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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.

01-17-2017
Iowa Hospital Settles Case Involving a Patient Dumping Allegations
On January 17, 2017, Covenant Medical Center (Covenant) in Waterloo, Iowa, entered into a $100,000 Settlement Agreement with OIG. The Settlement Agreement resolves allegations that Covenant violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate psychiatric screening examination or stabilizing treatment for three patients who presented to the emergency department (ED) when an on-call psychiatrist was available. A woman presented to the ED complaining of depression and suicidal thoughts, but was later discharged with instructions to follow-up with her primary care physician. A child presented to the ED following violent outbursts, but was later discharged with instructions to follow-up with his primary care physician. A man presented to the ED stating his mind was "disturbed," but later eloped from the ED into single degree weather wearing paper scrubs while his discharge was processed. His body was found about 300 feet from Covenant with the cause of death attributed to hypothermia. Senior Counsel Henry Green and Associate Counsel Madeline Bainer represented OIG.
01-11-2017
New Jersey Dentist Agrees to $1.1 Million Payment and 50-Year Exclusion To Settle Civil Monetary Penalty Case
Roben Brookhim, an unlicensed Dentist in New Jersey, agreed to pay $1,134,000 for allegedly violating the Civil Monetary Penalties Law and agreed to be excluded from participation in Federal health care programs for a period of fifty years under 42 U.S.C. 1320a-7a and 42 U.S.C. 1320a-7(b)(7). OIG alleged that Brookhim owned, controlled, and managed Associated Dental NP, LLC (ADNP), a New Jersey dental practice with multiple locations, in violation of his exclusion from Federal health care program participation in August 2000. OIG further alleged that as part of his fraud scheme, Brookhim assumed the identity of a licensed New Jersey dentist (Dentist A), to provide services to ADNP patients. Brookhim assumed Dentist A's identity because Brookhim's license to practice dentistry was suspended in 1999 and revoked in 2004. OIG contends that Brookhim presented claims for services to various New Jersey Medicaid Managed Care Organizations identifying Dentist A as having providing services; in fact, Dentist A never rendered services to ADNP patients. Brookhim continued to pose as Dentist A and submit claims in his name -- even after Dentist A died. Senior Counsels David Blank and Michael Torrisi represented OIG with the assistance of Paralegal Specialist Mariel Filtz. News Release
01-10-2017
North Carolina Hospital Settles Case Involving Patient Dumping Allegation
On January 10, 2017, Cape Fear Medical Center (Cape Fear) in Fayetteville, North Carolina, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that Cape Fear violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination and stabilizing treatment for a woman who presented to Cape Fear's Emergency Department in labor with her third child. The patient was discharged a little over one hour after she presented to Cape Fear. OIG alleged that Cape Fear did not properly examine the patient (including checking the progress of her labor) before the patient was discharged. The patient drove home and immediately gave birth to her child at home. Senior Counsel Sandra Sands represented OIG.
01-06-2017
Utah Nursing Home and Owner Agree to 30 Year Exclusion
On January 6, 2017, Deseret Health Group and Jon Robertson (Robertson), Bountiful, Utah, agreed to be excluded from participation in all Federal health care programs for a period of thirty years under 42 U.S.C. 1320a-7(b)(7) and 1320a-7(b)(6)(B). OIG alleged that Deseret Health Group and Robertson: (a) failed to provide adequate care planning and assessments of residents; (b) failed to provide medications, treatments, laboratory tests, physical therapy, and other services as ordered and/or prescribed by residents' physicians; (c) failed to properly use and/or administer psychotropic drugs; (d) failed to follow appropriate pressure ulcer and infection control protocols for some residents; (e) failed to follow appropriate fall protocols for some residents; (f) failed to properly administer medications to some of the residents to avoid medication errors; (g) failed to provide a safe living environment for residents; and (h) failed to answer some residents' call lights promptly. Senior Counsel Felicia Heimer represented OIG.
12-29-2016
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On December 29, 2016, Phoebe Putney Memorial Hospital (Phoebe Putney) in Albany, Georgia, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that Phoebe Putney violated the Emergency Medical Treatment and Labor Act when it failed to accept an appropriate transfer. A 73-year-old man was transported to another hospital by EMS and presented with hematuria, bleeding at the site of his Foley catheter and abdominal pain. The patient required urological services that were unavailable at that hospital. The hospital requested Phoebe Putney accept the transfer of this patient. OIG alleged that Phoebe Putney's on-call urologist refused the transfer when Phoebe Putney had both the capability and capacity to treat the patient. Senior Counsel Sandra Sands represented OIG.
