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Civil Monetary Penalties and Affirmative Exclusions

2017

11-06-2017
Ohio Home Health Agency Settles Case Involving Excluded Individual
On November 6, 2017, Diamonds & Pearls Health Services, LLC (DPHS), Cleveland, Ohio, entered into a $75,471.92 settlement agreement with OIG. The settlement agreement resolves allegations that DPHS employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a scheduling/staffing coordinator, provided items or services to DPHS patients that were billed to Federal health care programs.
11-06-2017
Indiana Practice Settles Case Involving Excluded Individual
On November 6, 2017, Center for Ear, Nose Throat & Allergy, P.C. (CENTA), Carmel, Indiana, entered into a $51,564.14 settlement agreement with OIG. The settlement agreement resolves allegations that CENTA employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a medical records file clerk, provided items or services to CENTA's patients that were billed to Federal health care programs. Associate Counsel Srishti Sheffner represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
10-24-2017
California Independent Diagnostic Testing Facility and Owner Agree to Voluntary Exclusion
On October 24, 2017, Prohealth Neurodiagnostic, Inc., an independent diagnostic testing facility in Van Nuys, California, and Arsen Oganesyan, its owner (collectively, "Prohealth"), agreed to be excluded for a period of five years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Prohealth submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare, in violation of a Local Coverage Determination governing the medical necessity of such studies. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, collaborated to achieve this resolution.
10-19-2017
Florida Laboratory Agrees to Voluntary Exclusion
On October 19, 2017, in connection with the resolution of its False Claims Act liability, Total Lab Care, LLC (Total Lab Care), Jacksonville, Florida, agreed to be permanently excluded from participation in all Federal health care programs under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Total Lab Care knowingly billed Federal health care programs for urine toxicology samples that were not reimbursable. Specifically, OIG alleged that Total Lab Care sought reimbursement for urine toxicology samples referred by a physician whom Total Lab Care paid improper financial remuneration. Senior Counsel Felicia Heimer represented OIG.
10-17-2017
Alabama Ambulance Companies Settles Case Involving False Claims
On October 17, 2017, Lifeguard Ambulance Service, LLC, Lifeguard Ambulance Service of Florida, LLC, and Lifeguard Ambulance Service of Texas, LLC (collectively, "Lifeguard"), headquartered in Birmingham, Alabama, entered into a $110,813.69 settlement agreement with OIG. The settlement agreement resolves allegations that Lifeguard 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.
10-17-2017
Texas Mental Health Provider Settles Case Involving Excluded Individual
On October 17, 2017, MHMR of Tarrant County (MHMR), Fort Worth, Texas, entered into a $97,869.78 settlement agreement with OIG. The settlement agreement resolves allegations that MHMR employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a program director, provided items or services to MHMR clients who were receiving services funded by a Medicaid waiver program. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Eula Taylor.
10-17-2017
Missouri Hospital Settles Case Involving Patient Dumping Allegations
On October 17, 2017, Southeast Missouri Hospital (SEM), Cape Girardeau, Missouri, entered into a $100,000 settlement agreement with OIG. The settlement agreement resolves allegations that SEM violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination and stabilizing treatment for two patients who presented to SEM's Emergency Department (ED) in 2011. OIG alleged that instead of being properly evaluated and treated, the patients were discharged with unstabilized emergency medical conditions to the custody of police pursuant to a hospital policy: if a patient had a blood alcohol level (BAL) above 100, the patient was given to local law enforcement and taken to jail. The first patient was 25 years old when she called a crisis hotline and an ambulance was dispatched to her residence. She was transported to SEM's ED for evaluation of a possible suicide attempt by overdose. The patient's BAL was 422 and the ED physician discharged her into the custody of local law enforcement where she was detained in jail and expected to see a counselor. The second patient was 41 years old when he presented to SEM after attempting suicide by overdose. The patient was depressed, had a history of psychiatric problems, and had recently been admitted for electroconvulsive therapy. The patient's BAL was 288 and he was discharged into the custody of local law enforcement and taken to jail. The next day the patient was seen by a counselor in jail and then released from custody. The patient returned to SEM that evening after again attempting suicide by overdose. The patient had slurred speech, was lethargic and had a flat affect and was admitted to the intensive care unit in guarded condition. Senior Counsel Sandra Sands represented OIG.
10-11-2017
Illinois Case Management Provider Settles Case Involving Excluded Individual
On October 11, 2017, Shawnee Health Services (Shawnee), Carterville, Illinois, entered into a $107,761.08 settlement agreement with OIG. The settlement agreement resolves allegations that Shawnee employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a case manager, provided items or services to Shawnee clients that were receiving services under a Medicaid waiver program.
10-10-2017
Arkansas Department of Health Settles Case Involving Excluded Individual
On October 10, 2017, The Arkansas Department of Health (ADH) entered into a $39,343.61 settlement agreement with OIG. The settlement agreement resolves allegations that ADH employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a hospice social worker, provided items or services to patients of a community based hospice operated by ADH that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Eula Taylor.
09-27-2017
New Jersey Physician Agrees to Voluntary Exclusion
On September 27, 2017, in connection with the resolution of his False Claims Act liability, Dr. Dinesh Patel (Dr. Patel), Edison, New Jersey, agreed to be excluded again 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 despite previously having been excluded from participation in New Jersey Medicaid on March 17, 2012, and excluded from participation in all Federal health care programs on February 20, 2014, Dr. Patel continued to provide administrative and management services to Edison Adult Medical Daycare (EAMD) in violation of the terms of his exclusion. Dr. Patel had a previous ownership interest in EAMD, which he transferred to his wife around the time of his exclusion from New Jersey Medicaid. Senior Counsel David Fuchs represented OIG.
09-27-2017
Arizona Pain Management Practice Settles Case Involving Kickback and Stark Allegations
On September 27, 2017, Advanced Pain Management (APM), a pain management practice with multiple locations in Arizona, entered into a $186,210.20 settlement agreement with OIG. As the result of its investigation, OIG alleged that APM received improper 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 that APM 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
09-22-2017
Podiatrist Agrees to Voluntary Exclusion
On September 22, 2017, Patricia Anne Chapman (Chapman), Liberty Lake, Washington, agreed to be excluded from participation in all Federal health care programs for a period of 10 years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that, in her Clinton, Iowa, podiatric practice, Chapman submitted false or fraudulent claims to Medicare using Current Procedural Terminology Code 97032: (1) for electrical stimulation services (e-stim) that were not medically reasonable or necessary, (2) for e-stim services not administered with "constant attendance" and "manual application," according to the requirements of the code, (3) for twice the number of e-stim units than documented in the beneficiaries' patient files, and (4) for using false records and statements to support the false e-stim claims. Senior Counsel Keshia Thompson represented OIG.
09-18-2017
New York Pharmacy Settles Case Involving Excluded Individual
On September 18, 2017, Century Pharmacy (Century), Brooklyn, New York, entered into a $10,000 settlement agreement with OIG. The settlement agreement resolves allegations that Century employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, who assisted in filling prescriptions in addition to performing other clerical tasks, provided items or services to Century patients that were billed to Federal health care programs. Senior Counsel Kenneth Kraft represented OIG with the assistance of Paralegal Specialist Eula Taylor.
09-18-2017
New York Addiction Treatment Center Settles Case Involving Kickback Allegations
On September 18, 2017, Parallax Center, Inc. (Parallax), New York, New York, entered into a $64,203.30 settlement agreement with OIG. As the result of its investigation, OIG alleged that Parallax received improper 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 that Parallax 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.
09-18-2017
North Shore Medical Center Settles Case Involving Patient Dumping Allegation
On September 18, 2017, North Shore Medical Center (NSMC), Lynn, Massachusetts, entered into a $60,000 settlement agreement with OIG. The settlement agreement resolves allegation that NSMC violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination for a fourteen-year-old patient and inappropriately transferred her to another hospital. The patient arrived at NSMC's Union Hospital emergency department by ambulance, secured to a stretcher and under police escort, for psychiatric evaluation after combative behavior at home and banging her head against a wall. Upon arrival at NSMC Union Hospital the patient was placed in a room, still secured to the stretcher. NSMC Union Hospital's emergency department physician came into the room and told the paramedics that the patient should be transported to NSMC's Salem Hospital emergency department for pediatric psychiatric evaluation. Before recommending transfer, NSMC failed to provide the patient with a medical screening exam. On route to NSMC Salem Hospital, the police instructed the ambulance to take the patient to a different hospital where her mother was waiting. Senior Counsel Kristen Schwendinger represented OIG.
09-15-2017
Texas Mental Health Facility Settles Case Involving Excluded Individual
On September 15, 2017, Sundance Behavioral Healthcare System (Sundance), Texas, entered into a $49,183.48 settlement agreement with OIG. The settlement agreement resolves allegations that Sundance employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a licensed vocational nurse, provided items or services to Sundance patients that were billed to Federal health care programs. Deputy Branch Chief Nicole Caucci represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
09-11-2017
West Virginia Physician Agrees to Voluntary Exclusion
On September 11, 2017, in connection with the resolution of her False Claims Act liability, Dr. Cheryl Wingate (Dr. Wingate), Fairmont, West Virginia, agreed to be excluded from participation in all Federal health care programs for a period of 5 years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Dr. Wingate caused compounding pharmacies to submit false claims for compound creams and medications to TRICARE and the Medicare Program by issuing or approving prescriptions that were not legitimate because Dr. Wingate did not examine or evaluate the patients in question and did not have an established physician-patient relationship with them. OIG's investigation also revealed that Dr. Wingate issued and approved the medication prescriptions in exchange for compensation paid to her by the pharmacies, telemedicine entities, or other intermediaries acting on behalf of the pharmacies.
09-08-2017
California Independent Diagnostic Testing Facility and Owner Agree to Voluntary Exclusion
On September 8, 2017, Olive Sleep & EEG, Inc., an independent diagnostic testing facility, and Mariam Unjughulyan, its owner, (collectively, "Olive Sleep") agreed to be excluded for a period of five years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Olive Sleep submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare in violation of a Local Coverage Determination governing the medical necessity of such studies. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, collaborated to achieve this resolution.
09-05-2017
Montana Physician Agrees to Voluntary Exclusion
On September 5, 2017, in connection with the resolution of False Claims Act liability, Dr. Cory Lee Pickens, Billings, Montana, agreed to be excluded for a period of ten years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that despite previously having been excluded from participation in all Federal health care programs on September 20, 2011, Dr. Pickens provided services to beneficiaries of the Medicaid program while he was excluded. Senior Counsel David Traskey represented OIG.
08-31-2017
Florida Pharmaceutical Company Settles Case Involving Drug Price Reporting
On August 31, 2017, Stratus Pharmaceuticals Inc. (Stratus), Florida, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that Stratus failed to submit 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 2014 and 2015. The Medicaid Drug Rebate Program requires pharmaceutical companies 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 pharmaceutical company's covered 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.
08-23-2017
Tennessee Transportation Service Provider and Owner Agree to Voluntary Exclusion
On August 23, 2017, in connection with the resolution of False Claims Act liability, Employment & Assessment Solutions, Inc., a transportation service provider, and Chris Manus, its owner (collectively, "EASI"), agreed to be excluded for a period of nine years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that EASI caused the submission of claims to Federal health care programs for services billed but not actually provided by EASI for patients, including transportation services not provided to patients who were incarcerated or hospitalized at the time of their purported transport. Associate Counsel Srishti Sheffner represented OIG.
08-15-2017
Utah Laboratory Settles Case Involving Select Agent Regulations
On August 15, 2017, a Utah laboratory agreed to pay $250,000 to resolve its liability for violating the select agent regulations. OIG alleged that the laboratory violated the select agent regulations by allowing access to select agents or toxins maintained in registered laboratory space to an individual who lacked a security risk assessment approval, and who was later identified as a restricted person. OIG contends this conduct subjects the laboratory to civil money penalties under the Bioterrorism Preparedness Act, 42 U.S.C. 262a(i) and 42 C.F.R. 1003.102(b)(16).
08-14-2017
Michigan Laboratory Settles Case Involving Select Agent Regulations
On August 14, 2017, a Michigan laboratory agreed to pay $55,000 to resolve its liability for violating the select agent regulations. OIG alleged that the laboratory violated the select agent regulations by allowing access to select agents or toxins maintained in registered laboratory space to an individual who lacked a security risk assessment approval, and who was later identified as a restricted person. OIG contends this conduct subjects the laboratory to civil money penalties under the Bioterrorism Preparedness Act, 42 U.S.C. 262a(i) and 42 C.F.R. 1003.102(b)(16).
08-11-2017
Texas Home Health Company Settles Case Involving Excluded Individual
On August 11, 2017, ASAP Professional Home Health (ASAP), Houston, Texas, entered into a $21,797.76 settlement agreement with OIG. The settlement agreement resolves allegations that ASAP employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an attendant, provided items or services to ASAP patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Eula Taylor.
07-21-2017
Utah Pain Doctor and Medical Practice Settle False and Fraudulent Medicare Claims Case
On July 21, 2017, Jahan Imani, M.D. (Imani), and Intermountain Medical Management, P.C. (IMM), a Utah based pain management specialist and his practice, entered into a $399,895.92 settlement agreement with OIG. The settlement agreement resolves allegations that IMM, through Imani, submitted false or fraudulent claims for payment by inappropriately using modifier 59 for multiple units of HCPCS code G0431 when only a single unit may be billed per patient encounter. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, collaborated to achieve this settlement.
07-06-2017
Pennsylvania Hospice CEO Agrees to Voluntary Exclusion
On July 6, 2017, Malvina Yakobashvili, the President, CEO, and owner of a Pennsylvania hospice company, agreed to be excluded for a period of ten years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Yakobashvili's company, Home Care Hospice, Inc.: (1) submitted claims to Medicare for hospice services that were provided to beneficiaries who did not qualify under the Medicare guidelines for (a) routine hospice care because patients were improperly certified as terminally ill or (b) continuous care; and (2) engaged in a cover-up scheme that included falsification of documents to conceal the fraud.
06-23-2017
South Carolina Hospital Settles Case Involving Patient Dumping Allegations
On June 23, 2017, AnMed Health (AnMed), in Anderson, South Carolina, entered into a $1,295,000 settlement agreement with OIG. The settlement agreement resolves allegations that, in 36 incidents investigated by OIG, AnMed violated the Emergency Medical Treatment and Labor Act (EMTALA). In these incidents, individuals presented to AnMed's Emergency Department (ED) with unstable psychiatric emergency medical conditions. Instead of being examined and treated by an on-call psychiatrist, and despite empty beds in its psychiatric unit to which the patients could have been admitted for stabilizing treatment, the patients were involuntarily committed and kept in AnMed's ED for between 6 and 38 days each. The following is an example of one such incident. A patient presented to AnMed's ED via law enforcement with psychosis and homicidal ideation and was involuntarily committed. The patient did not receive psychiatric examination or treatment by available AnMed psychiatrists and was not admitted to the psychiatric unit for stabilizing treatment. Instead, the patient was kept in the ED for 38 days and at one point was seen by a psychiatrist from another facility that was familiar with her condition. The psychiatrist prescribed a variety of medications for agitation. The patient eventually was discharged home. Senior Counsel Sandra Sands represented OIG.
06-21-2017
Louisiana Dentist Settles Case Involving Medically Unnecessary Claims
On June 21, 2017, Robert J. Edwards, DDS (Dr. Edwards), Baton Rouge, Louisiana, entered into a $80,070.10 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Edwards submitted claims for medically unnecessary root canals on permanent teeth, extractions, restorations, and stainless steel crowns for a number of pediatric Medicaid dental beneficiaries. OIG's Office of Evaluations and Inspections and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Geeta Tyalor, collaborated to achieve this settlement.
06-20-2017
Florida Pharmacy Settles Case Involving Excluded Individual
On June 20, 2017, Linton Square Pharmacy & Medical Supplies, Inc. (Linton Square), Delray Beach, Florida, entered into a $339,956.05 settlement agreement with OIG. The settlement agreement resolves allegations that Linton Square employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a pharmacist, provided items or services to Linton Square patients that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
06-16-2017
UMass Medical Center Settles False and Fraudulent Medicare Claims Case
On June 16, 2017, UMass Memorial Medical Center, Inc. (UMass), entered into a $441,047.36 settlement agreement with OIG. The settlement agreement resolves allegations that UMass submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205 when the patients at issue were actually "established patients" and, thus, UMass should have submitted those claims using the lower-paying HCPCS codes 99213-99215. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, collaborated to achieve this settlement.
06-16-2017
Boston Medical Center Settles False and Fraudulent Medicare Claims Case
On June 16, 2017, Boston Medical Center Corporation d/b/a Boston Medical Center (BMC), entered into a $313,246 settlement agreement with OIG. The settlement agreement resolves allegations that BMC submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205 when the patients at issue were actually "established patients" and, thus, BMC should have submitted those claims using the lower-paying HCPCS codes 99213-99215. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, collaborated to achieve this settlement.
05-30-2017
Mental Health Services Company Agrees to Permanent Exclusion
On May 30, 2017, in connection with the resolution of False Claims Act liability, Complementary Support Services, CCS South, LLC, CCS Central, LLC, CCS North, LLC, CCS Metro, LLC, and Clinical Support Services, LLC (collectively, "CSS"), Minnesota, agreed to be permanently excluded from participation in all Federal health care programs under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that CSS submitted false claims for mental health services to the Minnesota Medicaid program. OIG alleged that CSS billed for documentation time despite a state statute and regulations permitting reimbursement only for face-to-face services. Senior Counsel Geeta Taylor and Associate Counsel David Fuchs represented OIG.
Illinois Skilled Nursing Facilities Settle Case Involving Excluded Individual
On May 30, 2017, Heritage Robinson, LLC and Burnsides Community Health Center, Inc. (collectively, "Heritage"), entered into a $26,748.22 settlement agreement with OIG. The settlement agreement resolves allegations that Heritage 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 Heritage patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG.
05-17-2017
New York Physician Agrees to Another Voluntary Exclusion
On May 17, 2017, in connection with the resolution of his False Claims Act liability, Dr. Michael Esposito (Dr. Esposito), Albany, New York, agreed to be excluded again from participation in all Federal health care programs for a period of fifteen years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that despite previously having been excluded from participation in all Federal health care programs on December 9, 2016, for a period of five years, he forged another physician's signature on prescriptions, including opioids, in order to obtain medications for himself and another person. In the instant matter, Dr. Esposito presented claims for payment to Medicare for services that he furnished, ordered, and prescribed to Medicare beneficiaries while he was excluded. Senior Counsel David Traskey represented OIG.
05-15-2017
California Dentist Settles Case Involving Medically Unnecessary Claims
On May 15, 2017, Ana M. Gama, DDS and Ana M. Gama, DDS, Inc. (collectively, Dr. Gama), Ontario, California, entered into a $31,817.88 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that Dr. Gama submitted claims for medically unnecessary pulpotomies, extractions, restorations, and stainless steel crowns for a number of pediatric Medicaid dental beneficiaries. OIG's Office of Evaluations and Inspections and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Geeta Tyalor, collaborated to achieve this settlement.
05-15-2017
New York Physician Agrees to Voluntary Exclusion
On May 15, 2017, Dr. Haroutyoun Margossian (Dr. Margossian), a New York physician specializing in female urinary incontinence, agreed to be excluded from participation in all Federal health care programs for a period of seven years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Dr. Margossian knowingly presented or caused to be presented claims to Medicare and Medicaid relating to the treatment of patients suffering from urinary incontinence that he should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended Dr. Margossian failed to: (1) employ licensed individuals to perform the urodynamic and pelvic floor therapy (PFT) services; and (2) properly supervise the individuals performing the urodynamic and PFT services. Senior Counsel David Blank and Associate Counsel Jennifer Leonardis represented OIG.
05-12-2017
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On May 12, 2017, Monroe County Hospital (MCH) in Forsyth, Georgia, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegation that MCH violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment for a woman who presented to MCH's Emergency Department (ED) complaining she was 36 weeks pregnant and her water had broken. The patient told a nurse that she wanted to see her physician in Macon, Georgia. Without providing a medical screening examination, ED staff decided that the patient could go see her physician in Macon. The patient was then escorted to her car and told to call 911. Emergency medical services arrived and found the patient in her car. She was brought to another hospital where she delivered her child within an hour of arriving. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Associate Counsel Srishti Sheffner represented OIG.
04-20-2017
Health Care Administrator Agrees to Voluntary Exclusion
On April 20, 2017, in connection with the resolution of his False Claims Act liability, Yogesh K. Pancholi (Pancholi), Michigan, 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 Pancholi caused the submission of false claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care services that were referred in exchange for illegal remuneration or kickbacks paid by Pancholi. Senior Counsel David Traskey represented OIG.
04-18-2017
Connecticut Hospital Settles False and Fraudulent Medicare Claims Case
On April 18, 2017, Hartford Hospital (Hartford), Connecticut, entered into a $2,469,374 settlement agreement with OIG. The settlement agreement resolves allegations that Hartford submitted claims where patients received home health services within three days of the patients' release from Hartford that were improperly coded as discharged rather than as a post-acute care transfer. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Nancy Brown, collaborated to achieve this settlement.
Connecticut Hospital Settles False and Fraudulent Medicare Claims Case
On April 18, 2017, Midstate Medical Center (Midstate), Connecticut, entered into a $436,748 settlement agreement with OIG. The settlement agreement resolves allegations that Midstate submitted claims where patients received home health services within three days of the patients' release from Midstate that were improperly coded as discharged rather than as a post-acute care transfer. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Nancy Brown, collaborated to achieve this settlement.
Texas Independent Diagnostic Testing Facility Settles False and Fraudulent Medicare Claims Case
On April 18, 2017, Frontera Strategies, LP (Frontera), Texas, entered into a $510,938.74 settlement agreement with OIG. The settlement agreement resolves allegations that Frontera submitted claims to Medicare for nerve conduction studies (NCS) that are considered screening exams and not covered by Medicare. Medicare Administrative Contractor Local Coverage Determinations specified that an electromyography must be performed as well as NCS for diagnostic purposes. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, collaborated to achieve this settlement.
04-14-2017
Mental Health Services Company Owner Agrees to Voluntary Exclusion
On April 14, 2017, in connection with the resolution of her False Claims Act Liability, Teri Dimond (Dimond), Minnesota, agreed to be excluded from participation in all Federal health care programs for a period of eight years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Dimond, through her company, caused to be presented false claims for mental health services to the Minnesota Medicaid program. OIG alleged the claims were false for one or more of the following reasons: (1) the services were provided by unlicensed practitioners without adequate clinical supervision; and (2) claims for reimbursement were submitted for the time spent maintaining patient records and/or the preparation of reports, in violation of state Medicaid regulations. Senior Counsel Geeta Taylor and Associate Counsel David Fuchs represented OIG.
03-31-2017
Texas Ambulance Company Settles Case Involving False Claims
On March 31, 2017, Freedom Ambulance, LLC (Freedom Ambulance), an ambulance company in Beeville, Texas, entered into a $846,563.92 settlement agreement with OIG. The settlement agreement resolves allegations that Freedom Ambulance knowingly presented to Medicare and Texas Medicaid false or fraudulent claims for non-emergency repetitive ambulance services between beneficiaries' residences or skilled nursing facilities and non-hospital based dialysis facilities. Senior Counsels Ellen Slavin and Katie Fink represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
Massachusetts Ambulance Company Settles Case Involving False Claims On March 31, 2017, EasCare, LLC (EasCare), an ambulance company in Dorchester, Massachusetts, entered into a $255,768.14 settlement agreement with OIG. The settlement agreement resolves allegations that EasCare 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.
03-16-2017 Florida Neurologist Excluded for Default
On March 16, 2017, OIG excluded Dr. Sean Orr (Dr. Orr), a Florida neurologist, for defaulting on his payment obligations under a Settlement Agreement (Agreement) with the Department of Justice (DOJ) and OIG. Dr. Orr previously entered into the Agreement for knowingly misdiagnosing certain patients with various neurological disorders, such as multiple sclerosis, which caused claims to be submitted to Federal health care programs for medically unnecessary items and services. The terms of the Agreement provided that Dr. Orr would make an initial upfront payment plus additional payments over a five-year period. On January 23, 2017, DOJ issued a Notice of Default to Dr. Orr. Senior Counsel Karen Glassman represented OIG.
03-13-2017
Iowa Chiropractor Agrees to 3-Year Exclusion
On March 13, 2017, Elizabeth Kressin, D.C. (Kressin), an Iowa chiropractor, agreed to be excluded from participation in Federal health care programs for a period of three years under 42 U.S.C. 1320a-7(b)(7) for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kressin caused claims to be submitted to Iowa Medicaid for chiropractic services performed on children, which were not provided as claimed and were for treatment of conditions for which payment is not allowed under applicable rules. Associate Counsel Jennifer Leonardis represented OIG.
03-08-2017
Michigan Physician Agrees to 3-Year Exclusion
On March 8, 2017, Dr. Vinod Sharma, (Dr. Sharma) a Michigan physician and pain management specialist, agreed to be excluded from participation in Medicare and the State health care programs for a period of three years under 42 U.S.C. 1320c-5 following a referral to OIG by Kepro, the Beneficiary and Family Centered Care Quality Improvement Organization (QIO). OIG's investigation determined that Dr. Sharma substantially violated the obligation to provide services (1) of a quality that met professionally recognized standards of health care, and (2) that were supported by evidence of medical necessity and quality in such form and fashion and at such time as was reasonably required by the QIO in the exercise of its duties and responsibilities. Specifically, OIG alleged that Dr. Sharma failed to sufficiently document his response to the results of urine drug screenings and any discussions he had with patients regarding the urine drug screening results when these patients (1) tested positive for illicit drugs; (2) tested positive for controlled substances Dr. Sharma did not prescribe; (3) tested positive for noncontrolled substances Dr. Sharma did not prescribe; or (4) tested negative for controlled substances Dr. Sharma prescribed. Senior Counsel Kristen Schwendinger, Senior Counsel Geoffrey Hymans and Associate Counsel Srishti Sheffner represented OIG.
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.
01-13-2017
Michigan Physician Agrees to Voluntary Exclusion
On January 13, 2017, in connection with the resolution of his False Claims Act liability, Dr. Sotero Ureta, Lake City, Michigan, agreed to be excluded from participation in all Federal health care programs for a period of three years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Dr. Ureta caused the submission of false claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care services that he referred in exchange for illegal remuneration or kickbacks. Senior Counsel David Traskey 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
Manager of Oklahoma Behavioral Health Counseling Center Agrees to Voluntary Exclusion
On January 6, 2017, Heather Doss agreed to be excluded from participation in all Federal health care programs for a period of two years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Doss knowingly submitted or caused to be submitted false or fraudulent claims to Medicaid for services not provided or provided by unqualified individuals, as well as claims with falsified dates or time of services. Senior Counsel Kenneth Kraft 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.

