to pay $596,986.77 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Gutierrez submitted claims to Federal health care programs for manual therapy when computerized therapy was being performed.
06-04-2015: After it self-disclosed conduct to OIG, Triangle Spine and Back Care Center of Raleigh (Triangle), North Carolina, agreed to pay $21,166.66 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Triangle submitted claims to Federal health care programs 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 Triangle submitted claims on behalf of and for services performed by a former physician, who worked for the practice for approximately six weeks, which contained inaccurate Current Procedural Terminology codes and inadequate documentation.
06-02-2015: After it self-disclosed conduct to OIG, Premier Urology Associates, L.L.C. (Premier), New Jersey, agreed to pay $266,882.13 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Premier submitted false or fraudulent claims to Federal health care programs as follows: (1) claims identified a physician as the rendering provider where the services were provided by a physician assistant and failed to meet "incident to" physician supervision requirements; (2) claims were submitted for evaluation and management (E&M) services using Modifier 25, on the same day as other services were billed, where medical record documentation did not support the separate E&M service charge; and (3) claims were supported by a physician for services that were already covered by global surgical package claims submitted by Premier.
05-15-2015: After it self-disclosed conduct to OIG, The Arc of Westchester (the Arc), New York, agreed to pay $16,920.81 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the Arc knowingly presented to Medicaid claim 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 the Arc submitted claims for prevocational services using rate codes 4464 and 4465 where supporting documentation was destroyed and replaced with improperly altered documentation.
05-14-2015: After it self-disclosed conduct to OIG, St. Vincent Medical Group, Inc. (St. Vincent), Indiana, agreed to pay $111,057.05 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. Vincent submitted claims to Medicare and Medicaid 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 St. Vincent submitted claims for evaluation and management services performed by a physician that did not meet applicable coding and documentation requirements.; After it self-disclosed conduct to OIG, Wael Asi, M.D., P.A., d/b/a Respiratory and Sleep Disorder Specialists (RSDS), Texas, agreed to pay $152,821.07 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that RSDS knowingly presented claims to Medicare for items or services that RSDS knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that RSDS submitted claims for services provided at a non-participating facility using RSDS's National Provider Identifier as though the services had been performed at a participating facility.
05-13-2015: After it self-disclosed conduct to OIG, Maryland Cardiology Associates, P.C. (MCA), Maryland, agreed to pay $134,506.47 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MCA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-06-2015: After he self-disclosed conduct to OIG, Arastoo Yazdani, M.D., Maryland, agreed to pay $42,334.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Yazdani employed an individual that he knew or should have known was excluded from participation in Federal health care programs.
04-27-2015: After it self-disclosed conduct to OIG, Golden Triangle Living Centers, Inc. (GTLC), Texas, agreed to pay $163,740.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that GTLC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-07-2015: After it self-disclosed conduct to OIG, Consulate Health Care at the Heart of Caring for its subsidiary Envoy of Richmond, LLC d/b/a Envoy of Westover Hills (Envoy), Virginia, agreed to pay $11,037.35 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Envoy employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-31-2015: After it self-disclosed conduct to OIG, Trinity Mission & Rehab of Farmville, LLC (Trinity Mission), Virginia, agreed to pay $399,573.85 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Trinity Mission employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-30-2015: After it self-disclosed conduct to OIG, Ripon Medical Center (Ripon), Wisconsin, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Ripon paid remuneration to certain physician-owners of physician practices through two lease arrangements. OIG contends that such remuneration created prohibited financial relationships and Ripon presented claims for designated health services during that resulted from prohibited referrals.
03-18-2015: After it self-disclosed conduct to OIG, Gwinnett Hospital System, Inc. d/b/a Glancy Rehabilitation Center (Glancy), Georgia, agreed to pay $750,815.90 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Glancy submitted claims for inpatient rehabilitation services that did not meet preadmission screening requirements in the following ways: (1) two of the four Clinical Evaluators employed by Glancy had lapsed credentials, and thus, were not licensed or certified clinicians during that time; and (2) the physiatrist had not documented his review and concurrence with the findings and results of the preadmission screenings conducted by the Clinical Evaluators.; After it self-disclosed conduct to OIG, Seton Family of Hospitals d/b/a Seton Shoal Creek Hospital (Seton), Texas, agreed to pay $2,474,008.76 for allegedly violating the Civil Monetary Penalties Law (CMPL) and provisions of the CMPL applicable to kickbacks. OIG alleged Seton paid remuneration to Medicare beneficiaries in the form of waiving collection of beneficiary coinsurance and deductible amounts. OIG further alleged that Seton presented 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 Seton submitted claims for partial hospitalization program (PHP) services that did not meet Medicare requirements in that: (1) claims were submitted where patients had been admitted without a proper certification by the physician that the patient would require inpatient psychiatric hospitalization if not admitted to the PHP program requiring at least 20 hours of therapeutic services through the PHP on a weekly basis;( 2) claims were submitted where the physician treating the patient failed to recertify the patient's ongoing need for PHP services; and (3) claims were submitted where PHP patients did not have individualized treatment plans, prescribed and signed by a physician, which identified treatment goals, described coordination of services, were structured to meet the particular needs of the patient, included a multidisciplinary team approach to care, and documented ongoing efforts to restore the patient to a higher level of function that would permit discharge from the PHP or reflected the continued need for the intensity of the active PHP therapy to maintain the individual's condition and functional level to prevent relapse or hospitalization.
