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Civil Monetary Penalties and Affirmative Exclusions

The Office of Inspector General (OIG) has the authority to seek civil monetary penalties (CMPs), assessments, and exclusion against an individual or entity based on a wide variety of prohibited conduct. In each CMP case resolved through a settlement agreement, the settling party has contested the OIG's allegations and denied any liability. No CMP judgment or finding of liability has been made against the settling party.

OIG Enforcement Cases

The cases listed below represent recently-closed cases initiated by the OIG's Office of Counsel to the Inspector General. To view additional cases, including those resolved through the provider self-disclosure protocol, click on the specific categories to the right.

09-27-2019
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On September 27, 2019, Doctors Hospital of Augusta (DHA), Augusta, Georgia, entered into a $180,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, DHA violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for a patient and failed to accept an appropriate transfer of a second patient. The first patient was a 25-year old female who presented to DHA's Emergency Department (ED) complaining of ingestion of an unknown substance and a loss of consciousness. The patient was reportedly tearful and anxious, and complained of a headache, neck pain, face pain, and left shoulder pain. A nurse triaged the patient and gave her an Emergency Severity Index score of three, which was "urgent" according to DHA's triage policy. A physician medically screened the patient; however, the screen did not include necessary laboratory tests related to the patient's presenting symptoms. The patient was entered into DHA's medical screening exam process for non-emergent patients and was asked for funds in order to continue evaluation. The patient was unable to pay, so she was discharged. The patient immediately sought treatment at another hospital, where she was treated.