2016

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.
10-31-2016
Colorado Health System Settles Case Involving False Claims
On October 31, 2016, UCH-MHS d/b/a Memorial Health System (Memorial) entered into a $58,512.00 settlement agreement with OIG. The settlement agreement resolves allegations that Memorial submitted claims to Medicare for health care items and services provided to individuals who were in the custody of penal authorities and which were not eligible for payment under Medicare Part A or B. Senior Counsel Geeta Taylor represented OIG.
10-27-2016
Missouri Ambulance Company Settles Case Involving False Claims
On October 27, 2016, American Paramedical Services, Inc. (APS), entered into a $187,480.12 settlement agreement with OIG. The settlement agreement resolves allegations that APS 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.
Virginia Health System Settles Case Involving False Claims
On October 27, 2016, Centra Health, Inc. (Centra), entered into a $137,864.68 settlement agreement with OIG. The settlement agreement resolves allegations that Centra 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.
10-26-2016
California Hospital Settles Case Involving a Patient Dumping Allegation
On October 26, 2016, Sonoma Valley Hospital (Sonoma), a small hospital in Sonoma, California, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegations that Sonoma violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide needed stabilizing treatment and an appropriate transfer for a 59-year old woman. OIG's investigation revealed that the patient arrived at Sonoma's Emergency Department (ED) via ambulance. The patient had a fever, no palpable pulses or blood pressure, a low respiratory rate and severe pain. Ten days earlier she had undergone surgery for diversional ileostomy (surgical formation of an opening of the intestine to the surface of the abdomen, through which fecal matter is emptied). The patient was diagnosed with sepsis and needed immediate surgery. Although Sonoma had the capabilities to provide this surgery, Sonoma's doctors wanted to send the patient back to the surgeon who performed her original surgery. Approximately 7.5 hours after the patient arrived at Sonoma's ED, she was inappropriately transferred to another hospital. At that hospital she received immediate surgery and died soon after. Senior Counsel Sandra Sands represented OIG.
Illinois Physician Agrees to Voluntary Exclusion
On October 26, 2016, in connection with the resolution of False Claims Act liability, Duttala Obul Reddy, M.D., agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Dr. Reddy submitted claims to Medicaid and Medicare seeking payment for Evaluation and Management services billed at Current Procedural Terminology code 93310 purportedly provided at long-term care facilities that either had not been provided or had not been provided to the extent claimed. Senior Counsel Geeta Taylor represented OIG.
10-19-2016
North Carolina Hospital Settles Case Involving a Patient Dumping Allegation
On October 19, 2016, Park Ridge Health (Park Ridge), a small hospital in Hendersonville, North Carolina, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that Park Ridge violated the Emergency Medical Treatment and Labor Act when it inappropriately transferred a patient, who was pregnant and experiencing contractions, to another hospital without properly stabilizing her emergency medical condition. Senior Counsel Gregory Wellins represented OIG.
10-17-2016
DME Company Owner Agrees to 10 Year Exclusion
On October 17, 2016, Phillip A. Minga, the owner of a durable medical equipment (DME) company, agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. 1320a-7(b)(7) and 42 U.S.C. 1320a-7(b)(16). OIG's investigation revealed that Minga knowingly caused claims to be submitted to Medicare for diabetes supplies that were not delivered, were the result of unsolicited Medicare beneficiary contact, in violation of the Social Security Act's DME Telemarketing Provisions and not covered by applicable exceptions, or were the result of a kickback. OIG's investigation further revealed that Minga knowingly retained or caused the retention of an overpayment owed to the Center for Medicare and Medicaid Services as a result of a Medicare Benefit Integrity Post-Payment Review conducted by Zone Program Integrity Contractor AdvanceMed. OIG's investigation also revealed that Minga knowingly made or caused to be made an omission or misrepresentation of a material fact in the applications of a DME company and its affiliates to participate or enroll as a supplier under Medicare, including organizations under Part C and D, when: (a) Minga was omitted as a managing employee; and (b) as a managing employee, Minga was not disclosed as having been convicted of a felony offense within the 10 years preceding enrollment or revalidation of enrollment. Senior Counsel Kristen Schwendinger and Associate Counsel David Fuchs represented OIG.
09-28-2016
University of California Medical Center Settles False and Fraudulent Medicare Claims Case
On September 28, 2016, University of California San Francisco Health d/b/a UCSF Medical Center (UCSF), entered into a $1,443,016 settlement agreement with OIG. The settlement agreement resolves allegations that UCSF submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205 when the patients at issue were actually "established patients" and, thus, UCSF should have submitted those claims using the lower-paying HCPCS codes 99213-99215. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, collaborated to achieve this settlement.
09-27-2016
Former South Carolina Hospital CEO Agrees to Voluntary Exclusion
On September 27, 2016, in connection with the resolution of False Claims Act and Stark Law liability, Ralph J. Cox, III, agreed to be excluded from participating in Federal health care programs for a period of four years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that during Cox's tenure as CEO and Board Member of the Board of Trustees of Tuomey Healthcare System, Inc. (Tuomey), in Sumter, South Carolina, he caused Tuomey to submit claims for payment to the Medicare and Medicaid Programs that were false because they violated the Stark Law. A jury had previously determined that Tuomey violated the False Claims Act by knowingly submitting to Medicare false claims for designated health services that had been referred to Tuomey in violation of the Stark Law. Deputy Branch Chief Kevin Barry represented OIG.
09-22-2016
Massachusetts Social Worker Agrees to Voluntary Exclusion
On September 22, 2016, in connection with the resolution of False Claims Act liability, David Margolis, a social worker, 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 alleged that Margolis submitted false claims to Medicare for: (1) more therapy sessions than he actually provided to the beneficiaries; (2) therapy sessions that did not occur because Margolis was actually on vacation; (3) therapy sessions that did not occur because of late cancellations by the beneficiaries; (4) therapy sessions that did not occur because the beneficiaries did not appear for appointments; and (5) therapy sessions for relatives of the beneficiaries. Senior Counsel John O'Brien represented OIG.
09-21-2016
New Jersey Physicians and Practice Settle False and Fraudulent Medicare Claims Case
On September 21, 2016, John G. Ciciarelli, II, MD, Jason Arash Nehmad, MD, and Northern Ocean County Medical Associates, PC, entered into a $36,850.38 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 that went beyond the report of the laboratory results; 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.
Kentucky Hospital Settles Case Involving a Patient Dumping Allegation
On September 21, 2016, T.J. Samson Community Hospital (T.J. Samson), in Glasgow, Kentucky, entered into a $35,000 settlement agreement with OIG. The settlement agreement resolves allegations that T.J. Samson violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to accept an appropriate transfer of a 29-year old woman in need of specialized capabilities available at T.J. Sampson. OIG's investigation revealed that the patient presented to a small hospital's Emergency Department with complaints of abdominal pain and right side back pain. She was diagnosed with appendicitis and in need of emergency surgery, which was unavailable at the hospital. That hospital contacted T.J. Samson to arrange for a transfer of the patient. The on-call surgeon at T.J. Samson inquired about the patient's insurance. When the on-call surgeon was told that the patient did not have insurance, he refused to accept the transfer. Senior Counsel Sandra Sands represented OIG.
09-19-2016
New Jersey Medical Biller Settles False and Fraudulent Claims Case and Agrees to 5-Year Exclusion
On September 19, 2016, Susan Toy, entered into a $100,000 settlement agreement with OIG and agreed to be excluded from participating in Federal health care programs for a minimum of five years. On July 1, 2016, OIG issued a letter to Toy, proposing to impose a civil money penalty and program exclusion on her, pursuant to the Civil Monetary Penalties Law. The settlement agreement resolves OIG's allegations that Toy prepared and submitted claims for services that were never performed. Toy, through her health care billing company, prepared and submitted claims for an obstetrics and gynecology physician practice located in New Jersey. Toy was responsible for preparing and submitting claims based, in part, on superbills identifying the services purportedly performed during a patient encounter. OIG contended that Toy prepared and submitted claims for Current Procedural Terminology code 91122 (anorectal manometry) for patient encounters where the procedure was neither performed nor identified as performed on the superbill. Senior Counsels David Blank and Tamara Forys represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
09-16-2016
Arkansas Ambulance Company Settles Case Involving False Claims
On September 16, 2016, Arkansas Excellent Transport, Inc. (AET), entered into a $35,208.35 settlement agreement with OIG. The settlement agreement resolves allegations that AET 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 Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
09-13-2016
Tennessee Hospital Settles Case Involving a Patient Dumping Allegation
On September 13, 2016, HMA Fentress County General Hospital, LLC f/d/b/a Jamestown Regional Medical Center (Jamestown), a small hospital in Jamestown, Tennessee, entered into a $10,000 settlement agreement with OIG. The settlement agreement resolves allegations that Jamestown violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination, treatment or transfer for a 69-year-old woman. OIG's investigation revealed that the patient presented to Jamestown's Emergency Department (ED) with the chief complaint of gastrointestinal bleeding accompanied with blood clots, abdominal pain, and back pain. The patient's pain level was 7 out of 10. A lab test revealed an elevated white blood cell count, and a CT scan of her abdomen and pelvis did not reveal anything abnormal. The patient was given antibiotics and pain medication and discharged with a diagnosis of sinusitis. Upon leaving the ED, the patient used the bathroom and passed blood clots. She requested the help of a nurse, but the ED doctor said she could come back in the ED for more tests or she could go to another hospital, without providing for an appropriate transfer. Senior Counsel Sandra Sands represented OIG.
09-12-2016
Jackson Health System in Florida Settles Case Involving a Patient Dumping Allegation
On September 12, 2016, Public Health Trust of Miami-Dade County, Florida d/b/a Jackson Health System (Jackson), in Miami, Florida, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that Jackson violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to accept the appropriate transfer of a patient who required the specialized capabilities available at Jackson. OIG's investigation revealed that a hospital in the Virgin Islands (requesting hospital) contacted Jackson and requested to transfer a patient who had a life-threatening Type A Aortic Dissection with Thrombus, which required immediate cardiothoracic surgical intervention. OIG's investigation revealed that Jackson declined to accept the transfer of the patient unless it received a guarantee of payment. The requesting hospital obtained the guarantee of payment, but Jackson still declined to accept the transfer because the request needed to be approved by a supervisor who would not be in until the following business day. A few hours later, the patient died at the requesting hospital. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Felicia Heimer represented OIG.
09-07-2016
New Jersey DME Company Agrees to Permanent Exclusion
On September 7, 2016, in connection with the resolution of False Claims Act liability, Oxford Diabetic Supply, Inc. (Oxford), agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Oxford set up and controlled an entity that it used to make unsolicited telephone calls to suspected Medicare beneficiaries in order to sell durable medical equipment (DME) to those beneficiaries, in violation of the Social Security Act's DME Telemarketing Provisions. OIG alleged that Oxford billed Medicare for DME that was sold pursuant to these unsolicited calls. Associate Counsel David Fuchs represented OIG.
09-06-2016
Puerto Rico Physician Agrees to Voluntary Exclusion
On September 6, 2016, in connection with the resolution of False Claims Act liability, Narciso Reyes Carrillo, MD, 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 alleged that Dr. Reyes submitted or caused to be submitted false claims under Medicare when he furnished healthcare services to Medicare beneficiaries in a hospital emergency department while he was excluded from participating in Federal healthcare programs. OIG had previously excluded Dr. Reyes in October 2009 for five years for his felony conviction in the U.S. District Court for the District of Puerto Rico. Senior Counsel Sarah Kessler represented OIG.
09-01-2016
West Virginia Psychiatrist Agrees to 10 Year Exclusion
On September 1, 2016, in connection with the resolution of False Claims Act liability, Delano H. Webb, MD, a West Virginia psychiatrist, agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Dr. Webb signed and supplied blank prescriptions and incomplete Certificates of Medical Necessity (CMNs) to durable medical equipment (DME) suppliers to complete and use in support of false claims to Medicare and West Virginia Medicaid for DME without regard for diagnosis or medical necessity. OIG alleged that the fraudulent prescriptions and CMNs containing Dr. Webb's signature purported to show that Dr. Webb had prescribed and certified the medical necessity and propriety of the DME when, in fact, he had not. After the initiation of an investigation in this matter, Dr. Webb participated in a scheme to obstruct the investigation by re-signing some of the fraudulent prescriptions and CMNs previously created by the DME supplier and ratifying those prescriptions and CMNs without regard to medical necessity or propriety. These re-signed claims were placed in patient records in an attempt to avoid having to repay Medicare and West Virginia Medicaid for the payments previously made based on the false claims submitted. Associate Counsel David Fuchs represented OIG.
08-31-2016
Texas Pharmacy and Pharmacy Manager Settle Case Involving Excluded Individual
On August 31, 2016, Lifechek 336 Pharmacy, LLC, Lifechek Staff Services, Inc., and Bruce Gingrich (collectively, "Lifechek"), Texas, entered into a $30,000 settlement agreement with OIG. The settlement agreement resolves allegations that Lifechek employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a store manager and pharmacy technician, provided items or services that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG.
08-29-2016
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.
08-24-2016
Connecticut Physicians and Practice Settle False and Fraudulent Medicare Claims Case
On August 24, 2016, Robert Borkowski, MD, Robert D. Malkin, MD, James St. Pierre, MD, Manny Katsetos, MD, and Lexington Cardiology Associates, LLC, entered into a $30,349.14 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.
Texas Physicians and Practice Settle False and Fraudulent Medicare Claims Case
On August 24, 2016, Harold J. Pean, MD, Mihaela Shuaib, MD, and Mission Internal Medicine, PA, entered into a $28,757.18 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.
08-19-2016
Pennsylvania Audiology Practice Agrees to Voluntary Exclusion
On August 19, 2016, in connection with the resolution of False Claims Act liability, John Balko & Associates, Inc. d/b/a Senior Healthcare Associates (SHA), agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that SHA knowingly and intentionally submitted or caused to be submitted claims for payment to Medicare for cerumen removal procedures, nail debridement procedures, and evaluation and management services using modifier-25, which were not medically necessary, were not authorized or requested by patients, were not supported by patient medical records, lacked required medical documentation, and/or were provided in reliance upon improper standing orders.
08-17-2016
Texas Hospice Provider Settles False and Fraudulent Medicare Claims Case
On August 17, 2016, Community Hospice of Texas (CHT), Texas, entered into a $34,986.68 settlement agreement with OIG. The settlement agreement resolves allegations that CHT submitted claims for hospice services at the general inpatient level of care when it knew or should have known that routine care should have been billed. Senior Counsels Geoffrey Hymans and David Traskey represented OIG.
08-12-2016
Florida Physician and Practice Settle False and Fraudulent Medicare Claims Case
On September 26, 2016, Chika E. Okereke, MD, and his medical practice, Cardiovascular Partners, PA, (collectively, Dr. Okereke), Florida, entered into a $139,383.72 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Okereke filed claims for Healthcare Common Procedure Coding System (HCPCS) code G0248 (demonstrate use home INR monitoring) where Dr. Okereke did not perform such services, and should instead have filed less frequent claims for HCPCS code G0250 (MD INR test review interpretation management). Senior Counsel Geoffrey Hymans represented OIG.
Arizona Physician Settles False and Fraudulent Medicare Claims Case
On August 12, 2016, Manith Mann, M.D., Arizona, entered into a $66,513.50 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Mann 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 judgement 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 Kenneth Kraft and Geoffrey Hymans represented OIG.
08-04-2016
Georgia Podiatrist Settles False and Fraudulent Claims Case
On August 4, 2016, Janaki Nadarajah, DPM, Georgia, entered into a $115,000 settlement agreement with the OIG. The settlement resolves allegations that Dr. Nadarajah improperly submitted claims: (1) for nail debridement and other podiatric services rendered to patients in assisted living facilities when she neither personally performed nor supervised the service; and (2) for Dermagraft skin substitute not provided in accordance with the product's Food and Drug Administration-approved label and applicable Medicare rules.
08-02-2016
Texas Skilled Nursing Facility Settles Case Involving Excluded Individual
On August 2, 2016, PHCC-The Pointe Rehabilitation & Healthcare Center LLC d/b/a The Pointe Rehabilitation and Healthcare Center, and PHCC-Paramount Health Care Company, LLC (The Pointe), Webster, Texas, entered into a $408,159.53 settlement agreement with OIG. The settlement agreement resolves allegations that The Pointe employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an office manager, provided items or services to The Pointe patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
08-01-2016
Palestine Regional Medical Center in Texas Settles Case Involving a Patient Dumping Allegation
On August 1, 2016, Palestine Regional Medical Center (PRMC), in Palestine, Texas, entered into a $45,000 settlement agreement with OIG. The settlement agreement resolves allegations that PRMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide stabilizing treatment and an appropriate transfer to a patient who presented to PRMC's emergency department. OIG's investigation revealed that a patient, who had a kidney transplant and was on dialysis, was waiting in the parking lot of a local dialysis center when she experienced significant shortness of breath. The patient was transported by ambulance to PRMC's emergency department, where she was diagnosed with acute pulmonary edema and discharged to receive dialysis on an outpatient basis. The patient arrived at the dialysis center where dialysis was started promptly, but the patient's condition deteriorated and she was taken back to PRMC's emergency department where she was pronounced dead. OIG's investigation concluded that PRMC failed to provide needed stabilizing treatment and an appropriate transfer when the patient presented to the emergency department the first time. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
07-29-2016
Missouri Pharmacy Settles False and Fraudulent Claims Case
On July 29, 2016, JSH Group, LLC (JSH Group), Missouri, entered into a $75,477.84 settlement agreement with the OIG. The settlement resolves allegations that JSH Group submitted claims to Medicare and Medicaid for Precision Xtra blood glucose test strips that JSH Group knew or should have known were not provided as claimed. Specifically, OIG alleged that JSH Group submitted claims for Precision Xtra blood glucose test trips that, based on inventory records, it could not have dispensed.
07-26-2016
Drug Testing Laboratory and Owner Agree to 7 Year Exclusion
On July 26, 2016, Nexus Medical Services, Inc. (Nexus), and its owner, French McClung (McClung), agreed to be excluded from participation in all Federal health care programs for a period of seven years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Nexus and McClung paid remuneration in the form of an inflated monthly rent payment to a physician's practice to sublease a portion of the practice's office space in exchange for referrals from the practice's physician owner to Nexus. OIG also alleged that Nexus and McClung employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
07-20-2016
Missouri Physician and Practice Settle False and Fraudulent Medicare Claims Case
On July 20, 2016, William Boulware, MD, and Boulware Medical Clinic, LLC (Boulware), entered into a $10,653.54 settlement agreement with OIG. The settlement agreement resolves allegations that Boulware 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.
Florida Ambulance Company Settles Case Involving False Claims
On July 20, 2016, Courtesy Transport Services, LLC (Courtesy), of Northeast Florida, entered into a $362,188 settlement agreement with OIG. The settlement agreement resolves allegations that Courtesy submitted claims 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.
Florida Pharmaceutical Company Settles Case Involving Drug Price Reporting
On July 20, 2016, Nephron Pharmaceuticals Corporation (Nephron), Florida, entered into a $60,000 settlement agreement with OIG. The settlement agreement resolves allegations that Nephron failed to submit 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 2013, 2014, and 2015. The Medicaid Drug Rebate Program requires pharmaceutical companies 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 pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
South Carolina Pharmaceutical Company Settles Case Involving Drug Price Reporting
On July 20, 2016, Cipher Pharmaceuticals US LLC (Cipher), South Carolina, entered into a $60,000 settlement agreement with OIG. The settlement agreement resolves allegations that Cipher failed to submit 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 2014, 2015, and 2016. The Medicaid Drug Rebate Program requires pharmaceutical companies 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 pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
Oklahoma Behavioral Health Counseling Center and Owner Agree to 5 Year Exclusion
On July 20, 2016, LXE Counseling, LLC (LXE), and its owner, Lexie Darlene George a/k/a Lexie Darlene Batchelor (Batchelor), 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 alleged that LXE and Batchelor knowingly submitted claims to Medicaid for services not provided, services provided by unqualified individuals, telemedicine services not approved, as well as claims with falsified dates, codes, and lengths of service. Senior Counsels Kenneth Kraft and Nancy Brown represented OIG.
07-14-2016
Colorado Hospice Settles Case Involving Excluded Individual
On July 14, 2016, Pinnacle Hospice Care (PHC), Colorado, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that PHC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual provided items or services to PHC patients that were billed to Federal health care programs. Senior Counsel Ellen Slavin represented OIG with the assistance of Paralegal Specialist Eula Taylor.
07-11-2016
OIG Excluded Alabama Physician