03-16-2015: After it self-disclosed conduct to OIG, Advance Home Health Care Services, Inc. (Advance HHC), Texas, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Advance HHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-25-2015: After it self-disclosed conduct to OIG, Grafton School, Inc. (Grafton), Virginia, agreed to pay $324,055.11 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Grafton employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
02-06-2015: After it self-disclosed conduct to OIG, Bourne Management Systems, Inc. and Bourne Manor Nursing, LLC (Bourne), Massachusetts, agreed to pay $123,893 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bourne employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-04-2015: After it self-disclosed conduct to OIG, Valley Presbyterian Hospital (Valley Presbyterian), California, agreed to pay $121,316.55 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Valley Presbyterian employed an individual that it knew or should have known was excluded from participation in the California Medicaid program.
01-21-2015: After it self-disclosed conduct to OIG, Hospice Care of America, Inc. d/b/a Hospice Care of California (HCC), California, agreed to pay $146,774.94 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HCC submitted claims to Medicare for hospice services that: (1) were not supported by face-to-face encounter documentation; and (2) were provided to one beneficiary as routine home care hospice services when the documentation did not support Medicare hospice eligibility requirements.
01-07-2015: After it self-disclosed conduct to OIG, Healthcare Authority for Medical West (Medical West), Alabama, agreed to pay $431,041.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Medical West employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2014

12-29-2014: After it self-disclosed conduct to OIG, Northampton Internal Medicine Associates, PC (NIMA), Massachusetts, agreed to pay $289,492.02 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NIMA: (1) purchased the following devices from foreign sources, Synvisc, Orthovisc and Euflexxa; (2) provided these devices to Federal healthcare program patients; and (3) billed Federal healthcare programs for these devices or for their biochemical equivalents sold in the United States.
12-23-2014: After it self-disclosed conduct to OIG, Grace Home Health, Inc. (Grace), Texas, agreed to pay $2,035,262 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Grace improperly submitted claims to Medicare for episodes of home health services that failed to meet Medicare's plan of care and/or certification requirements for home health services. OIG further alleged that Grace submitted claims to Medicare for episodes of home health services that failed to meet Medicare's face-to-face encounter and/or encounter documentation requirements.
12-22-2014: After it self-disclosed conduct to OIG, Mercer Osteopathic, Ltd. (Mercer), Ohio, agreed to pay $49,598.10 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mercer improperly billed Medicare for patient visits under a physician's National Provider Identifier when the services had been rendered by a nurse practitioner and did not comply with Medicare's "incident to" requirements.; After it self-disclosed conduct to OIG, Physicians Immunodiagnostic Laboratory, Inc. (PIL), California, agreed to pay $1,386,816 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PIL employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-19-2014: After it self-disclosed conduct to OIG, Salinas Valley Memorial Hospital System (Salinas), California, agreed to pay $354,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Salinas paid remuneration to a health care company owned and operated by two physicians on staff at Salinas. OIG further alleged that the remuneration paid took the form of payments under an arrangement for Salinas to pay the health care company to rent a laser when the laser was not needed by Salinas because a second laser had been purchased by Salinas for its own use. OIG contended that Salinas failed to discontinue the arrangement after purchasing its own laser because continued payments to the health care company took into account the value of the company owners' referrals.
12-18-2014: After it self-disclosed conduct to OIG, Standish Community Hospital, Inc. d/b/a St. Mary's of Michigan Standish Hospital (SMMSH), Michigan, agreed to pay $64,854.41 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that SMMSH paid remuneration in the form of below-fair market value rates for the use of two hospital employees.; After it self-disclosed conduct to OIG, St. Agnes Healthcare, Inc. d/b/a St. Agnes Hospital (St. Agnes), Maryland, agreed to pay $1,414,248 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that St. Agnes paid remuneration to a cardiology practice in the form of equipment, supplies, staff and space needed to provide certain nuclear diagnostic cardiology testing services. OIG alleged that the cardiology practice paid St. Agnes less than fair market value for these services.
