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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.

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

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