Effective July 11, 2016, OIG excluded Bobby Merkle, MD, from participation in all Federal health care programs for a period of three years under 42 U.S.C. 1320c-5 following a referral to the OIG by Kepro, the Beneficiary and Family Centered Care Quality Improvement Organization (QIO). OIG's investigation determined Dr. Merkle violated his obligations to provide services to five Medicare beneficiaries: (1) when, and to the extent, they were medically necessary; (2) of a quality that met professionally recognized standards of care; and (3) supported by the appropriate evidence of medical necessity and quality in a form and fashion and at such time as they were required by the QIO. Dr. Merkle violated his obligations through prescription practices and choices of medications which violated professionally recognized standards of care, through documentation that did not support the proper management of chronic conditions or diseases in the patients, through failure to assess pain or response to treatment in patient with chronic pain, and for failure to document response to treatment or patient progress for pain, edema, or gastrointestinal upset. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
07-08-2016
Texas Doctor Settles Case Involving Kickback Allegations
On July 8, 2016, Angel Perez, M.D., Channelview, Texas, entered into a $73,939.44 settlement agreement with OIG. OIG's investigation revealed that Dr. Perez received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Perez. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
07-07-2016
Regional One Health in Tennessee Settles Case Involving a Patient Dumping Allegation
On July 7, 2016, Regional One Health (ROH), in Memphis, Tennessee, entered into a $45,000 settlement agreement with OIG. The settlement agreement resolves allegations that ROH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment to a patient and inappropriately transferred the patient to another hospital. The patient presented at ROH with complaints of sudden pain in the lower right quadrant of his abdomen. OIG's investigation revealed that despite the fact that ROH was aware of the patient's abnormal lactic acid levels and perforated viscus, ROH failed to fully evaluate the severity and cause of the patient's emergency condition and failed to provide the patient stabilizing treatment for sepsis. Instead, ROH transferred the patient to another hospital, even though ROH was capable of providing the highest level of care to the patient. OIG contends that the transfer by ROH was inappropriate because the patient was not informed of the risks of transfer, the benefits of transfer did not outweigh the risks, and the transfer unnecessarily cause a delay in the patient's care. The patient died due to septic shock and respiratory failure within a week of his transfer by ROH. Under EMTALA, hospitals can be fined up to $50,000 per violation. Associate Counsel Srishti Miglani represented OIG.
06-24-2016
California Ambulance Company Settles Case Involving False Claims
On June 24, 2016, Enloe Medical Center (Enloe), of Butte County, California, entered into a $570,912.40 settlement agreement with OIG. The settlement agreement resolves allegations that Enloe submitted claims 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.
06-22-2016
Former Owner of Illinois Home Health Agency Enters Settlement Agreement with OIG Based on Kickback Allegations
On June 22, 2016, Tariq Chaudhry entered into a settlement agreement with OIG for $50,000 to resolve kickback allegations. Chaudhry is a former owner of a Chicago-area home health agency (HHA). OIG contends that Chaudhry paid illegal remuneration to a Chicago physician in exchange for the physician's referral of patients for home health care services to Chaudhry's HHA. The kickback was disguised as medical director fees, when, in fact, no services were performed. OIG also contends that Chaudhry and the HHA he formerly owned made the payments to the physician through one or more of its marketer employees or contractors.
Arizona Hospice Provider Settles False and Fraudulent Medicare Claims Case
On June 24, 2016, Hospice of the Valley (HOTV), Arizona, entered into a $91,932.16 settlement agreement with the OIG. The settlement resolves allegations that HOTV submitted claims for hospice services at the general inpatient level of care when it knew or should have known that routine care was the correct level of hospice care that should have been billed. Senior Counsels Geoffrey Hymans and David Traskey represented OIG.
Oklahoma Chiropractic Center Settles Case Involving Excluded Individual
On June 24, 2016, Simpson Chiropractic (Simpson), Oklahoma, entered into a $31,000 settlement agreement with OIG. The settlement agreement resolves allegations that Simpson employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a chiropractic assistant, provided items or services to Simpson patients that were billed to Federal health care programs. Senior Counsel Ellen Slavin represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
06-17-2016
Florida Physician and Practice Settle False and Fraudulent Medicare Claims Case
On June 17, 2016, Francis Glicksman, MD and Francis Glicksman, MD, PA (Glicksman), entered into a $12,613.72 settlement agreement with OIG. The settlement agreement resolves allegations that Glicksman 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.
06-13-2016
Florida County and its Biller Settle Case Involving False Ambulance Claims
On June 13, 2016, The Board of County Commissioners of Flagler County, Florida (Flagler County), and PST Services, Inc. (PST), entered into an $86,251 settlement agreement with OIG. The settlement agreement resolves allegations that between September 1, 2009, and May 30, 2011, Flagler County and PST submitted, or caused to be submitted, Medicare claims for emergency ambulance transportation services provided to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. The settlement agreement also resolves allegations that between June 1, 2011, and March 28, 2015, Flagler County (with no involvement of PST) submitted or caused to be submitted Medicare claims for emergency ambulance transportation services provided 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 Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
06-10-2016
Louisiana Hospital Owner Agrees to 15 Year Exclusion
On June 10, 2016, Mark Goff, agreed to be excluded from participation in all Federal health care programs for a period of fifteen years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Goff submitted or caused the hospital he co-owned and managed, to submit to the Medicare program false or fraudulent claims for Intensive Outpatient Program (IOP) psychiatric services. Senior Counsel Ellen Slavin represented OIG.
06-09-2016
Wisconsin Podiatrist Agrees to 10 Year Exclusion
On June 9, 2016, in connection with the resolution of False Claims Act liability, Alan Balkansky, a Wisconsin podiatrist, agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Balkansky and his practices submitted false claims to the Medicare program for: (1) physical therapy services that had been provided by massage therapists, rather than licensed physical therapists; (2) podiatry services that were not rendered; (3) routine foot care services provided to patients who did not meet the medical criteria to be eligible for Medicare coverage of such services; and (4) podiatry services that failed to meet documentation requirements that are Medicare conditions of payment. Senior Counsel Geeta Taylor represented OIG.
06-08-2016
Minnesota Skilled Nursing Facility Settles Case Involving Excluded Individual On June 8, 2016, KASKA, Inc. d/b/a St. Otto's Care Center (SOCC), Minnesota, entered into a $65,000 settlement agreement with OIG. The settlement agreement resolves allegations that SOCC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a certified nursing assistant, provided items or services to SOCC patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
05-31-2016
Tennessee Physician Agrees to Voluntary Exclusion
Effective May 31, 2016, in connection with the resolution of False Claims Act liability, Dr. Jonathan Oppenheimer, a Tennessee laboratory owner, who is also a physician, agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. 1320a-7(b)(7). Based on OIG's investigation, it was alleged that Dr. Oppenheimer donated money towards the physician practices' purchase of Electronic Health Records (EHR) systems in violation of the Anti-Kickback Statute and the Limitation on Certain Physician Referrals. Specifically, OIG alleged that Dr. Oppenheimer: (1) directly considered the volume and/or value of referrals and business between his laboratory and the physician practice when determining whether to make an EHR donation and the size of the EHR donation; (2) improperly considered the volume of Medicare business supplied by the physician practice when considering an EHR donation; and (3) occasionally withheld agreed-upon EHR donation payments until a certain number of cases/referrals were received from the physician practice. OIG further alleged that Dr. Oppenheimer submitted false claims to the Medicare and TRICARE programs by billing for a non-covered form of fluorescence in situ hybridization (FISH) testing. It was specifically alleged that Dr. Oppenheimer continued billing for this test despite an adverse coverage determination indicating that this form of test was experimental and, accordingly, not billable. Senior Counsel Andrea Treese Berlin represented OIG.
05-27-2016
Arkansas Physician and Practice Settle False and Fraudulent Medicare Claims Case
On May 27, 2016, Koyia Latrece Figures, MD, and Alliance Senior Health, PLLC (Figures), entered into a $15,071.20 settlement agreement with OIG. The settlement agreement resolves allegations that Figures 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.
05-18-2016
Georgia Dermatology Practice and Owners Excluded for Default
On May 18, 2016, OIG excluded a dermatology practice headquartered in Georgia, and the practice's two owners (collectively, "dermatology practice"), for defaulting on their payment obligations under their Settlement Agreement (Agreement) with the Department of Justice (DOJ) and OIG. The dermatology practice had previously entered into the Agreement for allegedly submitting false claims to the Medicare program that violated the False Claims Act because they: (1) were for laboratory referrals from physicians whose financial relationship with the dermatology practice violated the Stark Law, or (2) improperly included a Modifier 25 billing code on claims submitted for services provided in Georgia. The terms of the Agreement provided that the dermatology practice would make an initial upfront payment plus additional payments over a five-year period. The dermatology practice failed to make a payment in April 2016, and DOJ issued a Notice of Default to the dermatology practice on May 5, 2016. Senior Counsel Karen Glassman represented OIG.
05-18-2016
Grady Health System in Georgia Settles Case Involving a Patient Dumping Allegation
On May 18, 2016, Grady Memorial Hospital Corporation d/b/a/ Grady Health System (GHS), in Atlanta, Georgia, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that GHS violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment to a patient. OIG's investigation revealed the following. The patient was extracted from his apartment by a SWAT team and brought to GHS's emergency department (ED) by a police officer due to complaints of suicidal and homicidal ideations. While at GHS, two Licensed Professional Counselors (LPCs) evaluated the patient and determined that the patient should be held involuntarily for further evaluation and treatment. Approximately five hours after the patient's arrival in the ED, the ED physician discharged the patient without consulting the LPCs or the on-call psychiatrist. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands and Associate Counsel Srishti Miglani represented OIG.
05-06-2016
Minnesota Pharmaceutical Company Settles Case Involving Drug Price Reporting
On May 6, 2016, Coloplast Corp. (Coloplast), Minnesota, entered into a $600,000 settlement agreement with OIG. The settlement agreement resolves allegations that Coloplast failed to submit 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 2013, 2014, and 2015. The Medicaid Drug Rebate Program requires pharmaceutical companies 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 pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
05-05-2016
Arizona Physician and Practice Settle False and Fraudulent Medicare Claims Case
On May 5, 2016, Eduardo Montes, DPM, and Eduardo Montes, DPM, PLLC (Montes), entered into a $10,887.60 settlement agreement with OIG. The settlement agreement resolves allegations that Montes 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 judgement 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.
Florida Podiatrist Agrees to 30 Year Exclusion
On May 5, 2016, Eugene A. Fox, D.P.M., 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). OIG's investigation revealed that Dr. Fox submitted claims to Medicare for podiatric services that were not rendered or were rendered by unqualified personnel. Senior Counsel Lauren Marziani and Associate Counsel David Fuchs represented OIG.
05-05-2016
Michigan Ambulance Company Settles Case Involving False Claims
On May 5, 2016, Allied EMS Systems, Inc. (Allied), of Petoskey, Michigan, entered into a $121,722.63 settlement agreement with OIG. The settlement agreement resolves allegations that Allied submitted claims 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 Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
05-05-2016
Florida Skilled Nursing Facilities Settle Case Involving Excluded Individual
On May 5, 2016, CCRC PropCo-Cypress Village, LLC (Cypress Village), and BLC Atrium-Jacksonville, LLC (Atrium), Florida, entered into a $17,881.65 settlement agreement with OIG. The settlement agreement resolves allegations that Cypress Village and Atrium employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a speech-language pathologist, provided items or services to Cypress Village and Atrium patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG.
04-15-2016
Texas Home Health Agency Settles Case Involving Excluded Individual
On April 15, 2016, Choice Home Health Care, Inc., and its former owners Patrick Fettinger and Ann Voss (collectively "CHHC"), Texas, entered into a $89,587.82 settlement agreement with OIG. The settlement agreement resolves allegations that CHHC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a home health community liaison/marketing specialist, provided items or services to CHHC patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG.
03-11-2016
Utah Ambulance Company Settles Case Involving False Claims
On March 11, 2016, Ogden City Corporation (Ogden), of Ogden, Utah, entered into a $363,159.38 settlement agreement with OIG. The settlement agreement resolves allegations that Ogden submitted claims 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 (upcoding). 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.
Oregon Physical Therapy Practice and Owner Settle Case Involving False Claims
On March 11, 2016, Dan Ibarra and Northwest Physical Therapy (collectively, NPT), Oregon, entered into a $200,000 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that NPT submitted claims to Medicare for payment for direct services rendered by unlicensed employees and also submitted claims for direct, one-on-one services when these services were rendered to multiple patients at the same time. Senior Counsel Nancy Brown represented OIG.
03-04-2016
Oklahoma Physician and Practice Settle False and Fraudulent Medicare Claims Case
On March 4, 2016, James R. Higgins, MD, and James R. Higgins MD, Inc. (Higgins), entered into a $10,346.96 settlement agreement with OIG. The settlement agreement resolves allegations that Higgins 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.
North Dakota Ambulance Provider Settles Case Involving False Claims
On March 4, 2016, Altru Health System (Altru), of Grand Forks, North Dakota, entered into a $300,974 settlement agreement with OIG. The settlement agreement resolves allegations that Altru submitted claims to Medicare for: (1) emergency Advanced Life Support ambulance transportation that should have been billed at the lower emergency Basic Life Support rate; (2) duplicate billings; (3) ambulance transportation services that were reimbursable by private insurance; and (4) emergency ambulance transportation services provided 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 Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
03-01-2016
Oregon Mental Health Facility Settles Case Involving Excluded Individual
On March 1, 2016, Cascadia Behavioral Health, Inc. (Cascadia), Oregon, entered into a $92,052.78 settlement agreement with OIG. The settlement agreement resolves allegations that Cascadia employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a residential counselor, provided items or services to Cascadia patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Eula Taylor.
02-26-2016
Connecticut Ambulance Company Settles Case Involving False Claims
On February 26, 2016, Campion Ambulance Service, Inc. (Campion), of Waterbury, Connecticut, entered into a $100,804.74 settlement agreement with OIG. The settlement agreement resolves allegations that Campion submitted claims 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 Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
02-22-2016
Arizona Physician Settles False and Fraudulent Medicare Claims Case
On February 22, 2016, Ronald Dale Parker, MD (Parker), entered into a $15,036.50 settlement agreement with OIG. The settlement agreement resolves allegations that Parker 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. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
Mississippi Physician Settles False and Fraudulent Medicare Claims Case
On February 22, 2016, Michael Baker, MD (Baker), entered into a $13,238.16 settlement agreement with OIG. The settlement agreement resolves allegations that Baker 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.
02-09-2016
Illinois Billing and Ambulance Companies Settle Case Involving False Claims
On February 9, 2016, Andres Medical Billing, Ltd. (Andres), and Kurtz Ambulance Service (Kurtz), Illinois, entered into a $77,542.72 settlement agreement with OIG. The settlement agreement resolves allegations that Andres, acting as the third-party biller for Kurtz, submitted claims to Medicare for basic life support (emergency) that did not meet Medicare requirements for emergency transport services and should have been billed at the lower non-emergency transport rate. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, collaborated to achieve this settlement.
02-05-2016
Arizona Physician Settles False and Fraudulent Medicare Claims Case
On February 5, 2016, Benjamin H. Venger, MD (Venger), entered into a $15,956.74 settlement agreement with OIG. The settlement agreement resolves allegations that Venger 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.
Michigan Ambulance Company Settles Case Involving False Claims
On February 5, 2016, White Lake Ambulance Authority (White Lake), Michigan, entered into a $113,635.08 settlement agreement with OIG. The settlement agreement resolves allegations that White Lake submitted claims to Medicare for basic life support (emergency) and advanced life support (emergency) ambulance transportation claims that did not meet Medicare requirements for emergency transport services. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, collaborated to achieve this settlement.
Illinois Pharmacist and Owner of a Durable Medical Equipment Supply Company Agrees to Three-Year Exclusion
On February 5, 2016, an Illinois pharmacist and owner of a durable medical equipment supply company agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the individual offered and paid kickbacks and bribes, directly or through an employee, to induce individuals representing hospitals and nursing homes to order health care items from his company for which payments were made under Medicare. Senior Counsel Henry Green represented OIG.
01-28-2016
Texas Doctor Settles Case Involving Kickback Allegations
On January 28, 2016, Jeffrey Ross, D.P.M, Houston, Texas, entered into a $116,388.56 settlement agreement with OIG. OIG's investigation revealed that Dr. Ross received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Ross. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
01-27-2016
Texas Physician Settles False and Fraudulent Medicare Claims Case
On January 27, 2016, Martin E. Gilliland, MD (Gilliland), entered into a $49,041.58 settlement agreement with OIG. The settlement agreement resolves allegations that Gilliland 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.
Texas Physician Settles False and Fraudulent Medicare Claims Case
On January 27, 2016, Roger C. Willette, MD (Willette), entered into a $44,120.14 settlement agreement with OIG. The settlement agreement resolves allegations that Willette 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.
Massachusetts Ambulance Company Settles Case Involving False Claims
On January 27, 2016, LifeLine Ambulance Service, LLC (LifeLine), of Woburn, Massachusetts, entered into a $74,414.66 settlement agreement with OIG. The settlement agreement resolves allegations that LifeLine submitted claims 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 Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
01-21-2016
Texas Doctor Settles Case Involving Kickback Allegations
On January 21, 2016, Nicolas Nammour, M.D., Houston, Texas, entered into a $111,709.04 settlement agreement with OIG. OIG's investigation revealed that Dr. Nammour received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Nammour. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
01-07-2016
Illinois Cardiology Practices Settle Case Involving Excluded Individual
On January 7, 2016, CardioSpecialists Group, Ltd. (CSG), Illinois, entered into a $274,721.40 settlement agreement with OIG. The settlement agreement resolves allegations that CSG employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a medical biller, provided items or services to CSG patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Eula Taylor.
01-06-2016
University of Mississippi Medical Center Settles Case Involving a Patient Dumping Allegation
On January 6, 2016, The University of Mississippi Medical Center (UMMC), in Jackson, Mississippi, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that UMMC failed to accept the appropriate transfer of a 64-year-old women who needed specialized capabilities of UMMC's hospital to stabilize her emergency medical condition. OIG's investigation revealed that the operator at UMMC refused the request to transfer the patient because of a UMMC policy that it would not accept the transfer of Louisiana residents. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
Floyd Medical Center in Georgia Settles Case Involving a Patient Dumping Allegation
On January 6, 2016, Floyd Medical Center (FMC), in Rome, Georgia, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that FMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to evaluate and treat a mentally ill patient who was transferred from another hospital to FMC for involuntary inpatient psychiatric care. OIG's investigation revealed the following. The patient was aggressive and combative upon his arrival to FMC's emergency department. Three security personnel, including an off-duty police officer working for FMC, attempted to restrain the patient while a nurse went to retrieve medication to calm him down. When the security personnel entered the room, the patient attempted to strike one of them. In response, a security officer hit the patient in the head and pushed him until he fell on the bed. The security officers then wrestled the patient to the ground and handcuffed him, causing injury to the patient. When the nurse returned, the security personnel informed her that the patient's behavior was beyond what FMC could safely control. Without psychiatric evaluation or appropriate medical treatment, the emergency department physician medically cleared the patient and he was taken to jail. Despite having an on-call psychiatrist and capabilities to treat the patient, at no point was he evaluated or treated by a mental health professional. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
01-05-2016
Three Florida Companies Agree to Permanent Exclusion
Effective January 5, 2016, in connection with the resolution of False Claims Act liability, three Florida based companies American Therapeutic Corporation, American Sleep Institute, and MedLink Professional Management (collectively, "the practices"), agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that the practices: (1) paid kickbacks to "patient brokers" who owned Assisted Living Facilities and Halfway Houses in the Miami area, in exchange for referring individuals known to be ineligible for treatment; (2) submitted or caused claims to be submitted to Medicare for medically unnecessary services and (3) falsified medical documentation to obtain Medicare reimbursement. Senior Counsel Kristen Schwendinger represented OIG.