12-17-2014: After it self-disclosed conduct to OIG, Presbyterian Healthcare Services (PHS), New Mexico, agreed to pay $31,810.31 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-16-2014: After it disclosed conduct to OIG, Memorial Medical Center of West Michigan (Memorial), Michigan, agreed to pay $218,517.54 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Memorial paid remuneration to a physician in the form of below-fair market value rental rates for use of a medical office building.
12-12-2014: After it self-disclosed conduct to OIG, Cary HealthCare, LLC (Cary), Georgia, agreed to pay $62,058.70 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Cary employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-09-2014: After it self-disclosed conduct to OIG, Good Samaritan Hospital Association d/b/a Heart of America Medical Center (HAMC) agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HAMC submitted claims to Medicare for durable medical equipment allegedly prescribed to patients where the medical record documentation that supported the claims had been falsified by a former employee.
12-01-2014: After it self-disclosed conduct to OIG, West Shore Health Center (WSHC), Rhode Island, agreed to pay $18,736.68 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that WSHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-18-2014: After they self-disclosed conduct to OIG, Douglas Charles Albers (Albers) and MedTrak Services, LLC (MedTrak), Kansas, agreed to pay $40,682.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MedTrak employed Albers while MedTrak and Albers knew or should have known he was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Mountain Land Rehabilitation (Mountain Land), Idaho, agreed to pay $37,206.75 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mountain Land employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-17-2014: After it self-disclosed conduct to OIG, Berkshire Medical Center, Inc. (Berkshire), Massachusetts, agreed to pay $14,490.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Berkshire employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-30-2014: After it self-disclosed conduct to OIG, Mid-Atlantic of Delmar, LLC (Mid-Atlantic), Delaware, agreed to pay $92,344.60 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mid-Atlantic employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-16-2014: After it self-disclosed conduct to OIG, The County of Wilson Emergency Medical Services (Wilson), North Carolina, agreed to pay $124,688.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Wilson employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, IHC Health Services, Inc. d/b/a McKay-Dee Hospital Center (McKay-Dee), Utah, agreed to pay $13,633.52 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that McKay-Dee employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-03-2014: After they self-disclosed conduct to OIG, DLP Maria Parham Medical Center, LLC (DLP Maria Parham) and Henderson/Vance Healthcare, Inc. (HVH), North Carolina, agreed to pay $141,459.59 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that DLP Maria Parham and HVH paid remuneration to a physician in the form of free useable office space not identified in or accounted for in their existing written lease agreement or in any written amendment to the lease agreement.
10-01-2014: After it self-disclosed conduct to OIG, Reliable Respiratory, Inc. (Reliable), Massachusetts, agreed to pay $23,065.89 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the Reliable employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-19-2014: After it self-disclosed conduct to OIG, the University of California, Los Angeles (UCLA), California, agreed to pay $470,422.85 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the UCLA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-15-2014: After it self-disclosed conduct to OIG, San Miguel Hospital Corporation d/b/a Alta Vista Regional Hospital (Alta Vista), New Mexico, agreed to pay $989,955 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Alta Vista submitted claims for physical therapy services that were performed by unqualified individuals.; After it self-disclosed conduct to OIG, Arrowhead Cardiology Medical Group, Inc., Steven Fitzmorris, M.D., and Sunil Nowrangi, M.D. (collectively Arrowhead), California, agreed to pay $485,217 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Arrowhead billed Medicare for CPT code 93042 (Rhythm ECG, 1-2 leads; interpretation and report only) in excess of one per patient per day where there was no documented change in the patient's condition to warrant an additional service.
09-09-2014: After it self-disclosed conduct to OIG, Rescue, Inc. (Rescue), Vermont, agreed to pay $152,593 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rescue employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Amedisys, Inc. (Amedisys), South Carolina, agreed to pay $2,069,936.26 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Amedisys submitted claims for home health services that were not supported by proper medical documentation due to forgery.
09-02-2014: After it self-disclosed conduct to OIG, Norwalk Hospital Association (Norwalk), Connecticut, agreed to pay $330,967.29 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Norwalk employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-24-2014: After it self-disclosed conduct to OIG, the City of Baytown, Texas, agreed to pay $29,431.43 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the City of Baytown employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-22-2014: After it self-disclosed conduct to OIG, Rolling Hills H.C., Inc. and Fountain Lake Health and Rehab, Inc. (Rolling Hills and Fountain Lake), Arkansas, agreed to pay $117,748.32 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rolling Hills and Fountain Lake employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
08-12-2014: After it self-disclosed conduct to OIG, Deerfield Valley Rescue, Inc. (Deerfield), Vermont, agreed to pay $71,503.06 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Deerfield employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Five Star Crossing LLC d/b/a The Form at the Crossing and Five Star Quality Care, Inc. (Fiver Star), Indiana, agreed to pay $121,855.01 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fiver Star submitted claims to Medicare for physical therapy services that were improperly documented by a physical therapist formerly employed by Fiver Star. OIG further alleged that the improper documentation included photocopied signed and unsigned physician certifications of plans of care that were whited-out, edited, and sometimes faxed back to physician for signature; and documentation that did not meet certain progress report requirements.