12-22-2016
South Carolina Hospital Settles Case Involving Patient Dumping Allegation
On December 22, 2016, McLeod Medical Center (MMC), a small hospital located in Dillon, South Carolina, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that MMC violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment of a patient who presented to MMC after being assaulted and hit in the head. The patient resisted efforts by his mother to get him into a wheelchair to enter the Emergency Department (ED). Security guards observed the patient's behavior and told the patient's mother that if she brought her son into the ED the guard would have him locked up. OIG alleges that the mother explained to the security guard that her son had been hit in the head and was bleeding and that a guard allegedly answered by reasserting that he would call the police if her son entered the ED. At that point the mother left with her son and later took him to another hospital for evaluation and treatment. Senior Counsel Sandra Sands represented OIG.
12-22-2016
Missouri Hospital Settles Case Involving a Patient Dumping Allegation
On December 22, 2016, OIG entered into a settlement agreement with HCA Midwest Division d/b/a Belton Regional Medical Center (BRMC), Belton, Missouri. BRMC agreed to pay $40,000.00 to resolve its liability for civil money penalties under the patient dumping statute. Specifically, OIG alleged that BRMC violated the Emergency Medical Treatment and Labor Act by failing to provide an appropriate medical screening examination and stabilizing treatment to two patients who came to BRMC's emergency department with emergency psychiatric conditions. Senior Counsel Henry E. Green represented OIG.
12-21-2016
Texas Doctors Settle Case Involving Kickback Allegations
On December 21, 2016, Mark Sands, D.P.M., and Jeffrey Baxter, D.P.M., Houston, Texas, entered into an $85,000 settlement agreement with OIG. OIG's investigation revealed that Dr. Sands and Dr. Baxter each received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from Medical Directorship agreements. OIG contends that the medical directorship agreements took into account the value and volume of referrals made to OneStep by Dr. Sands and Dr. Baxter's podiatric practice. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
12-16-2016
New York Chiropractor and Practices Agree to 40 Year Exclusion
On December 16, 2016, Alexander Khavash, a chiropractor, and the two chiropractic practices he owned, Alexander Khavash, DC, P.C., and AK Chiropractic, P.C., agreed to be excluded from participation in all Federal health care programs for a period of forty years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Khavash and his practices submitted claims to Medicare for chiropractic services that were not medically necessary and not provided as claimed. Senior Counsels Michael Torrisi, Joan Matlack and Andrea Treese Berlin represented OIG.
12-09-2016
New York Physician Agrees to 5 Year Exclusion
On December 9, 2016, Dr. Michael Esposito agreed to be excluded from participation in all Federal health care programs for a period of five years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Dr. Esposito forged the signature of another physician on prescriptions for medications for himself and another person that were paid for by the Medicare program. Senior Counsel David Blank and Associate Counsel Jennifer Leonardis represented OIG.
11-30-2016
New York Skilled Nursing Facility Settles Case Involving Excluded Individual
On November 30, 2016, Ditmas Park Rehab/Care Center (Ditmas Park), Brooklyn, New York, entered into a $205,089.22 settlement agreement with OIG. The settlement agreement resolves allegations that Ditmas Park employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a licensed practical nurse, provided items or services to Ditmas Park patients that were billed to Federal health care programs. Senior Counsel Katie Fink represented OIG with the assistance of Paralegal Specialist Eula Taylor.
Florida Hospital Settles Case Involving a Patient Dumping Allegation
On November 30, 2016, Okaloosa Hospital, Inc. d/b/a Twin Cities Hospital (Twin Cities), a small hospital in Niceville, Florida, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that Twin Cities violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment of a 56-year-old male patient who was experiencing difficulty breathing and was unstable. Twin Cities' Emergency Department staff met the emergency medical transport in the ambulance bay and redirected the transport to another hospital, where the patient previously received treatment. Twin Cities failed to provide the patient with a medical screening examination or stabilizing treatment before redirecting the emergency medical transport. The patient died shortly after arriving at the other hospital. Twin Cities self-reported the incident shortly thereafter. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Senior Counsel Geeta Taylor represented OIG.
New Jersey Doctor Enters Settlement Agreement with OIG on Kickback Allegations
On November 30, 2016, Dr. Robert Collin, a Newark, New Jersey, internist, entered into a $111,415 settlement agreement with OIG. The settlement resolves allegations that Dr. Collin received remuneration from Orange Community MRI, LLC, an imaging facility in Orange, New Jersey, in exchange for patient referrals. Senior Counsels David M. Blank and Lauren E. Marziani represented OIG.