2015

12-29-2015
Moses H. Cone Memorial Hospital in North Carolina Settles Case Involving a Patient Dumping Allegation
On December 29, 2015, Moses H. Cone Memorial Hospital (MCMH), in Greensboro, North Carolina, entered into a $35,000 settlement agreement with OIG. The settlement agreement resolves allegations that MCMH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for an 86-year-old female who presented to MCMH's emergency department after falling at home. OIG's investigation revealed that although an emergency room doctor evaluated her knee pain and performed other imaging tests, he did not fully evaluate her reported severe pain and inability to ambulate. OIG alleged she was discharged with a displaced fracture of her hip. Senior Counsel Sandra Sands represented OIG.
12-23-2015
Vermont Municipality Settles Case Involving False Claims
On December 23, 2015, the City of Barre, Vermont (Barre), entered into a $127,669.90 settlement agreement with OIG. The settlement agreement resolves allegation that Barre submitted claims for basic life support (emergency) and advanced life support (emergency) ambulance transportation claims that did not meet Medicare requirements for emergency transport services and 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 Counsel Nicole Caucci, collaborated to achieve this settlement.
Texas Doctor Settles Case Involving Kickback Allegations
On December 23, 2015, Gustavo Grieco, M.D., Houston, Texas, entered into a $208,000 settlement agreement with OIG. OIG's investigation revealed that Dr. Grieco received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Grieco. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
12-21-2015
Mississippi Ambulance Company Settles Case Involving False Claims
On December 21, 2015, South Central Regional Medical Center (SCRMC), of Laurel, Mississippi, entered into a $318,885.62 settlement agreement with OIG. The settlement agreement resolves allegations the SCRMC submitted claims 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.
Santa Rosa Memorial Hospital in California Settles Case Involving a Patient Dumping Allegation
On December 21, 2015, Santa Rosa Memorial Hospital (SRMH), in Santa Rosa, California, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that SRMH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate medical screening examination and stabilizing treatment to a patient found on SRMH's property. OIG's investigation revealed the following. The patient was seen the previous day in SRMH's emergency department for alcohol withdrawal and neck pain. The physician prescribed a medication for alcohol withdrawal and discharged the patient with instructions for alcohol withdrawal and alcohol abuse. The next morning, the patient was seen by multiple members of the hospital staff, including security, lying on the ground near the perimeter of SRMH's parking lot, possibly in need of medical assistance. Despite being notified several times that the patient may be in need of medical assistance, SRMH failed to respond. Eventually, a staff member who was jogging saw the patient on the ground and called 911. When EMS arrived, the patient had died shortly before EMS's arrival. An autopsy report revealed the cause of death to be acute bacterial pneumonia of the left lung. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
Lake City Medical Center in Florida Settles Case Involving a Patient Dumping Allegation
On December 21, 2015, Lake City Medical Center (LCMC), in Lake City, Florida, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegations that LCMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate medical screening examination and stabilizing treatment for a 42-year-old female. OIG's investigation revealed the following. The patient arrived at LCMC's emergency department complaining of headaches, right arm pain and diarrhea the previous day. She was seen by a physician's assistant and then asked to wait in the waiting room. While there, she vomited and continued to complain of right arm pain. The physician's assistant concluded that she did not need immediate medical attention and asked the patient to leave the emergency department. When the patient resisted and her family complained, the emergency department personnel called the police to escort her out of the emergency department. After unsuccessful attempts by police and paramedics to get the patient into a car, her family requested the emergency department call an ambulance so she could be taken to another hospital. When the ambulance arrived, the patient was unresponsive and taken to another hospital where she was placed on a ventilator in the Intensive Care Unit and later diagnosed with bacterial meningitis. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Senior Counsel Sandra Sands represented OIG.
Pennsylvania Chiropractor Agrees to 25-Year Exclusion
On December 21, 2015, in connection with the resolution of False Claims Act liability, a Pennsylvania chiropractor agreed to be excluded from participating in Federal health care programs for a period of twenty-five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the chiropractor knowingly submitted or caused to be submitted false or fraudulent claims to Medicare for services rendered as a de facto executive and administrator of a chiropractic center notwithstanding the fact that he was excluded from participating in Federal health care programs. Senior Counsel Katherine Matos and Associate Counsel Kaitlyn Dunn represented OIG.
12-16-2015
Arizona Physician and Practice Settles False and Fraudulent Medicare Claims Case
On December 16, 2015, Frank Agnone, MD (Agnone), entered into a $28,863.14 settlement agreement with OIG. The settlement agreement resolves allegations that Agnone 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.
Texas Physician and Practice Settle False and Fraudulent Medicare Claims Case
On December 16, 2015, Roberto Diaz, MD (Diaz), entered into a $13,418.56 settlement agreement with OIG. The settlement agreement resolves allegations that Diaz 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.
12-11-2015
St. Francis Hospital - Downtown in South Carolina Settles Case Involving Patient Dumping Allegations
On December 11, 2015, St. Francis Hospital - Downtown (St. Francis), in Greenville, South Carolina, entered into a $100,000 settlement agreement with OIG. The settlement agreement resolves allegations that St. Francis violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to fully evaluate and treat two gunshot victims. OIG's investigation revealed that the first patient presented to St. Francis after being robbed and shot in the left leg within close range and the second patient after being shot in the abdomen at a club. OIG contends that although St. Francis had the capacity and capability to provide treatment to both gunshot victims, St. Francis transferred the patients to another hospital. OIG further contends that the benefits of the transfers did not outweigh the risks and unnecessarily placed the health of both gunshot victims at further risk. Under EMTALA hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
12-07-2015
Texas Ambulance Company Settles Case Involving False Claims
On December 7, 2015, EMS Mediventure, Inc. (EMS), of Lampasas, Texas, entered into a $92,020 settlement agreement with OIG. The settlement agreement resolves allegations that EMS submitted claims for basic life support (emergency) and advanced life support (emergency) ambulance transportation claims that did not meet Medicare requirements for emergency transport services and 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 Counsel Nicole Caucci, collaborated to achieve this settlement.
11-13-2015
New York Ambulance Company Settles Case Involving False Claims
On November 13, 2015, SeniorCare Emergency Medical Services, Inc. (SeniorCare), of the Bronx, New York, entered into a $103,334 settlement agreement with OIG. The settlement agreement resolves allegations that SeniorCare submitted claims 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 Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
Texas Doctor Settles Case Involving Kickback Allegations
On November 13, 2015, Sohail Siddiqui, M.D., Sugar Land, Texas, entered into a $75,000 settlement agreement with OIG. OIG's investigation revealed that Dr. Siddiqui received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Siddiqui. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
11-12-2015
Wisconsin Ambulance Company Settles Case Involving False Claims
On November 12, 2015, Shawano Ambulance Service, Inc. (Shawano), of Shawano, Wisconsin, entered into a $108,086 settlement agreement with OIG. The settlement agreement resolves allegation that Shawano 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 Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
Nevada Mobile Imaging Provider Settles Case Involving Excluded Individual
On November 12, 2015, Quality Medical Imaging (QMI), Nevada, entered into a $34,187.34 settlement agreement with OIG. The settlement agreement resolves allegations that QMI employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an x-ray technician, provided items and services to QMI patients that were billed to Federal health care programs. Senior Counsel Katie Fink represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
11-10-2015
California Skilled Nursing Facility Settles Case Involving Excluded Individual
On November 10, 2015, Windsor Health Care Golden Palms, LLC d/b/a Golden Hill Subacute and Rehabilitation Center (Golden Hill), California, entered into a $214,303.69 settlement agreement with OIG. The settlement agreement resolves allegations that Golden Hill employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a social services assistant, provided items and services to Golden Hill patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
California Skilled Nursing Facility Settles Case Involving Excluded Individual
On November 10, 2015, S&F Market Street Healthcare, LLC d/b/a Windsor Gardens Convalescent Center of North Long Beach (Windsor North Long Beach), California, entered into a $207,427.34 settlement agreement with OIG. The settlement agreement resolves allegations that Windsor North Long Beach employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a certified nursing assistant, provided items and services to Windsor North Long Beach patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
California Skilled Nursing Facility Settles Case Involving Excluded Individual
On November 10, 2015, Windsor Oakridge Healthcare Center, L.P. d/b/a Windsor Healthcare Center of Oakland (Windsor Oakland), California, entered into a $34,943.48 settlement agreement with OIG. The settlement agreement resolves allegations that Windsor Oakland employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, an activities assistant, provided items and services to Windsor Oakland patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
11-04-2015
Oregon Physical Therapist Settles Case Involving False Claims
On November 4, 2015, Michael Zingg, P.T., Oregon, entered into a $13,307.52 settlement agreement with OIG. The settlement agreement resolves allegations that Zingg submitted claims to Medicare for physical medicine and rehabilitation services that were not provided as claimed or were false or fraudulent. OIG alleged the claims were false or fraudulent because: 1) Zingg failed to personally provide or directly supervise certain physical therapy services; 2) services were billed as one-on-one provider-patient physical therapy services, when, in fact, they were provided in a group setting; and 3) services were rendered by individuals not qualified to provide therapy services under Medicare guidelines. Senior Counsel Lauren E. Marziani represented OIG.
11-03-2015
California and Michigan Laboratories Settle Case Involving Excluded Individuals
On November 3, 2015, Quest Diagnostics Incorporated (Quest), Summit Health, Inc. (Summit), and Unilab Corporation (Unilab) entered into a $126,599.25 settlement agreement with OIG. Summit and Unilab are subsidiaries of Quest. The settlement agreement resolves allegations that a Summit location in Michigan employed an individual to administer vaccinations who was excluded from participation in Federal health care programs, and a Unilab location in California employed a Quality Assurance Specialist who was excluded from participation in Federal health care programs. Senior Counsel Lisa Veigel represented OIG with the assistance of Paralegal Specialist Eula Taylor.
11-02-2015
South Carolina Urgent Care Centers and Owners Excluded for Default
On November 2, 2015, OIG excluded five urgent care centers located in, and around, Charleston, South Carolina, and the urgent care centers' two owners (collectively, urgent care centers), for default on their payment obligations under their Settlement Agreement (Agreement) with the Department of Justice (DOJ) and OIG. The urgent care centers and their owners had previously entered into the Settlement Agreement for allegedly submitting false claims to Federal health care programs for: (1) unnecessary laboratory tests; (2) evaluation and management services; (3) tetanus immunoglobulin injections when tetanus toxoid was given instead; and (4) radiological services that were performed by an unlicensed employee. The terms of the Agreement provided that the urgent care centers would make an initial upfront payment and two additional installment payments within one year of the Agreement. The urgent care centers failed to make the first of the two installment payments, and DOJ issued a Notice of Default to the urgent care centers on October 15, 2015.
10-30-2015
Texas Physician and Practice Settle False and Fraudulent Medicare Claims Case On October 30, 2015, Tajul Chowdhury, MD, and the Center for Pain Management, PLLC (Chowdhury), entered into a $26,587.20 settlement agreement with OIG. The settlement agreement resolves allegations that Chowdhury 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.
Texas Physician and Practice Settle False and Fraudulent Medicare Claims Case
On October 30, 2015, Renaud Rodrigue, MD, and Bulger and Rodrigue Southwest Pain Group, PLLC (Rodrigue), entered into a $22,807.06 settlement agreement with OIG. The settlement agreement resolves allegations that Rodrigue 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.
Delaware Physician Settles False and Fraudulent Medicare Claims Case
On October 30, 2015, Edwin David Gar-El, MD, entered into a $11,954.86 settlement agreement with OIG. The settlement agreement resolves allegations that Gar-El 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.
10-28-2015
Wisconsin Home Health Agency and Owner Agree to Voluntary Exclusion
On October 28, 2015, in connection with the resolution of False Claims Act liability, a Wisconsin Home Health Agency and its owner agreed to be excluded from participating in Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the agency and its owner submitted claims to Wisconsin Medicaid for personal care worker services that were not provided, were not provided pursuant to appropriate supervision by the agency, were not medically necessary, or were referred or ordered in violation of the Anti-Kickback Statute. Senior Counsels Geeta Taylor and Tamara Forys represented OIG.
10-23-2015
Illinois Hospital Corporation Settles Case Involving Excluded Individuals
On October 23, 2015, Advocate Health and Hospitals Corporation (Advocate), Illinois, entered into a $317,660.89 settlement agreement with OIG. The settlement agreement resolves allegations that Advocate employed two individuals who were excluded from participation in any Federal health care program. OIG's investigation revealed that the excluded individuals, both registered nurses, provided items and services to Advocate patients that were billed to Federal health care programs. Senior Counsel Karen Glassman represented OIG with the assistance of Paralegal Specialist Jennifer McKoy.
10-22-2015
Texas Skilled Nursing Facility Settles Case Involving Excluded Individual
On October 22, 2015, Huntington Healthcare & Rehabilitation Center, Ltd. (HHRC), Texas, entered into a $214,016.48 settlement agreement with OIG. The settlement agreement resolves allegations that HHRC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a nurse, provided items and services to HHRC patients that were billed to Federal health care programs. Senior Counsel David Blank represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
10-16-2015
Kansas Fiscal Intermediary Settles Case Involving Excluded Individual
On October 16, 2015, South Kansas Independent Living Resource Center, Inc. (SKIL), Kansas, entered into a $47,520.18 settlement agreement with OIG. The settlement agreement resolves allegations that SKIL employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a home health aide, provided items and services to SKIL patients that were billed to Kansas Medicaid. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
10-07-2015
New Jersey Pharmaceutical Company Settles Case Involving Drug Price Reporting