08-05-2014: After it self-disclosed conduct to OIG, Oregon Health & Science University (OHSU), Oregon, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OHSU employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Diagnostic Laboratories and Radiology (DLR), California, agreed to pay $1,983,907.51 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DLR employed four individuals that it knew or should have known were excluded from participation in Federal health care programs.
07-31-2014: After it self-disclosed conduct to OIG, Integrated First Response - Great Lakes, LLC (IFR-GL), Michigan, agreed to pay $96,476.63 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that IFR-GL contracted with and employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-28-2014: After it self-disclosed conduct to OIG, Park West Surgical Center, LLC (Park West), Ohio, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Park West employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-17-2014: After it self-disclosed conduct to OIG, Willow Springs, LLC (Willow Springs), Nevada, agreed to pay $475,423.86 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Willow Springs employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-08-2014: After it self-disclosed conduct to OIG, DJK Home Healthcare, LLC d/b/a Children's Home Healthcare (CHH), Texas, agreed to pay $318,598.43 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Central Maine Health Care Corporation and Central Maine Medical Center (CMMC), Maine, agreed to pay $164,841.90 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CMMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-26-2014: After it self-disclosed conduct to OIG, Americare Certified Special Services, Inc. (Americare), New York, agreed to pay $44,593.41 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Americare (1) submitted claims to Medicare for home health care services provided by an RN that were not rendered; and (2) submitted claims to Medicare for items or services provided by individuals who did not receive home health aide training or who lacked the requisite home health aide certificate.
06-24-2014: After it self-disclosed conduct to OIG, Hospicare and Palliative Care Services of Tompkins County, Inc. (HPC), New York, agreed to pay $10,726.68 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HCP employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-20-2014: After it self-disclosed conduct to OIG, Hospice by the Sea, Inc. (HBTS), Florida, agreed to pay $428,935.46 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HBTS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Bennington Rescue Squad, Inc. (Bennington), Vermont, agreed to pay $94,441.35 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bennington employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-13-2014: After it self-disclosed conduct to OIG, Redlands Community Hospital (Redlands), California, agreed to pay $155,563.44 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Redlands employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-05-2014: After it self-disclosed conduct to OIG, Valeo Behavioral Health Care, Inc. (Valeo), Kansas, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Valeo submitted claims to Federal health care programs containing Evaluation & Management codes 99202 through 99205, which were for higher levels of services than those services actually provided.
05-28-2014: After it self-disclosed conduct to OIG, Remington Family Dental, PLLC, Hardin Family Dental, PLLC, and Rubicon Dental Associates, PLLC (collectively, Remington), Montana, agreed to pay $24,579.93 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Remington employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-15-2014: After it self-disclosed conduct to OIG, Carteret Medical Group, LLC (Carteret), North Carolina, agreed to pay $29,493.21 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Carteret employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Kindred Nursing Centers West, LLC (Kindred), Colorado, agreed to pay $62,964.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kindred employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Brighton Operations, LLC (Brighton Operations), Colorado, agreed to pay $49,430.22 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bright Operations employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, California Cancer Associates for Research and Excellence (CCARE), California, agreed to pay $17,346.84 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CCARE billed Medicare for Evaluation and Management visits that were already covered within a grant funded by a pharmaceutical company and should have not been billed separately to Medicare.
05-09-2014: After it self-disclosed conduct to OIG Winterholler Dentistry, P.C. and Morrison Family Dentistry, P.C. d/b/a Winterholler Dentistry (collectively, Winterholler), Montana, agreed to pay $54,621.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Winterholler employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-06-2014: After it self-disclosed conduct to OIG, Uhrichsville Health Care Center, Inc. d/b/a Beacon Pointe Rehabilitation Center (Beacon Pointe), Ohio, agreed to pay $110,270.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Beacon Pointe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-24-2014: After it self-disclosed conduct to OIG, Kmart Corporation (Kmart), doing business in New York, agreed to pay $497,110.97 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kmart employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Immediate Homecare, Inc. d/b/a Immediate Homecare and Hospice (Immediate), Pennsylvania, agreed to pay $78,160.59 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Immediate employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-07-2014: After it self-disclosed conduct to OIG, Harvard Vanguard Medical Associates, Inc. (HVMA), Massachusetts, agreed to pay $168,687 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HVMA submitted claims to Medicare, Medicare's Atrius Health Pioneer Accountable Care Organization, and Massachusetts Medicaid using CPT codes 90805 and 90807 for services provided by a physician when the services rendered by the physician did not meet the coverage requirements for CPT codes 90805 and 90807.