The second patient was an 84-year-old female with pneumonia, and severe hypernatremia and hyperglycemia. The patient needed Intensive Care United (ICU) level care and the transferring hospital did not have an ICU. A physician at DHA refused to accept the transfer of the patient, stating that the referring facility could manage the patient. DHA had the capability and the capacity to care for the patient. Associate Counsel Candace Ashford represented OIG.
08-22-2019 Florida Laboratory Settles Case Involving False Claims
On August 22, 2019, American Clinical Solutions, LLC (ACS), Boca Raton, Florida, entered into a $61,546.31 settlement agreement with OIG. The settlement agreement resolves allegations that ACS submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Andrea Treese Berlin and Deputy Branch Chief Kirk Sripinyo represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
08-20-2019
Georgia Physician Settles Case Involving False Claims
On August 20, 2019, Gregory D. Martin, M.D., Valdosta, Georgia, entered into a $181,874.30 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Martin submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Martin submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
08-13-2019
New Jersey Diagnostic Testing Facility Settles False and Fraudulent Claims Case
On August 13, 2019, MDR Diagnostics, LLC (MDR), New Brunswick, New Jersey, entered into a $144,621.98 settlement agreement with OIG. OIG's investigation revealed that MDR submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsel Geoffrey Hymans, collaborated to achieve this resolution.
08-07-2019
Kentucky Laboratory Settles Case Involving False Claims
On August 7, 2019, PremierTox 2.0, Inc. (PremierTox), Russell Springs, Kentucky, entered into a $99,157 settlement agreement with OIG. The settlement agreement resolves allegations that PremierTox submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
New Jersey Physicians and Practice Settle Case Involving Kickbacks
On August 7, 2019, Joseph P. Clancy, Jr., M.D., Walter P. Miller, M.D., and Southern Ocean Primary Care Associates, LLC (collectively, "Southern Ocean"), with multiple locations in New Jersey, entered into a $311,626 settlement agreement with OIG. The settlement agreement resolves allegations that Southern Ocean solicited and received remuneration from laboratory companies Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), in the form of "process and handling" payments related to the collection of blood. OIG alleged that Southern Ocean solicited and received the remuneration from HDL and Singulex in exchange for Southern Ocean and a Southern Ocean employee referring patients for laboratory testing services to HDL and Singulex, for which the Medicare program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
Tennessee Laboratory Settles Case Involving False Claims
On August 7, 2019, Discover Diagnostic Laboratory, LLC (DDL), Oak Ridge, Tennessee, entered into a $95,882.36 settlement agreement with OIG. The settlement agreement resolves allegations that DDL submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
08-05-2019
Kansas Infusion Company Owner Agrees to Voluntary Exclusion
On August 5, 2019, in connection with the resolution of his False Claims Act liability, Donald R. Peterson, Overland Park, Kansas, agreed to be excluded from participation in all Federal health care programs under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Peterson, through IVXpress, Inc., submitted claims to Medicare for infusions and/or injections that lacked the requisite direct supervision of the infusion and/or injection by a physician or nurse practitioner. Associate Counsel Dennis Pangindian represented OIG.
07-31-2019
Tennessee Biotechnology Firm Settles Case Involving False Statement in an HHS Grant Application
On July 31, 2019, Prizam Healthcare Technologies, LLC d/b/a Raiven Healthcare and James Stefansic (collectively, "Raiven"), Nashville, Tennessee, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that Raiven submitted an NIH grant application that falsely represented that a community mental health center had agreed to recruit participants for Raiven's proposed study. Senior Counsels Michael Torrisi and David Traskey represented OIG.
07-19-2019
Georgia Pharmaceutical Company Settles Case Involving Drug Price Reporting
On July 19, 2019, U.S. Pharmaceutical Corporation (USPC), Decatur, Georgia, entered into a $380,142.05 settlement agreement with OIG. The settlement agreement resolves allegations that USPC failed to submit timely certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2012, 2015, 2016, and 2017. The Medicaid Drug Rebate Program requires manufacturers to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the manufacturer's covered outpatient drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Mary Riordan represented OIG with the assistance of Program Analyst Mariel Filtz.
Texas Physician and Hospital Executive Settles Case Involving Kickbacks
On July 19, 2019, Corazon Ramirez, M.D., Dallas, Texas, entered into a $171,480 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Ramirez, as the former CEO and COO of Pine Creek Medical Center, paid remuneration to various physician-owners of Pine Creek Medical Center in the form of payments for print and billboard advertisements for the physician-owners and their medical practices. Senior Counsel Karen Glassman, Senior Counsel Michael Torrisi, and Deputy Branch Chief Kirk Sripinyo represented OIG.
07-18-2019
Pennsylvania Physician Agrees to Voluntary Exclusion
On July 18, 2019, Richard Mintz, D.O., a physician in Dresher, Pennsylvania, agreed to be excluded from participation in all Federal health care programs for a period of 7 years under 42 U.S.C. 1320a-7(b)(6)(B). OIG alleged that Dr. Mintz issued medically unnecessary prescriptions for opioids in exchange for cash which failed to meet the professionally recognized standards of care. Senior Counsel Lisa Veigel represented OIG.
07-12-2019
Michigan Physician Practice Settles Case Involving Kickback and Stark Allegations
On July 12, 2019, Anesthesia Services, P.C. d/b/a University Pain Clinic (UPC), Detroit, Michigan, entered into a $44,900 settlement agreement with OIG. The settlement agreement resolves allegations that UPC received remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and UPC caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
Illinois Podiatry Practice Settles Case Involving Excluded Individual
On July 12, 2019, Smith Centers for Foot & Ankle Care (SCFAC), Chicago, Illinois, entered into a $37,688.76 settlement agreement with OIG. The settlement agreement resolves allegations that SCFAC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a medical assistant, provided items or services to SCFAC's patients that were billed to Federal health care programs.
07-08-2019
Pennsylvania Ambulance Companies, Owner, and Related Party Agree to Voluntary Exclusions
0n July 8, 2019, in connection with the resolution of their False Claims Act liability, Damon Wade, Amy Wade, Unicare Ambulance, LLC (Unicare), and PA Paramedics LLC d/b/a Eastern Care Ambulance (PA Paramedics), Bensalem, Pennsylvania, agreed to be excluded from participation in all Federal health care programs under 42 U.S.C. 1320a-7(b)(7). Damon Wade agreed to be excluded for a period of 10 years. Amy Wade, Unicare, and PA Paramedics agreed to be excluded for a period of 5 years. OIG alleged that Damon Wade, Amy Wade, Unicare, and PA Paramedics made repeated false statements to avoid overpayment debts to the Medicare program and to hide the fact that Damon Wade's state paramedic license had previously been suspended because he had admitted to forging a physician's signature. Senior Counsel Gregory Wellins represented OIG.

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