On October 7, 2015, Ascend Laboratories, LLC (Ascend), New Jersey, entered into a $1,287,000 settlement agreement with OIG. The settlement agreement resolves allegations that Ascend failed to submit monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2013 and 2014. The Medicaid Drug Rebate Program requires pharmaceutical companies 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 pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
09-30-2015
OIG Excludes Florida Dentist
On September 30, 2015, OIG excluded Howard Sheldon Schneider, DDS, from participation in all Federal health care programs because his license to practice in the State of Florida was revoked, suspended, or otherwise lost for reasons bearing on his professional competence, professional performance, or financial integrity. OIG conducted an investigation of Dr. Schneider which revealed that the State of Florida Board of Dentistry issued a Final Order for a Disciplinary Voluntary Relinquishment of his dental license after the Florida Department of Health opened an investigation into allegations of Dr. Schneider's abuse of his pediatric dental patients. Dr. Schneider cannot apply for reinstatement until his dental license is reissued by the State of Florida. Senior Counsels Geoffrey Hymans and Geeta Taylor represented OIG.
09-29-2015
Former Arizona Hospice CEO Agrees to Voluntary Exclusion
On September 29, 2015, in connection with the resolution of False Claims Act liability, the former CEO of an Arizona hospice agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that during the tenure of the CEO, the hospice submitted false claims to Medicare for some patients who were provided a higher level of hospice care than was necessary or allowable under Medicare's hospice benefits and/or were completely partially ineligible for Medicare's hospice benefits because, during some or all of the period they received hospice, they did not have a medical prognosis of six months or less if their illnesses ran their normal course. Senior Counsel Gregory Wellins represented OIG.
09-17-2015
Tennessee Physician and Practice Settle False and Fraudulent Medicare Claims Case
On September 17, 2015, Dennis C. Ford, MD, and the Ford Center for Pain Management, PLLC (Ford), entered into a $32,184.74 settlement agreement with OIG. The settlement agreement resolves allegations that Ford 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.
New Jersey Physician and Practice Settle False and Fraudulent Medicare Claims Case
On September 17, 2015, Karl T. Chen, MD, and Karl T. Chen, LLC (Chen), entered into a $25,937.72 settlement agreement with OIG. The settlement agreement resolves allegations that Chen 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.
New Mexico Physician and Practice Settle False and Fraudulent Medicare Claims Case
On September 17, 2015, Jesus J. Fonseca, MD, and The Medicine Clinic, LLC, entered into a $17,925.24 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.
09-03-2015
Massachusetts Physician and his Practice Settle Case Involving False Claims
On September 2, 2015, Dr. Ronald Goldberg and his practice, Haverhill Family Practice, LLC (collectively "Goldberg and Haverhill"), Massachusetts, entered into a $1,000,000 settlement agreement with OIG. The settlement agreement resolves allegations that Goldberg and Haverhill improperly submitted claims under Dr. Goldberg's billing number for services provided to nursing home patients that had been provided by nurse practitioners. Goldberg and Haverhill also entered into an Integrity Agreement with OIG. Senior Counsel Karen Glassman represented OIG.
09-01-2015
Ohio Durable Medical Equipment Fitter Agrees to Voluntary Exclusion
On September 1, 2015, in connection with the resolution of False Claims Act liability, an Ohio fitter of durable medical equipment agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the fitter caused the submission of false claims to Medicare and Medicaid for back braces that were not supplied, not medically necessary, resulted in the payment of a kickback, or not fitted by a person qualified to perform such services. Senior Counsel Lauren Marziani and Associate Counsel David Fuchs represented OIG.
Florida Dermatologist Agrees to Voluntary Exclusion
Effective September 1, 2015, in connection with the resolution of False Claims Act liability, a Florida dermatologist agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the dermatologist submitted claims to Medicare for Mohs surgeries that were not medically necessary or not performed, and claims for adjacent tissue transfers (also known as flaps) that were not medically necessary or not performed. Senior Counsel Karen Glassman represented OIG.
08-31-2015
New Jersey Pharmaceutical Company Settles Case Involving Drug Price Reporting
On August 31, 2015, Glenmark Pharmaceuticals, Inc. USA (Glenmark), New Jersey, entered into a $2,887,300 settlement agreement with OIG. The settlement agreement resolves allegations that Glenmark failed to timely submit monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2013 and 2014. The Medicaid Drug Rebate Program requires pharmaceutical companies 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 pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
08-27-2015
Texas Doctor Settles Case Involving Kickback Allegations
On August 27, 2015, Marco Vargas, D.P.M., Sugar Land, Texas, entered into a $65,000 settlement agreement with OIG. OIG's investigation revealed that Dr. Vargas received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from a Medical Directorship agreement. OIG contends that this financial arrangement took into account the value and volume of referrals made to OneStep by Dr. Vargas. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
08-14-2015
Milwaukee Pain Doctor and Medical Practice Settles False and Fraudulent Medicare Claims Case
On August 14, 2015, David Irving Stein, MD (Stein), and Milwaukee Pain Treatment Services (MPTS), a Wisconsin based pain management specialist and his practice, entered into a $374,864.78 settlement agreement with OIG. The settlement agreement resolves allegations that MPTS, through Stein, submitted false or fraudulent claims for payment for multiple units of HCPCS codes G0431 and G0434 when only a single unit may be billed per patient encounter by inappropriately using modifiers 91 and QW. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
08-12-2015
Colorado Dentist Agrees to Voluntary Exclusion
On August 12, 2015, Dr. Robert E. Hackley, Jr., DDS, agreed to be excluded from participation in all Federal health care programs for a period of three years. OIG conducted an investigation of Dr. Hackley for dental care he provided to patients at Small Smiles Dentistry for Children in Colorado Springs, Colorado. OIG's investigation revealed that Dr. Hackley furnished dental services to patients of a quality which failed to meet professionally recognized standards of care, including: performing medically unnecessary dental procedures, failing to treat existing dental conditions, and performing dental procedures that were below professionally recognized standards of care. Senior Counsels Geoffrey Hymans and Tamara Forys represented OIG.
07-29-2015
Owner of a Pennsylvania Durable Medical Equipment Supplier and Her Spouse Agree to Voluntary Exclusions
On July 29, 2015, the owner of a durable medical equipment (DME) supplier and the owner's spouse, who was also an employee, agreed to be excluded from participation in Federal health care programs. The owner agreed to be excluded for a period of fifteen years and the owner's spouse agreed to be excluded for a period of thirty years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the DME company and its owner furnished supplies reimbursed by Federal health care programs through the owner's spouse while the spouse was excluded from participating in Federal health care programs. Senior Counsels Lauren Marziani and Katherine Matos represented OIG.
07-27-2015
OIG Excludes Georgia Laboratory
On July 27, 2015, OIG excluded C.F. Health Management, Inc. d/b/a Gainesville Pain Management (Gainesville), Georgia, for defaulting on payment obligations under a settlement agreement with OIG. The settlement agreement, effective May 17, 2013, required Gainesville to pay $1,577,597 over a period of time. The OIG alleged that Gainesville submitted false or fraudulent claims: 1) by inappropriately using Modifiers 76 and 59, to submit claims for payment for multiple units of Healthcare Common Procedure Coding System (HCPCS) codes G0431 and G0434 when only a single unit may be billed per patient encounter; and 2) by inappropriately using Modifier QW and billing for HCPCS G0431 when the less expensive services represented by HCPCS code G0434 were actually provided. Gainesville's exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates Gainesville's participation in Federal health care programs. Senior Counsels Geoffrey Hymans and Andrea Treese Berlin represented OIG.
07-23-2015
Minnesota Nursing Home Settles Case Involving Excluded Individual
On July 23, 2015, Itasca County, Minnesota, and its nursing home, the Itasca Nursing Home d/b/a Grand Village (Itasca), a county-owned nursing home in Grand Rapids, Minnesota, entered into a $179,484.98 settlement agreement with OIG. The settlement agreement resolves allegations that Itasca employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a housekeeper and health information specialist, provided items and services to Itasca patients that were billed to Federal health care programs. Senior Counsel Patrick Garcia represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
07-20-2015
Indiana Lab Settles Case Involving False and Fraudulent Claims
On July 20, 2015 American Institute of Technology (AIT), Indiana, entered into a settlement agreement with OIG and agreed to pay $229,924.74 for allegedly violating the Civil Monetary Penalties Law. The settlement agreement resolves conduct that was investigated by OIG as well as conduct that was self-disclosed by AIT. OIG's investigation revealed that AIT inappropriately used Modifiers 59 and 91 to submit claims for payment for multiple units of HCPCS code G0431 when only a single unit may be billed per patient encounter. Also, AIT self-disclosed to OIG that it had employed an individual that it knew or should have known was excluded from participation in Federal health care programs. The excluded individual, a clinical technician, provided items and services to AIT patients that were billed to Federal health care programs. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
07-17-2015
Indiana Dialysis Provider Settles Case Involving Excluded Individual
On July 17, 2015, Fresenius Medical Care (Fresenius), Indiana, entered into a $120,447.23 settlement agreement with OIG. The settlement agreement resolves allegations that Fresenius employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that an Indiana Fresenius location employed an excluded nurse who provided items and services to Fresenius patients that were billed to Federal health care programs. Senior Counsel Henry Green represented OIG.
07-13-2015
OIG Issues Cease and Desist Letter to BankRate Insurance
On July 13, 2015, OIG notified BankRate Insurance (BankRate) that BankRate's unauthorized and inappropriate use of the word "Medicare" and other information in the name and webpages found at http://www.louisiana-medicare.com/ was potentially in violation of section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and Departmental emblems. Before OIG initiated litigation, BankRate agreed to: (1) increase the prominence of BankRate's consumer notices, including usage of 12-16-point font in disclaimers and notices; (2) expand significantly BankRate's disclosure of its non-governmental affiliation in its consumer notices; and (3) provide each Medicare Plan (on which BankRate offers consumer information) a copy of or a link to BankRate's webpages.
06-30-2015
Dental Practice Settles Case Involving Excluded Individual
On June 30, 2015, Adam Diasti, D.D.S., P.C. (Diasti), a dental services provider, entered into a $22,319.26 settlement agreement with OIG. The settlement agreement with OIG resolves allegations that Diasti employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that in two Diasti-affiliated California dental offices, the excluded registered dental assistant provided items and services to patients that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Jennifer McKoy and Program Support Assistant Tynishia Gardner.
06-29-2015
New York Doctor Agrees to Voluntary Exclusion
On June 29, 2015, a New York physician agreed to be excluded from participating in Federal health care programs for a period of two years under 42 U.S.C. § 1320a-7(b)(16). OIG's investigation revealed that the physician filed a Medicaid provider enrollment application with the New York State Department of Health containing false statements of material fact as to the physician's prior restriction from the Medicaid program and prior enrollment denials. Associate Counsel Kaitlyn Dunn represented OIG.
06-19-2015
Midwest Home Health Agency Settles Case Involving Excluded Individual
On June 19, 2015, Accurate Home Care, LLC (Accurate), an Otsego, Minnesota-based, provider of nursing and personal care services, entered into a $334,651.82 settlement agreement with OIG. The settlement agreement resolves allegations that Accurate employed an excluded individual to provide services to Medicaid beneficiaries. Associate Counsel Kaitlyn Dunn represented OIG.
06-08-2015
Texas Skilled Nursing Facility Settles Case Involving Excluded Individual
On June 8, 2015, Meridian Williamsburg Acquisition Partners, LP d/b/a Williamsburg Village Healthcare Campus (Williamsburg) entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services. Williamsburg agreed to pay $77,772.08 to settle allegations that it employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a certified nurse aide, provided items and services to Williamsburg patients that were billed to Federal health care programs. Senior Counsel Ellen Slavin and Paralegal Specialist Mariel Filtz represented OIG.
06-01-2015
Texas Skilled Nursing Facilities Settle Case Involving Excluded Individuals
On June 1, 2015, P & S Healthcare Management, LLC the former general partner of Woodland Springs Healthcare, LP (Woodland Springs) and P & S Healthcare, LP (P & S) agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law (CMPL). OIG alleged that Woodland Springs employed an individual who was excluded from participating in any Federal health care programs. OIG also alleged that P & S employed two individuals who were excluded from participating in any Federal health care programs. OIG's investigation revealed that these excluded individuals provided items and services to Federal health care programs beneficiaries. Senior Counsel Karen Glassman represented OIG.
05-31-2015
OIG Excludes District of Columbia Nuclear Cardiologist
On March 31, 2015, a District of Columbia nuclear cardiologist was excluded from participation in all Federal health care programs for a period of seventeen years under 42 U.S.C. § 1320a-7(b)(7). The cardiologist rendered and billed Federal health care programs for nuclear cardiology services, including myocardial perfusion imaging single-photon emission computed tomography (MPI SPECT) procedures (commonly known as nuclear stress tests). OIG's investigation revealed the claims billed for MPI SPECT procedures and related services that did not comply with applicable Federal health care program rules and regulations. The cardiologist also unbundled and separately billed for services that were contemplated as being part of the reimbursement for the MPI SPECT studies and double-billed for multi-study MPI SPECT procedures. Senior Counsels Kaitlyn Dunn and Jill Wright represented OIG.
05-29-2015
Michigan Physician Agrees to Voluntary Exclusion
On May 29, 2015, in connection with the resolution of False Claims Act liability, a Michigan physician specializing in physical medicine and pain management agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the physician caused the submission of false claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care services that the physician referred in exchange for illegal remuneration or kickbacks. Senior Counsel Patrick Garcia represented OIG.
05-27-2015
South Florida Business Owner Agrees to Voluntary Exclusion and Divestiture
Tracy Nemerofsky - a Palm Beach Gardens, Florida private business owner - agreed to be excluded from participation in all Federal health care programs for a period of five years. OIG conducted an investigation of Nemerofsky for knowingly submitting or causing to be submitted to Medicare false claims in violation of the Anti-Kickback Statute. Based upon that investigation, OIG alleged that Nemerofsky violated the Anti-Kickback Statute through her company A Plus Home Healthcare, Inc. (A Plus), when she directed and managed A Plus' payments to eight different physicians' spouses, in exchange for the physicians' Medicare referrals. OIG alleged that the eight spouses were not bona fide employees of A Plus and that these arrangements did not fit within the exception to the Anti-Kickback Statute payment prohibition. OIG alleged that Nemerofsky offered and paid the remuneration described above and this conduct forms a basis for her exclusion.