03-24-2014: After it self-disclosed conduct to OIG, Ukiah Valley Medical Center (UVMC), California, agreed to pay $1,692,588 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that UVMC paid improper remuneration to physicians who invested in a joint venture ambulatory surgical center with UVMC.
03-20-2014: After it self-disclosed conduct to OIG, Mission Medical Associates, Inc. (MMA), North Carolina, agreed to pay $141,809.74 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MMA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-12-2014: After it self-disclosed conduct to OIG, Amedisys, Inc. (Amedisys), West Virginia, agreed to pay $1,974,812.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Amedisys, on behalf of its wholly-owned subsidiaries West Virginia, LLC, d/b/a Amedisys Hospice of Parkersburg (Amedisys-Parkersburg) and Tender Loving Care Health Care Services of West Virginia, LLC d/b/a Amedisys Hospice (Amedisys-St. Clairsville), submitted claims for hospice services for which the certification documents did not meet Federal health care program requirements. OIG contends the contracted medical directors at Amedisys-Parkersburg and Amedisys-St. Clairsville pre-signed blank medical forms, including certificates of terminal illness and face-to-face visit forms, which were later completed by Amedisys staff members.
03-11-2014: After it self-disclosed conduct to OIG, Community Memorial Healthcenter (CMH), Virginia, agreed to pay $52,332.41 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-07-2014: After it self-disclosed conduct to OIG, Brentwood Healthcare, Ltd. (Brentwood), Texas, agreed to pay $243,266.31 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Brentwood employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Little Flower Haven (LFH), Iowa, agreed to pay $61,054.64 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LFH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Centegra Health Systems and Centegra Primary Care, LLC (Centegra), Illinois, agreed to pay $398,053.31 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Centegra improperly submitted claims to Medicare and Medicaid for medical services performed by a physician based on CPT codes that resulted in greater payment than the code applicable to the services actually provided.
02-18-2014: After it self-disclosed conduct to OIG, KTLA Properties LP d/b/a Alamitos West Healthcare Center (Alamitos), California, agreed to pay $27,617.37 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Alamitos employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-18-2014: After it self-disclosed conduct to OIG, Heritage Healthcare of Macon, LLC (Heritage), Georgia, agreed to pay $88,113.93 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Heritage employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-14-2014: After it self-disclosed conduct to OIG, Interim HealthCare of the Eastern Carolinas, Inc. (Interim HealthCare), North Carolina, agreed to pay $79,694 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Interim HealthCare employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-27-2014: After it self-disclosed conduct to OIG, Home Care United, Inc. (HCU), Wisconsin, agreed to pay $22,867.67 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HCU submitted claims to federal health care programs using Certifications of Medical necessity (CMNs) or Detailed Physician Orders (DPOs) that had been improperly altered by one of HCU's CMN Specialists. OIG alleged that these improper alterations included cutting and pasting physician signatures from other CMN or DPO forms; handwriting in a date or parts of numbers that had been cut off when the forms were faxed to HCU from the authorized physicians' offices; and using white out to change information.
01-13-2014: After it self-disclosed conduct to OIG, Spanish Fork Nursing and Rehabilitation Center (Spanish Fork), Utah, agreed to pay $10,000.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Spanish Fork employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-13-2014: After it self-disclosed conduct to OIG, Elim Care, Inc. (Elim), Minnesota, agreed to pay $11,477.34 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Elim employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
01-09-2014: After it self-disclosed conduct to OIG, Voices for Independence (Voices), Pennsylvania, agreed to pay $59,197.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Voices employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

12-23-2013: After it self-disclosed conduct to OIG, Northland Retirement Community, Inc. (Northland), Wisconsin, agreed to pay $12,775.16 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Northland employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Havasu Regional Medical Center (Havasu), Arizona, agreed to pay $510,179.44 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Havasu paid remuneration to a doctor in the form of the allowed rental of usable space at a below-market rental rate and the inappropriate provision of employee services.