11-28-2016
Missouri Hospital Settles Case Involving Patient Dumping Allegations
On November 28, 2016, Research Medical Center (RMC) in Kansas City, Missouri, entered into a $360,000 settlement agreement with OIG. The settlement agreement resolves allegations that RMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and improperly transferred a patient. The patient presented to RMC's Emergency Department (ED) with a psychiatric emergency medical condition. Without providing stabilizing treatment, RMC transferred the patient to a nearby facility by private vehicle; en route, the patient exited the vehicle and was struck by another vehicle. RMC self-disclosed the incident involving this patient. Based on its investigation, OIG concluded that RMC implemented a transfer policy applicable to patients who presented to RMC's ED with psychiatric emergency medical conditions that also resulted in multiple violations of EMTALA. Specifically, OIG found seventeen occasions where RMC failed to provide adequate medical screening examinations and improperly transferred or discharged, without providing stabilizing treatment, patients who presented to RMC's ED with psychiatric emergency medical conditions. At the time each patient presented, RMC had the capacity to treat, stabilize, or admit each patient. Senior Counsel Geeta Taylor represented OIG.
Illinois Ambulance Company Settles Case Involving False Claims
On November 28, 2016, Mitchell-Jerdan Funeral Home, Ltd. (MJFH), an ambulance company in Mattoon, Illinois, entered into a $126,425.02 settlement agreement with OIG. The settlement agreement resolves allegations that MJFH submitted claims to Medicare for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
11-15-2016
New York Skilled Nursing Facility Settles Case Involving Excluded Individuals
On November 15, 2016, Fort Tryon Rehabilitation and Healthcare Facility, LLC (Fort Tryon), New York, New York, entered into a $110,223.36 settlement agreement with OIG. The settlement agreement resolves allegations that Fort Tryon employed two individuals who were excluded from participating in Federal health care programs. OIG's investigation revealed that one excluded individual was a registered nurse supervisor and the other was a licensed practical nurse. While excluded, both individuals provided items or services to Fort Tryon patients that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Eula Taylor.
New Jersey Physician and Practice Settles False and Fraudulent Medicare Claims Case
On November 15, 2016, Lawrence C. Antonucci, M.D., Clifford Sebastian, M.D., and Lawrence C. Antonucci MD LLC, entered into a $60,884.90 settlement agreement with OIG. The settlement agreement resolves allegations that they submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
11-07-2016
Tennessee Hospital Settles Case Involving a Patient Dumping Allegation
On November 7, 2016, Metro Knoxville HMA, LLC (Metro Knoxville), in Knoxville, Tennessee, entered into a $45,000 settlement agreement with OIG. The settlement agreement resolves allegations that Metro Knoxville violated the Emergency Medical Treatment and Labor Act when it discharged a patient without having provided an adequate medical screening examination or treatment sufficient to stabilize the patient. OIG's investigation revealed that blood test results indicated the presence of an emergency medical condition; however, Metro Knoxville discharged the patient without confirming that such blood levels had stabilized. Senior Counsel Katherine Matos represented OIG.
11-04-2016
Physician Agrees to 20-Year Exclusion To Resolve Civil Monetary Penalty Case
Labib Riachi, M.D., a New Jersey based OB/GYN with a subspecialty in urogynecology, agreed to be excluded from participation in Federal health care programs for a period of twenty years under 42 U.S.C. 1320a-7(b)(7) for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Riachi knowingly submitted claims to Medicare and Medicaid for pelvic floor therapy services that he knew or should have known were not provided as claimed or were false or fraudulent. These claims were not provided as claimed or were false or fraudulent for one or more of the following reasons: (1) Dr. Riachi failed to personally perform or directly supervise services while he was traveling outside the United States or State of New Jersey; (2) Dr. Riachi failed to personally supervise the performance of a diagnostic procedure performed by his medical assistants; (3) services were not actually provided; (4) physical therapy services were provided by unlicensed and unqualified individuals; (5) services were not documented; and (6) diagnostic services were not reasonable and necessary. David Blank, Tamara Forys, and Jennifer Leonardis represented OIG with assistance from Paralegal Specialist Mariel Filtz. News Release
11-02-2016
Arizona Physician and Practice Settles False and Fraudulent Medicare Claims Case
On November 2, 2016, A. Clark Ruttinger, DO, and A. Clark Ruttinger DO, PLLC (Ruttinger), entered into a $52,961.20 settlement agreement with OIG. The settlement agreement resolves allegations that Ruttinger claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.

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