Nemerofsky agreed to enter a voluntary exclusion with OIG for a period of five years after she resolved the above mentioned conduct through a False Claims Act monetary settlement with the United States, a settlement in which OIG expressly reserved its exclusion authority. In order to resolve her companies' exclusion liability as well, Nemerofsky also agreed to divest herself of five health care businesses: A Plus; A Plus Private Care Services; Ocean Therapy Group, Inc.; Professional Touch Rehab, Inc.; and RockHill Rehab Services Inc. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
05-15-2015
Michigan Nurse Practitioner Agrees to Voluntary Exclusion
On May 15, 2015, a Michigan Nurse Practitioner (NP) agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the NP knowingly and willfully referred patients for physical therapy and home health care services billed to Federal health care programs in exchange for illegal kickbacks. Senior Counsel Patrick Garcia represented OIG.
05-08-2015
Kansas Pharmaceutical Company Settles Case Involving Drug Price Reporting
On May 8, 2015, B.F. Ascher & Company, Inc. (B.F. Ascher), a Kansas pharmaceutical manufacturer, entered into a $178,000 settlement agreement with OIG. The settlement agreement resolves allegations that B.F. Ascher failed to timely submit certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters from 2012 to 2014. The Medicaid Drug Rebate Program requires pharmaceutical companies 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 pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsels Geeta W. Kaveti and Nicole Caucci represented OIG.
05-06-2015
New Jersey Pharmaceutical Company Settles Case Involving Drug Price Reporting
On May 6, 2015, Seton Pharmaceuticals (Seton), a Manasquan, New Jersey, specialty generic pharmaceutical company, entered into a $91,800 settlement agreement with OIG. The settlement agreement resolves allegations that Seton failed to timely submit 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 and 2013. The Medicaid Drug Rebate Program requires pharmaceutical companies 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 pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsels Geeta W. Kaveti and Nicole Caucci represented OIG.
04-27-2015
Texas Nursing Facility Settles Case Involving Excluded Individual
On April 27, 2015, Town Hall Estates- Arlington, Inc. (Town Hall), an Arlington, Texas, nursing home, entered into a $70,000 settlement agreement with OIG. The settlement agreement with OIG resolves allegations that Town Hall employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a licensed vocational nurse, provided items and services to Town Hall patients that were billed to Federal health care programs. Senior Counsel Karen Glassman represented OIG.
04-15-2015
Georgia Ophthalmologist Agrees to Voluntary Exclusion
On April 15, 2015, a Georgia ophthalmologist agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the ophthalmologist submitted claims to Georgia Medicaid for services that were not medically necessary and overstated the level of service provided. Associate Counsel David Fuchs represented OIG.
04-10-2015
Florida Mental Health Counselor Settles Case Involving False Claims
On April 10, 2015, Timothy Fennell, a Florida licensed mental health counselor, entered into a settlement agreement with OIG under which Fennell would pay $120,000 and be excluded for twelve years. The settlement agreement with OIG resolves allegations that Fennell submitted false claims to Medicare for psychotherapy and other services allegedly rendered at Fennell's former company, Lakemont Clinic. Fennell used the provider information of an Orlando-area physician to submit claims for services that were not rendered or supervised by a physician. Senior Counsels Lauren Marziani and Katherine Matos represented OIG.
04-06-2015
Pennsylvania Home Care Agency Settles Case Involving Excluded Individual
On April 6, 2015, YCB, Inc. d/b/a Home Helpers (Home Helpers), a Drexel, Pennsylvania, provider of non-medical and personal in-home care, entered into a $69,130 settlement agreement with OIG. The settlement agreement resolves allegations that from July 1, 2010, to December 12, 2011, Home Helpers employed an excluded individual. OIG alleged that the excluded individual provided services to Medicaid recipients. Senior Counsel Lauren Marziani represented OIG.
03-23-2015
Indiana Health Systems Settles Case Involving Excluded Laboratory Technician
On March 23, 2015, Parkview Health System, Inc. (Parkview), a not-for-profit, community-based health system that serves northeast Indiana and northwest Ohio, entered into a $129,216.80 settlement agreement with OIG. The settlement agreement resolves allegations that Parkview employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a laboratory technician, provided items and services to Parkview patients that were billed to Federal health care programs. Senior Counsel Henry Green represented OIG.
03-19-2015
OIG Excludes Illinois Home Health Agency
Ambulatory Health Care Services, LTD. - a Skokie, Illinois home health agency was excluded from participation in all Federal health programs for a period of three years as a result of its employment of an excluded nurse. OIG's investigation revealed that Ambulatory Health Care Services, LTD, billed the Federal health care programs for services provided by the excluded nurse to Medicare and Medicaid beneficiaries. The exclusion became effective March 19, 2015, and prohibits Ambulatory Health Care Services, LTD, from participating in the Federal health care programs. Ambulatory Health Care Services, LTD is no longer in operation. Senior Counsels David M. Blank and Lauren Marziani, along with Paralegal Specialist Eula Taylor, represented OIG.
03-18-2015
Oklahoma Prosthetics Suppliers Settles Case Involving False Claims
On March 18, 2015, La Fuente Ocular Prosthetics, LLC (La Fuente), an Oklahoma City, Oklahoma, prosthetics supplier, entered into a $90,000 settlement agreement with OIG. The settlement agreement resolves allegations that La Fuente submitted false or fraudulent claims to Medicare and created false records material to a false claim. OIG contends that La Fuente submitted claims for services (1) where the treating physician had not provided La Fuente with an order or other required documentation prior to billing the Medicare program and (2) provided patients with prosthetics that were higher functional level products than necessary. OIG's Office of Audit Services, Office of Investigations and Office of Counsel to the Inspector General, represented by Associate Counsel Paul Westfall and Senior Counsel Geoffrey Hymans, collaborated to achieve this settlement.
03-17-2015
Newton Medical Center in Kansas Settles EMTALA Case
A Newton, Kansas hospital that failed to provide an adequate medical screening examination for a pregnant woman who was later admitted to another hospital and gave birth to a stillborn baby has agreed to pay $45,000 to settle allegations by the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services that those actions violated the Emergency Medical Treatment & Labor Act (EMTALA). The OIG alleged that Newton Medical Center failed to provide an adequate medical screening examination for a patient who presented to Newton's emergency department 38-weeks pregnant and complaining of abdominal and lower back pain. Newton did not take the patient's medical history, take any vitals, conduct fetal monitoring, test for fetal movement, or perform any exam on the patient. Instead, Newton instructed the patient to see her personal physician. The patient left Newton by private vehicle and presented at the emergency department of another hospital where she was admitted and delivered a stillborn baby.

The settlement, effective March 17, 2015, resolves Newton's civil monetary penalties liability under EMTALA. The maximum penalty under EMTALA for a large hospital is $50,000. Senior Counsel Geeta Taylor and Associate Counsel David Fuchs represented OIG.
03-17-2015
Pennsylvania Staffing Agency Settles Case Involving Excluded Individual
On March 17, 2015, Flexible Staffing Solutions, Inc. d/b/a OneSource Medical Staffing (OneSource), a Wilkes-Barre, Pennsylvania, healthcare staffing agency, entered into a $24,775.56 settlement agreement with OIG. The settlement agreement resolves allegations that OneSource employed an individual who was excluded from participating in any Federal health care programs. The excluded individual provided items and services as a Licensed Practical Nurse (LPN) at nursing facilities that billed Federal health care programs. Senior Counsel Nicole Caucci represented OIG.
03-11-2015
New Jersey Pharmaceutical Company Settles Case Involving Misrepresenting Drug Pricing Data to Medicare
On March 11, 2015, Sandoz, Inc. (Sandoz), a New Jersey generic pharmaceutical manufacturer, entered into a $12,640,000 settlement agreement with OIG. The settlement agreement resolves allegations that Sandoz misrepresented drug pricing data to the Medicare program. Federal law requires drug makers to report both accurate and timely "Average Sales Price" information to the Centers for Medicare & Medicaid Services (CMS). CMS uses this information to set payment amounts for most drugs covered under Medicare Part B. Inaccurate pricing information can cause Medicare to overpay for these drugs. Senior Counsels Geeta W. Kaveti and Nicole Caucci represented OIG. News Release
02-27-2015
Texas Physician Agreed to Voluntary Exclusion
On February 27, 2015, in connection with the resolution of False Claims Act liability, a Texas physician and two companies he operated, a research firm and consulting business, agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the physician and his business received kickbacks in exchange for recommending or promoting the use of a surgical product. Senior Counsel Sandra Sands represented OIG.
02-25-2015
Denver Skilled Nursing Facility Settles CMP Case
A Denver, Colorado, skilled nursing facility that employed an individual who had been excluded from participation in all Federal health programs and provided items and services to residents who were Medicare and Medicaid beneficiaries has agreed to pay a civil monetary penalty of $242,434.92, the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services has announced. OIG's investigation revealed that the Denver North Care Center had employed an excluded nurse that provided items and services to Denver North Care Center patients that were paid for by Medicare and Medicaid. The effect of an OIG exclusion is that no payment may be made by any Federal health care program for any items or services furnished by an excluded individual. The settlement agreement, effective February 25, 2015, was entered into with both the OIG and the State of Colorado. Senior Counsels David M. Blank and Patrick Garcia, along with Paralegal Specialist Eula Taylor, represented OIG.
02-24-2015
Alabama Physician and Medical Practice Settles False and Fraudulent Medicare Claims Case
Stevenson Medical Center and Alan J. Wayne, M.D. (collectively, Stevenson), a Stevenson, Alabama physician and his practice that performed in-office urine drug testing, entered into a $225,000 Settlement Agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services effective February 24, 2015. The Agreement resolves allegations Stevenson submitted false or fraudulent claims to Medicare. Specifically, OIG contends Stevenson submitted claims to Medicare for high and low/moderate complexity urine drug tests exceeding the number of units allowed by Medicare by using an inappropriate code to bypass computer programming that would have otherwise rejected such claims. The OIG also contends that Stevenson submitted claims for high complexity drug tests when it performed less-expensive low/moderate complexity drug tests. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, collaborated to achieve this settlement.
02-24-2015
California Pharmacy Settles False and Fraudulent Medicare Claims Case
On February 24, 2015, a Los Angeles, California pharmacy and its owner agreed to pay $1,342,295.50 to settle allegations by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services under the Civil Monetary Penalties Law. The agreement with OIG resolves allegations that Hyundai Drugs and its owner Sang Kim submitted claims to Medicare Part D for brand name prescription drugs that it could not have dispensed based on inventory records. The case was investigated as part of Operation Pharm Fury, a joint effort between OIG's Office of Investigations, Office of Evaluation and Inspections, and Office of Counsel to the Inspector General. Senior Counsel Tamara Forys represented OIG.
02-09-2015
Loxahatchee, Florida Hospital Settles EMTALA Case
On February 9, 2015, Palms West Hospital (Palms), a Loxahatchee, Florida hospital, agreed to pay a maximum penalty of $50,000 in a settlement agreement with OIG. The agreement resolves allegations that Palms refused to accept the transfer of a toddler who had ingested Drano. The mother of an 18-month old toddler brought her daughter to a hospital emergency department (ED) for ingestion of an unknown quantity of Drano. Poison control recommended that the toddler be treated by a pediatric gastroenterologist (GI), which that hospital did not have. The ED physician contacted the Hospital Corporation of America's Transfer Center (TC) to arrange a transfer of the patient. As protocols required, TC had a copy of Palms' on-call list. TC called Palms to confirm that pediatric GI services were available and to arrange for the transfer of the toddler. The ED physician at Palms accepted the transfer, but later rescinded the acceptance believing that she had made a mistake about on-call coverage. As a result, the toddler was transferred to another hospital. Palms, however, did have a pediatric GI available on call when the request was made to transfer the toddler. TC failed to check on the transfer request in a timely manner and learned of the refusal after the patient had been transferred to another facility. Senior Counsel Sandra Sands represented OIG.
02-06-2015
Arizona Behavioral and Developmental Services Provider Settles Case Involved Excluded Nurses
On February 6, 2015, Community Provider of Enrichment Services (CPES), a Tucson, Arizona, provider of adult day programs, adult residential services, and other behavioral and developmental services for behaviorally and mentally challenged adults and children, entered into a $250,000 settlement agreement with the OIG. The settlement agreement resolves allegations that CPES employed two individuals who were excluded from participating in any Federal health care programs. The excluded nurses provided items and services to CPES patients that were billed to Federal health care programs. Senior Counsel Nancy Brown and represented OIG, with the assistance of Paralegal Specialist Eula Taylor.
02-04-2015
Group Home in Arizona Settles Excluded Provider Case
A group home providing services to disabled individuals has settled with the HHS Office of the Inspector General allegations that it employed a nurse who has been excluded from participation in Federal health care programs and allowed that person to care for residents. The facility, Agape Homes, LLC, of Avondale, Arizona also offers day treatment services. Under federal law, a provider who has been excluded from federal health care programs can neither provide services to Medicare or Medicaid beneficiaries nor have those services paid for by Medicare or Medicaid. Agape agreed to pay $41,995.30 to settle these allegations. Senior Counsel Nancy W. Brown represented OIG.
01-30-2015
Alabama Hospital Settles Case Involving Excluded Individual
Affinity Medical Center, LLC, - a community hospital in Birmingham, Alabama that operates under the name Trinity Medical Center - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective December 15, 2014. The $111,969.11 settlement resolves the allegation that the hospital employed an individual who was excluded from participating in any Federal health care programs and then billed Federal health care programs for items and services provided by the excluded individual.