12-19-2013: After it self-disclosed conduct to OIG, Palm Drive Hospital (PDH), California, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law (CMPL) and provisions of the CMPL applicable to physician self-referrals and kickbacks. OIG alleged that PDH submitted claims for physician services provided by three providers to Medicare beneficiaries using the provider identification number of a physician who neither furnished the services nor personally supervised the services rendered. OIG further alleged that PDH knowingly charged facility fees and submitted claims for services provided at Palm Drive Medical Clinic (Clinic) when the Clinic failed to fully meet Medicare's regulations for Provider-Based Status, which resulted in improper billing of the claims disclosed. OIG also alleged that PDH paid remuneration to a physician in the form of payments for rent and other Clinic expenses. OIG further alleged that PDH paid remuneration to another physician in the form of payments under a service agreement and a recruitment agreement.
12-16-2013: After it self-disclosed conduct to OIG, Wyoming County Community Health System (WCCHS), New York, agreed to pay $15,000.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that WCCHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-13-2013: After it self-disclosed conduct to OIG, Laboratory Corporation of America (LabCorp), Virginia, agreed to pay $21,051 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LabCorp employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Pioneer Health Services of Newton, LLC (Pioneer), Mississippi, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pioneer employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to OIG, Seton Family of Hospitals (Seton) d/b/a Towers Nursing Home (Towers), Texas, agreed to pay $1,139,789.65 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Seton billed for posthospital extended care services furnished at Towers using certifications and recertifications that did not meet applicable Medicare criteria.
12-11-2013: After it self-disclosed conduct to OIG, East River Medical Imaging, PC (East River), New York, agreed to pay $227,427.42 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that East River employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-05-2013: After it self-disclosed conduct to OIG, Fairview Health Services (Fairview), Minnesota, agreed to pay $37,823.57 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fairview employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-03-2013: After it self-disclosed conduct to OIG, Atlantic Gastroenterology, P.A. (Atlantic), North Carolina, agreed to pay $120,073.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Atlantic submitted claims for evaluation and management services provided by a former physician employee under CPT codes 99231, 99232, and 99233, that were not provided as claimed and were billed at levels unsupported by the record documentation.; After it self-disclosed conduct to OIG, Kishwaukee Community Hospital (Kishwaukee), Illinois, agreed to pay $230,320 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Kishwaukee paid remuneration to three medical group practices in the forms of a cash collections guarantee, start-up expenses, and loan forgiveness to subsidize the practices recruitment of a midwife, an advanced practice nurse practitioner, and a certified nurse practitioner.
11-15-2013: After it self-disclosed conduct to OIG, Helen Newberry Joy Hospital (HNJH), Michigan, agreed to pay $221,080.47 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that HNJH entered into improper financial relationships with a doctor involving the lease of space, discounted internet service, professional liability and health insurance, arrangement for office supplies and pharmaceuticals, arrangement for back-up call coverage, physician supervision and attendance at certain medical leadership meetings, and failure to collect interest on an outstanding loan balance.
11-14-2013: After it self-disclosed conduct to OIG, 60 Geneva Health Care, Inc., 840 Sherman Healthcare, Inc., and BCFL Holdings (Geneva), Ohio, agreed to pay $115,856.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Geneva employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-29-2013: After it self-disclosed conduct to OIG, St. John's Health Care Corporation d/b/a St. John's Home (St. John's), New York, agreed to pay $42,556.29 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. John's submitted claims for occupational therapy services provided concurrently but billed as if provided individually.
10-18-2013: After it self-disclosed conduct to the OIG, Memphis Pathology Laboratory d/b/a American Esoteric Laboratories (AEL), Tennessee, agreed to pay $6,780.63 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that AEL employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-08-2013: After it self-disclosed conduct to the OIG, Conroe Healthcare (Conroe), Florida, agreed to pay $145,106.68 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Conroe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to the OIG, The Guidance Center (Guidance), Michigan, agreed to pay $742,398 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Guidance made false records or statements material to improper claims for payment for multiple developmental disability services provided simultaneously to Medicaid patients when only one service was eligible for payment.
10-02-2013: After it self-disclosed conduct to the OIG, Valley View Regional Hospital (VVRH), Oklahoma, agreed to pay $44,307.15 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that VVRH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to the OIG, United General Hospital - Public Hospital District 304 (UGH), Washington, agreed to pay $74,067 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that UGH paid remuneration to a physician in the form of excessive compensation for services performed at its facility.
09-30-2013: After it self-disclosed conduct to the OIG, Atmore Community Hospital (Atmore), Alabama, agreed to pay $10,996.20 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Atmore employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-27-2013: After it self-disclosed conduct to the OIG, Ocala Specialty Surgery Center, LLC (Ocala), Florida, agreed to pay $21,523.44 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Ocala employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to the OIG, the City of El Paso, Texas (El Paso), agreed to pay $1,162,828.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that El Paso submitted claims to Medicare for emergency Advanced Life Support ambulance transportation services when, in actuality, the medically reasonable and necessary level of services was the lower cost emergency Basic Life Support ambulance transportation services.; After it self-disclosed conduct to the OIG, Mercy Medical Center, Inc. (Mercy), Maryland, agreed to pay $50,000 for allegedly violating the Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Mercy paid remuneration to a physician owned real estate company in the form of not collecting net profits from the real estate company due under an agreement between Mercy and the real estate company. Further, this agreement established Mercy's right to forty percent of the net profits the real estate company and Mercy obtained as joint owners of a property.
