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ALJ Upholds OIG Civil Monetary Penalty and Exclusion Determination

On August 29, 2016, an Administrative Law Judge (ALJ) for the Departmental Appeals Board issued an order upholding OIG's imposition of penalties, an assessment, and exclusion against Dr. Mohammad Siddique and Shoals Medical Group, LLC (collectively, Siddique) for knowingly presenting claims to Medicare for items or services that Siddique knew or should have known were not provided as claimed and were false or fraudulent. Specifically, the ALJ found that through the use of Modifier 59, Siddique knowingly submitted or caused to be submitted excess claims for payment for multiple units of Healthcare Common Procedure Coding System (HCPCS) code G0434 for a single patient encounter when HCPCS code G0434 can only be billed once per patient encounter. The ALJ also found that a Civil Money Penalty of $1,710,400, an assessment of $1,057,251.78, and exclusion of Siddique from all federal health care programs for ten years were reasonable sanctions. OIG was represented in the investigation and litigation of this matter by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin.

Action Details

  • Date:August 29, 2016
  • Enforcement Types:
    • CMP and Affirmative Exclusions