The excluded individual was identified through a data analysis project initiated by the OIG's Office of Evaluation and Inspections. OIG's Office Evaluation and Inspections and the Office of Counsel to the Inspector General, represented by Senior Counsel Kenneth D. Kraft, collaborated to reach this settlement.
01-23-2015
Ownership of Minnesota Pharmacy While Excluded Results in Settlement With OIG
Minnesota pharmacist Joseph C. Moon entered into a $96,259.57 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective January 20, 2015. The settlement resolves allegations that from March 10, 2006 to July 17, 2013, Moon owned and managed a pharmacy that participated in Federal health care programs while he was excluded from participating in these programs. Senior Counsel David M. Blank and Paralegal Specialist Mariel Filtz represented OIG.
01-20-2015
Georgia Physician Settles False and Fraudulent Medicare Claims Case
Dennis Conrad Harper, M.D. (Harper), a Georgia physician who overbilled for in-office urine drug testing, agreed to enter into a $305,168.54 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services effective January 20, 2015. The settlement resolves allegations Harper submitted false or fraudulent claims to Medicare. Specifically, OIG contends Harper submitted claims to Medicare for low and moderate complexity urine drug tests exceeding the number of units allowed by Medicare by using an inappropriate code to bypass computer programming that would have otherwise rejected such claims. OIG also contends that he submitted claims for high complexity drug tests when he performed less-expensive low or moderate complexity drug tests. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoff Hymans, collaborated to achieve this settlement.
01-20-2015
Tristar Summit Medical Center in Tennessee Settles Patient Dumping Allegations
A hospital in Tennessee that allegedly transferred an unstable patient for insurance reasons will pay $40,000 in a settlement with the Office of the Inspector General (OIG) of the Department of Health and Human Services, it was announced today. Tristar Summit Medical Center in Hermitage, TN is settling allegations by the OIG that it broke the law when it transferred a patient that had come to its emergency department after consuming a bottle of antifreeze without first stabilizing the patient's medical condition. Emergency room personnel, it is alleged, determined the patient should be admitted to an intensive care unit and, despite the availability of a bed in the Tristar Summit ICU, the patient was sent elsewhere because the hospital did not accept the patient's insurance. The Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986—often referred to as the patient anti-dumping law—requires a hospital to stabilize a patient's emergency condition within its capabilities prior to transfer, and a hospital may not transfer an unstable patient unless the patient requests transfer or a physician certifies that the benefits of transfer outweigh the risks. Under EMTALA hospitals can be fined up to $50,000 per violation.

2014

12-29-2014
Atmore Community Hospital Settles EMTALA Case
A small hospital in Atmore, Alabama, settled claims that it refused to provide pain medication to a man who had been shot in the arm. The 65-year old man was sent to Atmore Community Hospital via ambulance to be air lifted to a hospital that was capable of treating his injury. However, it was too foggy for the helicopter to land, so the paramedics needed to drive him to the hospital, which was one hour away. The patient did not think he could make the trip without pain medication, so he requested pain relief for his severe pain - something Atmore had the capability to provide. As the paramedics unloaded the patient from the ambulance, Atmore's emergency department doctor and a nurse came out to the ambulance and refused to let the patient enter the hospital because they did not have a trauma surgeon on staff. Both the paramedic and the patient explained that the patient wanted pain relief for the long trip, but the doctor and nurse returned inside, with locked doors closing behind them.

The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services alleged this conduct violates the Emergency Medical Treatment & Labor Act, which requires hospitals to provide stabilizing treatment to patients with emergency medical conditions, including severe pain. On December 29, 2014, Atmore agreed to pay $25,000 - the maximum penalty for a small hospital - to resolve these allegations. Senior Counsel Sandra Sands represented OIG.
12-29-2014
Memorial Health Care System Settles EMTALA Case
A small hospital in Hixson, Tennessee, that failed to provide stabilizing treatment to an 18 year-old with severe pain and multiple broken bones, has settled allegations by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services that it violated the Emergency Medical Treatment & Labor Act. EMTALA requires hospitals to provide stabilizing treatment to anyone with an emergency medical condition. The patient came to the emergency room of Memorial North Park, one of Memorial Health Care System's satellite hospitals, with severe pain in his feet, ankles, and right shin after jumping from a twenty foot wall and landing on concrete. Although Memorial had an orthopedic surgeon on call, the emergency room staff did not consult with him nor did they provide treatment for the patient's pain or splint his legs before transferring him to the trauma center. The trauma center ultimately did not consider the patient a trauma case.

The hospital agreed to pay $20,000 in a settlement agreement with the OIG, effective December 29, 2014. Under EMTALA , the maximum penalty for hospitals with fewer than 100 beds is $25,000. Senior Counsel Sandra Sands represented OIG.
12-29-2014
Baptist Medical Center - Princeton Settles EMTALA Case
A Birmingham, Alabama, medical center that refused to accept the appropriate transfer of a 61-year-old woman, has agreed to settle allegations that it violated the Emergency Medical Treatment & Labor Act. EMTALA requires hospitals with specialized capabilities-in this case a neurosurgeon-to accept transfers of patients who require those services.

The patient, who was found to be unresponsive in her home, was initially taken to a facility that did not have the capability to treat her condition. The hospital diagnosed her with altered mental status caused by a change in brain function: she had a subdural hematoma and needed emergency surgery, which that hospital could not provide. When the ED physician called Baptist to make arrangements to transfer the patient to Baptist, Baptist transferred the call to its ED and the transferring physician was told that he needed to talk to the on-call neurosurgeon. The call was then forwarded to the Hospitalist, who repeated that he had to speak with the on-call neurosurgeon. The transferring ED physician was then connected to the neurosurgeon and explained the patient's condition. The neurosurgeon responded that it sounded like the patient was brain dead. The ED physician explained that she was not and that he had paralyzed her to intubate her for medical purposes. The neurosurgeon repeated that she sounded brain dead and refused the transfer. Before hanging up, the neurosurgeon said he would be willing to consult on the case, but not accept transfer of the patient to Baptist. The ED physician then transferred the patient to another hospital where she successfully underwent surgery and was released to a rehabilitation facility five days later. Baptist, after finding out about its refusal to accept this patient, ordered the neurosurgeon to call Baptist back and to accept the patient, which he did, but the patient had already been sent to another hospital.

Baptist, on December 29, 2014, agreed to pay $40,000 to resolve allegations of an EMTALA violation investigated by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services. The maximum penalty for violating the so-called "patient dumping" law is $50,000 for a large hospital. Senior Counsel Sandra Sands represented OIG.
12-29-2014
Caldwell Medical Center Settles EMTALA Case
Caldwell Medical Center, a small hospital in Princeton, Kentucky, has settled allegations that it failed to evaluate a patient's head pain or provide stabilizing treatment. A 72-year old woman lost consciousness and fell face-first onto a concrete floor. She regained consciousness about five hours later, called an ambulance, and was taken to Caldwell's Emergency Department (ED). She had bruising and abrasions on her nose, two black eyes and a skin tear on her right arm. She complained of severe pain in her face and head. Her abrasions and skin tear were cleaned and she was discharged home a little over one hour after she arrived in the ED. She did not receive any diagnostic tests, including a CAT Scan, and she received no treatment for her head pain.

The patient continued to have pain: she could not chew and she vomited blood. The next morning she called an ambulance again and returned to Caldwell's ED. This time she received an appropriate medical screening exam, which revealed multiple head fractures. She was then transferred to a hospital with neurosurgery capabilities and she underwent several surgeries and was discharged thirteen days later.

Caldwell agreed to pay $10,000 in a settlement with the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services effective December 29, 2014. Senior Counsel Sandra Sands represented OIG.
12-19-2014
Denver Hospital System Settles False Claims Allegations
Effective December 19, 2014, Denver Health and Hospital Authority entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services. The $51,803.86 settlement resolves allegations that Denver Health submitted claims to Medicare for services provided to individuals it knew, or should have known, were incarcerated or in custody. In most circumstances, Medicare does not pay for health care services for individuals who are incarcerated or in custody. Senior Counsels Tamara Forys and Geeta Taylor represented OIG.
12-18-2014
Hospice Owners Settle False and Fraudulent Medicare Claims Case
The current and former owners of Premier Hospice and Palliative Care, LLC and Premier Hospice & Palliative Care - Indiana, LLC jointly entered into a $2,674,895.79 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective December 18, 2014. The settlement resolves allegations that from October 1, 2009 to April 30, 2013, Premier submitted hospice claims to Medicare for patients whose health records indicated they were ineligible for such services. SP Management, Inc. and Jeff L. Smith owned the hospices when the alleged conduct began. They sold the hospices to Abode Healthcare, Inc. on December 31, 2012, and shortly after, Abode self-disclosed potential violations of the Civil Monetary Penalties Law to OIG. This settlement resolves allegations for all parties: SP Management, Jeff L. Smith, and Abode. Senior Counsel Tamara Forys represented OIG.
12-18-2014
A Medical Practice, Doctor in New York Settle False and Fraudulent Claims Case
Jennan Comprehensive Medical, P.C. (Jennan) - a medical group practice in New York - and its owner, Henry Chen, M.D., entered into a $694,887.02 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective December 18, 2014. The settlement resolves allegations that from May 15, 2008 to December 31, 2013, Jennan and Dr. Chen knowingly submitted or caused to be submitted false and/or fraudulent claims to Medicare for physical therapy services. Specifically, OIG alleged that these claims were false and/or fraudulent for one or more of the following reasons: 1) physical therapy services were not provided or supervised by the rendering provider; 2) group services were billed as one-on-one provider-patient physical therapy services; 3) services were performed by unqualified individuals; and/or 4) claims for time-based physical therapy services did not accurately reflect the actual time spent performing the services. Senior Counsels David M. Blank, Tamara T. Forys, and Lauren E. Marziani, along with Paralegal Specialist Mariel Filtz, represented OIG.

This case developed as a result of OIG's prior investigation of Joseph A. Raia, M.D., a former Jennan employee. Dr. Raia entered into a settlement with OIG on February 11, 2014 for $1.5 million and agreed to be excluded from participating in Federal health care program for a minimum of 15 years.
12-03-2014
Texas Otolaryngology Practice Settles False and Fraudulent Medicare and Medicaid Claims Case
Ear Nose and Throat Associates of Corpus Christi, LLC - a physician practice providing otolaryngology services in Corpus Christi, TX - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective December 3, 2014. The $200,630 settlement resolves allegations that for nearly three years the practice improperly submitted claims to Medicare and Texas Medicaid for hearing assessment services performed by unqualified technicians. Senior Counsel Ellen Slavin represented OIG.
11-26-2014
Ohio Chiropractor Agrees to Voluntary Exclusion
On November 26, 2014, an Ohio chiropractor agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the chiropractor billed Medicare for custom orthotics and related add-on codes when he actually provided standard equipment that was: (1) not billable to Medicare; (2) billed at a higher rate of reimbursement than appropriate; (3) provided to patients who were not eligible for such equipment; and (4) not medically necessary. OIG also alleged that the chiropractor inappropriately solicited potential clients at nursing homes, ordered equipment without proper clinical evaluations, ordered orthotics for both feet without medical necessity, advised patients that there would be not cost for the equipment, and any co-payments would be waived. Senior Counsel Geeta W. Kaveti represented OIG.
11-17-2014
South Carolina's Trident Health System Settles EMTALA Case Involving Patient Dumping Allegations
Effective November 17, 2014, Trident Health System (Trident) in South Carolina entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services to resolve claims that it failed to provide stabilizing treatment to a patient in one of its emergency rooms. Specifically, OIG alleged that on February 12, 2012, a 58-year-old male patient, who was incarcerated at the time, was transported by an Emergency Medical Services (EMS) ambulance to Moncks Corner Medical Center, a Trident facility. EMS contacted emergency room personnel to inform them of the patient's transport but, when the patient arrived at the emergency room, a nurse informed EMS personnel that the medical center could not treat the patient because Trident had a "no trespass" order on him. EMS then took the patient to a nearby hospital, and Trident never provided a medical screening examination of the patient. This $40,000 settlement resolves Trident's civil monetary penalties liability under the patient dumping statute.
10-30-2014
DCH Regional Medical Center Settles EMTALA Case
Effective October 30, 2014, DCH Regional Medical Center-a 583-bed hospital located in Tuscaloosa, Alabama-entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services to resolve its civil monetary penalties liability under the Emergency Medical Treatment and Labor Act (EMTALA). DCH paid $40,000 to settle allegations that it violated EMTALA by failing to conduct an appropriate medical screening examination and provide stabilizing treatment to a patient who came to the DCH emergency department with an emergency medical condition.

Specifically, the patient came to the DCH emergency department with a gunshot wound in his abdomen region. The emergency department physician determined that the on-call general surgeon needed to evaluate and treat the patient and the staff contacted the on-call general surgeon multiple times. The on-call general surgeon indicated that he was performing a previously scheduled elective surgery in the operating room. DCH's emergency department was unable to find another general surgeon to evaluate and provide stabilizing treatment to the patient. The on-call general surgeon then performed a second previously scheduled elective surgery in the operating room without first evaluating and providing stabilizing treatment to the patient in the emergency department. After waiting approximately two hours at DCH, the patient died, never having received an evaluation or stabilizing treatment from a general surgeon.
10-24-2014
Texas Company Settles Case Involving Excluded Individuals
Daybreak Venture, LLC, the general partner of 74 skilled nursing and long-term-care facilities throughout Texas, entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 24, 2014. The $357,341.96 settlement resolves allegations that seven facilities operated by Daybreak each employed an individual who was excluded from participating in any Federal health care programs. These facilities then billed Federal health care programs for items or services provided by the excluded individuals.