09-26-2013: After it self-disclosed conduct to the OIG, Vital Signs Staffing, LLC (Vital Signs), Utah, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law. The OIG Alleged that Vital Signs employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to the OIG, St. Vincent's East (St. Vincent's), Alabama, agreed to pay $50,000 for allegedly violating the Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that St. Vincent's paid remuneration to a sports medicine practice in the form of payment for Durable Medical Equipment (DME). Specifically, the OIG alleged that St. Vincent's arranged to purchase DME prescribed by the sports medicine practice physician for their patients' inpatient stay directly from the sports medicine practice.
09-20-2013: After it self-disclosed conduct to the OIG, Osler HMA Medical Group, LLC (Osler), Florida, agreed to pay $13,836.99 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Osler employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-17-2013: After it self-disclosed conduct to the OIG, Center for Human Genetics, Inc. (CHG) and Dr. Jeffrey Milunsky (Dr. Milunsky), Massachusetts, agreed to pay $798,993 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CHG billed for single genetic tests over multiple dates of service, determined by the time span of the tests analysis. By doing so, CHG avoided "edits" built into the computerized payment systems of the government payors which would have prevented the payment of certain specific parts of Current Procedural Terminology codes on the same date of service. The OIG further alleged that Dr. Milunsky knowingly presented or caused to be presented claims for items or services that Dr. Milunsky should have known were not provided as claimed. Specifically, CHG, under Dr. Milunsky's National Provider Number, billed for services of genetic counselors "incident to" his own professional services when those genetic counselors did not provide such services under Dr. Milunsky's direct supervision because they were not located in the same office suite or at the same address.
09-13-2013: After it self-disclosed conduct to the OIG, Molina Healthcare of Florida, Inc. (Molina), Florida, agreed to pay $257,111 for allegedly violating the Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Molina offered to increase the capitation rates paid to four physicians in exchange for the referral of their patients to Molina and did increase the capitation rates of two of the four physicians.
09-09-2013: After it self-disclosed conduct to the OIG, Miami Behavioral Health Center, Inc. (MBHC), Florida, agreed to pay $150,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MBHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-06-2013: After it self-disclosed conduct to the OIG, Hampton Behavioral Health Center (Hampton), New Jersey, agreed to pay $30,541.49 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Hampton employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-30-2013: After it self-disclosed conduct to the OIG, Cystic Fibrosis Services, Inc. (CFS), Maryland, agreed to pay $307,877.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CFS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-12-2013: After it self-disclosed conduct to the OIG, Saint Francis Hospital and Medical Center (Saint Francis), Connecticut, agreed to pay $78,931.62 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Saint Francis employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-07-2013: After it self-disclosed conduct to the OIG, Dr. Susoni Health Community Services, Corp., d/b/a Dr. Cayetano Coll & Toste Regional Hospital (Cayetano), Puerto Rico, agreed to pay $381,841.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Cayetano employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-07-2013: After it self-disclosed conduct to the OIG, Hospital Doctor Susoni, Inc., d/b/a Hospital Dr. Susoni (Susoni), Puerto Rico, agreed to pay $78,229.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Susoni employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-17-2013: After it self-disclosed conduct to the OIG, North Arkansas Regional Medical Center (NARMC), Arkansas, agreed to pay $395,591.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NARMC improperly billed separately for "incident to" services that were included in its Rural Health Center payment.
07-12-2013: After it self-disclosed conduct to the OIG, Saint Luke's Health System (SLPS), Missouri, agreed to pay $142,740 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SLPS improperly billed Medicare and Medicaid for interventional radiology services furnished by a radiology practitioner assistant (RPA) in SLPS's Radiology Department. Specifically, SLPS separately and improperly billed Medicare for services furnished by an RPA even though, under Medicare rules, payment for services furnished by an RPA in a hospital setting are bundled and paid to the hospital as part of its facility payment.
07-08-2013: After it self-disclosed conduct to the OIG, Sonora Regional Medical Center (SRMC) California, agreed to pay $597,193 for allegedly violating the Civil Monetary Penalties Law. SRMC contracted with a physician to provide professional services at SRMC's medical oncology outpatient center. The OIG alleged that SRMC submitted claims containing CPT codes 99204, 99205, 99214, and 99215, that it submitted for services provided by the physician that were upcoded and that the physician engaged in a pattern or practice of coding at a higher level that he knew or should have known would result in a greater payment than the code applicable to the services he was actually providing.
06-19-2013: After it self-disclosed conduct to the OIG, Rutherford Hospital, Inc. (Rutherford), North Carolina, agreed to pay $706,090.46 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Rutherford submitted or caused to be submitted claims for physicians' services provided by a doctor to beneficiaries of Federal health care programs using the provider identification numbers of another doctor, who did not further the services. The OIG contends that Rutherford knowingly misused provider identification numbers, which resulted in improper billing of the claims identified and disclosed by Rutherford.
06-10-2013: After it self-disclosed conduct to the OIG, Mercy Clinic Oklahoma Communities, Inc. (Mercy Clinic), Oklahoma, agreed to pay $51,444.03 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mercy Clinic employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-24-2013: After it self-disclosed conduct to the OIG, Expeditive, LLC (Expeditive), New Jersey, agreed to pay $2,883.53 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Expeditive employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to the OIG, SpecialtyCare Surgical Assist, LLC (SCSA), Florida, agreed to pay $247,024.19 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SCSA knowingly presented to Medicare, Medicaid, and TRICARE claims for items or services that SCSA knew or should have known were not provided as claimed and were false or fraudulent. Specifically, the OIG contends that SCSA billed the above programs for assistant-at-surgery services provided by certified surgical assistants and registered nurse first assistants, when these programs reimburse such services only if provided by physicians and/or physician assistants.
05-21-2013: After it self-disclosed conduct to the OIG, St. Peter's Hospital of the City of Albany (St. Peter's), New York, agreed to pay $16,538.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that St. Peter's employed an individual that it knew or should have known was excluded from participation in Federal health care programs.; After it self-disclosed conduct to the OIG, Shahid Mansoor, M.D. doing business as Mansoor Pediatrics (Mansoor), Louisiana, agreed to pay $51,315.90 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mansoor employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-10-2013: After it self-disclosed conduct to the OIG, Sutter Health Sacramento Sierra Region (SHSSR), California, agreed to pay $130,308.39 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SHSSR employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-03-2013: After it self-disclosed conduct to the OIG, Jackson Pediatric Associates, P.A. (JPA), Mississippi, agreed to pay $89,080.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that JPA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-03-2013: After it self-disclosed conduct to the OIG, RenalSouth Garden District (RSGD), Louisiana, agreed to pay $10,487.45 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that RSGD employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-05-2013: After it self-disclosed conduct to the OIG, Hospital Authority of Benn Hill County, Georgia d/b/a Dorminy Medical Center (Dorminy), Georgia, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Dorminy paid remuneration to a doctor in the form of free use of hospital space for a period of time.
03-04-2013: After it self-disclosed conduct to the OIG, Radiology Associates, P.C. (RA) and Oregon Imaging Centers, LLC (OIC), OR, agreed to pay $189,045.28 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that OIC inappropriately billed Medicare for certain diagnostic tests provided by radiology practitioner assistants employed by RA that required personal supervision by a physician, but instead were provided under direct supervision.
02-27-2013: After it self-disclosed conduct to the OIG, Glen Haven Home, Inc. (GH), Iowa, agreed to pay $34,575.35 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that GH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-08-2013: After it self-disclosed conduct to the OIG, Ability and Performance Home Care, LLC (Ability), Texas, agreed to pay $92,976.44 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Ability submitted claims to Medicare for home health care services provided to patients that included false or fraudulent documentation.
02-08-2013: After it self-disclosed conduct to the OIG, Steward Good Samaritan Medical Center, Inc. (Good Samaritan), Massachusetts, agreed to pay $15,104.13 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Good Samaritan employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-05-2013: After it self-disclosed conduct to the OIG, Swan Pointe Care Center (Swan Pointe), Ohio, agreed to pay $213,708.00 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Swan Pointe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-17-2013: After it self-disclosed conduct to the OIG, RCHP-Florence, LLC d/b/a Shoals Hospital (Shoals), Alabama, agreed to pay $45,682.02 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Shoals employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-17-2013: After it self-disclosed conduct to the OIG, Paterson Community Health Center (Paterson), New Jersey, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Paterson submitted claims for items and services furnished by an unlicensed and unregistered physician.
01-16-2013: After it self-disclosed conduct to the OIG, Bartlett Regional Hospital (Bartlett), Arkansas, agreed to pay $1,434,664.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bartlett submitted claims using incorrect physician names and NPI numbers and submitted claims for non-physician provider services that were billed under a physician's name and NPI number.

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