Five of the seven individuals were identified through a data analysis project initiated by the OIG's Office of Audit Services. During OIG's investigation, Daybreak identified two additional employees who were excluded as well. OIG's Office of Investigations, Office of Audit Services, and Office of Counsel to the Inspector General, represented by Senior Counsel Karen Glassman, collaborated to reach this settlement.
10-24-2014
New Jersey Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Rajan Shah - a Newark, NJ gastroenterologist - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 24, 2014. The $104,950.00 settlement resolves allegations that Dr. Shah received remuneration from Orange Community MRI, LLC, an imaging facility in Orange, NJ, in exchange for patient referrals. Senior Counsel David M. Blank and Lauren E. Marziani represented OIG in this case.
10-17-2014
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Jimmy Dung Doan - a Houston, TX family practice physician - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 17, 2014. The $50,000 settlement resolves allegations that Dr. Doan received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form services received under a Referral Coordinator contract. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Doan. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Dan Kelly Eidman - a Houston, TX orthopedic surgeon - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 17, 2014. The $50,000 settlement resolves allegations that Dr. Eidman received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of monthly payments made under a Medical Director contract. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Eidman. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
10-16-2014
Utah Skilled Nursing Facility Settles Case Involving Excluded Nursing Assistant
Manor Care of South Ogden UT, LLC d/b/a ManorCare Health Services - South Ogden (MCHS - South Ogden), a skilled nursing facility located in Utah, entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 16, 2014. The $41,129.76 settlement resolves allegations that MCHS - South Ogden employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a certified nursing assistant, provided items and services to MCHS - South Ogden patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci and Associate Counsel Kaitlyn L. Dunn represented OIG in this case.
10-02-2014
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Robert L. Burke - a Houston, TX orthopedic surgeon - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 2, 2014. The $99,000 settlement resolves allegations that Dr. Burke received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of money paid above a compensation rate negotiated in a Medical Director Agreement. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Burke. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
09-29-2014
Connecticut Laboratory Settles False and Fraudulent Medicare Claims Case
Clinical Lab Partners (CLP), a laboratory in Newington, CT, that performed urine drug testing, agreed to enter into a $145,789.34 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services effective September 29, 2014. The settlement resolves allegations CLP submitted false or fraudulent claims to Medicare. Specifically, OIG contends CLP submitted claims to Medicare for high complexity urine drug tests exceeding the number of units allowed by Medicare by using a code to bypass computer programming that would have otherwise rejected such claims. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoff Hymans, collaborated to achieve this settlement.
09-12-2014
Overland, Ordal, Thorson, and Fennell Pulmonary Consultants, P.C. (OOTFPC), Oregon, agreed to pay $79,792.33 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OOTFPC submitted claims to Medicare for Evaluation and Management services (CPT codes 99204, 99214, 99205 and 99215) and Consultation services (CPT Codes 99244 and 99245) using a higher paying CPT code than supported by the medical documentation. OIG also alleged that OOTFPC submitted claims for prolonged service code (CPT 99354) when the service did not meet Medicare guidelines.
09-10-2014
Ohio Retirement Community Settles Case Involving an Excluded Nurse
Wesley Glen Retirement Community – a non-profit retirement community in Columbus, OH – entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective September 10, 2014. The $19,890 settlement resolves allegations that Wesley Glen employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that Wesley Glen employed an excluded nurse to provide items or services which were reimbursed by Federal health care programs.
09-10-2014
Illinois Physician Practice Resolves Allegations of False and Fraudulent Medicare Claims
Pain Specialists of Greater Chicago (PSGC), an Illinois physician practice that performs in-office urine drug testing, entered into a $590,763.45 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective September 10, 2014. The settlement resolves allegations PSGC submitted false or fraudulent claims to Medicare. Specifically, OIG contends PSGC submitted claims to Medicare for high and low/moderate complexity urine drug tests exceeding the number of units allowed by Medicare by using a code to bypass computer programming that would have otherwise rejected such claims. The OIG also contends that PSGC submitted claims for high complexity drug tests when it performed less-expensive low or moderate complexity drug tests. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, collaborated to achieve this settlement.
09-09-2014
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Thanh A. Nguyen - a Houston, TX urologist - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective September 9, 2014. The $60,000 settlement resolves allegations that Dr. Nguyen received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Nguyen. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
09-03-2014
Springfield Hospital (Springfield), Vermont, agreed to pay $50,000 resolve its liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that: (1) Springfield failed to provide stabilizing treatment to a patient with an emergency psychiatric condition before having him criminally charged and transferred to jail; and (2) Springfield failed to provide an appropriate medical screening examination to a second patient before having him criminally charged and sent to jail.
08-24-2014
Iowa Skilled Nursing Facility Settles Case Involving Allegations of Employing an Excluded Individual
Rock Rapids Health Centre (RRHC), a skilled nursing facility located in Iowa, entered into a settlement agreement with the Office of Inspector General (OIG) for the Department of Health and Human Services, effective August 24, 2014. The settlement resolves allegations that RRHC employed an individual who was excluded from participating in any Federal health care programs. The excluded individual provided items and services to RRHC patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG in this case.
Florida Respiratory Therapist and His Sleep Clinic Agree to Voluntary Exclusion
On August 24, 2014, in connection with the resolution of False Claims Act liability, a Florida respiratory therapist and his sleep clinic agreed to be excluded from participating in Federal health care programs for a period of eight years under U.S.C. § 1320a-7(b)(7). OIG's revealed the respiratory therapist and his sleep clinic submitted claims for polysomnographic sleep studies and psychological testing that was not medically necessary, was not conducted by the appropriately licensed individuals, or was not actually performed. Senior Counsel Kristen Schwendinger represented OIG.
08-21-2014
Florida-based Distributor Enters Settlement Agreement with OIG on Kickback Allegations
Zimmer-Deptula, Inc. (ZDI) - a former Florida-based distributor for Zimmer, Inc. - entered into a $123,000 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective August 21, 2014. This settlement resolves allegations that ZDI violated the Civil Monetary Penalties Law by paying kickbacks. Specifically, OIG alleges that two ZDI independent contractors paid third parties to recommend Zimmer, Inc. products to Florida-based physicians. OIG contends that ZDI knowingly and willfully offered and paid the kickbacks to the third parties to induce them to recommend and arrange for the purchase of Zimmer, Inc. products which were paid for by Federal health care programs. Senior Counsel David M. Blank, Robert M. Penezic, and Lauren E. Marziani represented OIG in this case.
08-15-2014
A physician and his wife agreed to be excluded from participating in Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician and his wife submitted claims to Federal health care programs for: (1) the treatment of migraines through the use of lengthy, multi-day dihydroergotamine (DHE) infusions, which were billed as chemotherapy and should have been provided through injection instead of infusion; and (2) office visits upcoded to a level 5 plus "prolonged services," which were not supported by the medical records and/or did not contain physician notes.
08-11-2014
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Gary Stephen Hurwitz - a Houston, TX urologist - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective August 11, 2014. The $170,000 settlement resolves allegations that Dr. Hurwitz received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Hurwitz. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Dilipkumar Chotabhai Patel - a LaPorte, TX primary care doctor and internist - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective August 11, 2014. The $146,000 settlement resolves allegations that Dr. Patel received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by Dr. Patel. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
08-11-2014
A Florida laboratory agreed to pay $50,000 to resolve its liability for violating the select agent regulations. OIG alleged that the laboratory violated the select agent regulations by: (1) its Responsible Official failing to ensure compliance with the Select Agent regulations; (2) failing to ensure an accurate and current inventory of each select agent in long term storage; and (3) failing to notify CDC and appropriate Federal, State, or local law enforcement agencies upon discovery of a missing select agent.
08-05-2014
Saint Joseph's Medical Center in New York Settles Case Involving a Patient Dumping Allegation
Effective August 5, 2014, Saint Joseph's Medical Center (SJMC), a 332 bed hospital located in Yonkers, NY, entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services. In the settlement agreement, SJMC agreed to pay $50,000 to resolve its civil monetary penalties liability under the patient dumping statute. Specifically, OIG alleged that SJMC violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide an appropriate medical screening examination to a patient that came to SJMC's emergency department with an emergency medical condition. Associate Counsel Patrick Garcia and Paralegal Specialist Mariel Filtz represented OIG in this matter.
08-05-2014
Florida Laboratory Settles Case Involving Allegations of False or Fraudulent Medicare Claims
Florida Family Laboratories, LLC (FFL), a Florida urine drug testing company, agreed to enter into a $197,400.09 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services effective August 5, 2014. The settlement resolves allegations FFL submitted false or fraudulent claims to Medicare. Specifically, OIG contends FFL submitted claims to Medicare for high complexity urine drug tests exceeding the number of units allowed by Medicare by using an inappropriate code to bypass computer programming that would have otherwise rejected such claims. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoff Hymans, collaborated to achieve this settlement.
07-31-2014
Missouri Health Care IT and Pharmacy Benefits Manager Settles Case Involving Allegations of Fraudulent Medicare Part D Claims
Argus Health Systems, Inc. - a health care information management services provider and pharmacy benefits manager headquartered in Kansas City, MO - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective July 31, 2014. Under the agreement, Argus agreed to pay OIG $2,029,210 to resolve allegations that the company submitted prescription drug event (PDE) data to Medicare that included sales tax from Louisiana pharmacies even though Medicare Part D drugs were not taxable under Louisiana law as of July 1, 2006. Specifically, OIG contends that from July 1, 2006 through December 31, 2009, Argus knowingly submitted or caused to be submitted PDE claims to the Centers for Medicare & Medicaid Services (CMS) that improperly claimed Louisiana sales tax costs. CMS then used those PDE claims to calculate Medicare payments to Part D sponsors with whom Argus contracted, which improperly increased reimbursement to the sponsors. Senior Counsel Christina McGarvey and Senior Counsel John O'Brien represented OIG in this case.
07-28-2014
Florida Doctor Settles Case Involving False Claims Allegations
Nabil Attalla Barsoum, M.D. (Barsoum), a Florida physician who performed in-office urine drug testing, agreed to enter into a $334,538.90 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services effective July 25, 2014. The settlement resolves allegations Barsoum submitted false or fraudulent claims to Medicare. Specifically, OIG contends Barsoum submitted claims to Medicare for low and moderate complexity urine drug tests exceeding the number of units allowed by Medicare by using an inappropriate code to bypass computer programming that would have otherwise rejected such claims. He also submitted claims for high complexity drug tests when he performed less-expensive low or moderate complexity drug tests. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoff Hymans, collaborated to achieve this settlement.
07-24-2014
Tennessee Senior Living Community Chain Settles Case Involving Allegations of Employing Excluded Individuals
Brookdale Senior Living, Inc. and three subsidiaries (collectively, Brookdale) - a chain of senior living communities headquartered in Brentwood, TN - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective July 24, 2014. The $353,248.82 settlement resolves allegations that Brookdale employed two individuals who were excluded from participating in any Federal health care programs. After one of the individuals self-disclosed to OIG that she worked as a documentation trainer at Brookdale during her exclusion, OIG opened an investigation to determine if Brookdale had employed any additional excluded individuals. During the course of the investigation, Brookdale disclosed that it employed another excluded individual as a nurse during the period of her exclusion.
07-11-2014
Utah Health Care System Settles Case Involving Allegations of Employing Excluded Individuals
University of Utah (UOU) - a university-based health care system including 4 hospitals and 10 neighborhood health care centers - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective July 8, 2014. The $197,839.94 settlement resolves allegations that UOU employed three individuals who were excluded from participating in any Federal health care programs. OIG's investigation revealed that UOU employed an excluded nurse who provided items or services paid for by Federal health care programs. During the investigation, UOU disclosed that it employed two additional excluded persons.
07-11-2014
Kentucky Long Term Care Organization Settles Case Involving Allegations of Employing An Excluded Individual
Bradford Heights Health & Rehab Center - a not-for-profit faith-based long-term-care organization in Hopkinsville, KY - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective July 1, 2014. The $30,121.82 settlement resolves allegations that Bradford employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that Bradford employed an excluded nurse to provide items or services that were reimbursed by Federal health care programs. Senior Counsel David M. Blank and Paralegal Specialist Jennifer McKoy represented OIG in this case.
07-08-2014
A clinical psychologist and her psychology practice agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the psychologist and her practice submitted, or caused to be submitted, claims to Medicare and Missouri Medicaid for services billed under the psychologist's NPI number for psychotherapy services that the psychologist did not personally perform. Specifically, OIG alleged that the psychologist and her practices submitted claims for psychotherapy services rendered in residential care facilities in Missouri using medical records that falsely represented her to be the "on-site supervising psychologist" for these services. OIG alleged that the psychologist typically was not on site or even available for consultation because the psychologist was treating patients in Texas. Further, OIG alleged that the services were actually performed by unsupervised licensed clinical professional counselors.
06-26-2014
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Steven A. Fein - a Houston, TX gastroenterologist - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective June 26, 2014. The $118,944 settlement resolves allegations that Dr. Fein received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement and from the benefit of referral coordinator whose compensation was paid by Fairmont. OIG alleged that these financial arrangements took into account the value and volume of referrals made to Fairmont by Dr. Fein. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Jerry McShane - a Houston, TX occupational health specialist- entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective June 26, 2014. The $134,200 settlement resolves allegations that Dr. McShane received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement and from the benefit of a referral coordinator whose compensation was paid by Fairmont. OIG alleged that these financial arrangements took into account the value and volume of referrals made to Fairmont by Dr. McShane. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
06-20-2014
Pennsylvania Health Care Staffing Agency Settles Case Involving Allegations of Employing An Excluded Individual
ePeople Healthcare, Inc., a health care staffing agency in Pennsylvania, entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective June 20, 2014. The $10,204 settlement resolves allegations that ePeople employed an individual who was excluded from participating in any Federal health care programs. The excluded individual was a licensed practical nurse who provided items and services to nursing facilities that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG in this case.
06-09-2014
Winter Haven Hospital (Winter Haven), Florida, agreed to pay $75,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that Winter Haven: (1) failed to accept the transfer of two patients who needed specialized capabilities or facilities available at Winter Haven; and (2) failed to provide medical examination and treatment to a third patient as required to stabilize his condition, within the capabilities of the staff and facilities available at Winter Haven.
06-06-2014
Trinity Medical Center d/b/a Trinity Bettendorf (Trinity), Iowa, agreed to pay $40,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that Trinity failed to provide appropriate screening or stabilizing treatment for an individual who came to Trinity's emergency department with emergency medical and psychiatric conditions.
06-05-2014
Indiana Hospital Settles EMTALA Case Involving Allegations of Patient Dumping
Effective June 5, 2014, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services entered into a settlement agreement with St. Vincent Jennings Hospital (SVJH). SVJH agreed to pay $25,000 to resolve its liability for civil monetary penalties under the patient dumping statute. Specifically, OIG alleged that SVJH violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide an appropriate medical screening examination to a patient who arrived via ambulance to SVJH's emergency department with an emergency medical condition. OIG was represented in this matter by Associate Counsel Patrick Garcia and Eula Taylor.
06-05-2014
California Hospital Settles EMTALA Case Involving Patient Dumping Allegations
Olive View - UCLA Medical Center - a county hospital in Sylmar, CA - entered into a settlement agreement with the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, effective May 23, 2014. The $40,750 settlement resolves allegations that Olive View violated the Emergency Medical Treatment and Labor Act, (EMTALA), by failing to provide an individual with an appropriate medical screening examination (MSE) within the capability of the hospital's emergency department in order to determine whether he had an emergency medical condition.

Specifically, the individual presented to the Olive View emergency department with signs of appendicitis and severe abdominal pain that he rated at a 10 on a 10-point scale. Despite his severe pain and symptoms, he was forced to wait for several hours to receive an MSE. After waiting for 6.5 hours, he left to seek medical screening and treatment at another hospital, where he was diagnosed with acute appendicitis with a large peritoneal abscess and had to undergo an immediate laparoscopic appendectomy. According to EMTALA, if an individual comes to a hospital emergency department and a request is made on his/her behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate MSE within the capability of the emergency department to determine whether or not an emergency medical condition exists. OIG was represented by Associate Counsel Odies Williams, IV. Olive View was represented by Brandi M. Moore of the Los Angeles County Counsel's Office.
06-04-2014
CVS Pharmacy Enters into $1.2M Settlement with OIG on Double-Billing Claims
CVS Pharmacy, Inc. (CVS) entered into a settlement agreement for $1,216,147.19 with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective May 28, 2014. The settlement resolves allegations that CVS improperly submitted, or caused to be submitted, duplicate claims to both Medicare Part B and to Medicare Part D plan sponsors or the sponsors' agents. Specifically, CVS allegedly double-billed for immunosuppressant drugs for the same patients on the same date of service.

OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsel Geoffrey Hymans and Associate Counsel Katherine Matos, collaborated to achieve this settlement.
05-30-2014
Leer's Quality Home Health Care Services Inc. (Leer's), Texas, agreed to pay $39,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Leer's employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-29-2014
Texas Health Care Center Settles with OIG on Charges of Employing an Excluded Individual
Rayburn Health Care & Rehabilitation (RHCR)- a nursing and rehabilitation center located in Jasper, TX- entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective May 15, 2014. The $110,712.60 settlement resolves allegations that RHCR employed an individual who was excluded from participating in any Federal health care programs. When the excluded individual applied to be reinstated into Federal health care programs, she reported on her application that she was employed by RHCR as a nurse for two years during her exclusion. During her employment tenure, she allegedly provided items or services reimbursed by Federal health care programs, which is prohibited for excluded individuals.
05-21-2014
New Jersey Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Ansar Sharif, M.D. - former owner of a Kearny, NJ, medical practice - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective May 20, 2014. The $52,280 settlement resolves allegations that Sharif received kickbacks from Orange Community MRI, LLC, a diagnostic testing facility, in exchange for patient referrals.

To date, the United States Attorney's Office for the District of New Jersey convicted 17 defendants - including 15 physicians - in connection with the government's ongoing investigation of illegal payments made by Orange MRI. The investigation by OIG's Office of Investigations indicated that Sharif received money from Orange MRI for patient referrals. This case marks the first Civil Monetary Penalty Law resolution stemming from the government's investigation of Orange MRI. OIG was represented by Senior Counsel David M. Blank and Lauren E. Marziani. Sharif was represented by Carmine Campanile.
05-15-2014
Mercy Hospital in Miami, FL Settles EMTALA Case
Mercy Hospital - a campus of Plantation General Hospital in Miami, FL - agreed to pay $45,000 to resolve allegations that it failed to provide appropriate medical screening for a 24-day-old baby brought to the hospital's Emergency Department for an emergency medical condition, including persistent low body temperature. The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services alleged that Mercy Hospital violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide adequate evaluation and treatment because it did not address the newborn's low temperature nor did it order any further laboratory tests, such as a blood count, blood chemistry lab, or urinalysis, before telling the parents to take the baby home. Minutes after leaving the hospital, the baby suffered cardiac arrest, kidney injury and potential injury to the brain from lack of oxygen because of an issue with the bowel, known as necrotic bowel. OIG contends that EMTALA is intended to protect vulnerable patients such as newborn babies who cannot articulate their own needs, and medical professionals must consider appropriate diagnostic techniques and adequately listen to family members presenting the baby's chief symptoms.
04-25-2014
Harper's Hospice Care, Inc. (Harper's Hospice), Mississippi, agreed to pay $150,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Harper's Hospice paid remuneration to a physician in the form of medical directorship fees. Specifically, the OIG contends that Harper's Hospice paid the remuneration to the physician in exchange for the physician referring patients to Harper's Hospice for hospice services and pre-singing blank prescription forms for patients treated by Harper's Hospice.
04-25-2014
An Arizona research university agreed to pay $165,000.00 to resolve its liability for violating the select agent regulations by failing to: (1) maintain current and accurate inventory records regarding certain select agents; (2) implement biosafety and containment procedures commensurate with the risks associated with the select agents and toxins in its possession; and (3) failed to ensure compliance with the requirement of 42 C.F.R. Part 73.
04-24-2014
Texas Doctor Agrees to Voluntary Exclusion with OIG on Kickback Allegations
A family practice physician in Houston, TX, agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7a(a)(7), 1320a-7(b)(6)(B) and 1320a-7(b)(7). OIG alleged that the physician received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement. OIG alleged that this financial arrangement took into account the value and volume of referrals made to Fairmont by the physician. OIG further alleged that the physician admitted to the Texas Medical Board that his medical practice fell below the standard of care in the treatment of eight patients and that he provided controlled substances to the patients without appropriate treatment plans or documentation.
04-15-2014
Gregory Bohn, M.D., Iowa, agreed to pay $35,000 to resolve his liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that Dr. Bohn, the on-call surgeon at Trinity Bettendorf, refused to examine or treat a patient who had an emergency medical condition that required surgery.
04-08-2014
In connection with the resolution of False Claims Act liability, an oncologist and his oncology practice agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the oncologist and his practice submitted, or caused to be submitted, claims to Medicare and Medicaid for chemotherapy drugs in excess of the amounts actually provided.
03-13-2014
In connection with the resolution of False Claims Act liability, an ophthalmologist agreed to be excluded from participating in Federal health care programs for a period of twenty years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the ophthalmologist presented or caused to be presented false or fraudulent claims for payment to Medicare and Medicaid for: (1) repeated Argon Laser Trabeculoplasties, a procedure used to treat open angle glaucoma, that were not reasonable and necessary; (2) repeated Lysis of Adhesion, a procedure used to correct a rare complication of cataract surgery, that were not reasonable and necessary; and (3) repeated Laser Peripheral Iridotomies, a procedure used to treat narrow angle glaucoma, that were not reasonable and necessary.
03-04-2014
HealthCare Partners, LLC (HCP), California, agreed to pay $341,309.93 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HCP employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
02-21-2014
OIG Issues Case and Desist Letter to CarePoint Medical
On February 21, 2014, OIG notified CarePoint Medical (CarePoint) that CarePoint's unauthorized and inappropriate use of the word "Medicare" and other misleading language in its mailings to beneficiaries was potentially in violation of section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and Departmental emblems. Before OIG initiated litigation, CarePoint agreed to: (1) discontinue using the word "Medicare" or other language in a manner that implies that CarePoint has an association or affiliation with the Medicare program, the Centers for Medicare and Medicaid Services or the United States Department of Health and Human Services; and (2) include in all future mailings promoting CarePoint's products and services a prominent disclaimer that states that neither CarePoint nor its activities are connected with, approved, endorsed, or authorized by the United States Department of Health and Human Services.
02-20-2014
PALMS Medical Transport, L.L.C. (PALMS), Georgia, agreed to pay $420,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PALMS submitted ambulance transport claims for Medicare beneficiaries using HCPCS billing code A0434 for one-way Specialty Care Transport (SCT) from a skilled nursing facility or residence to a non-hospital based End Stage Renal Disease entity. OIG contends that these transports did not qualify as SCT because: (1) non-hospitals-based dialysis facilities are not considered "facilities" for the purposes of SCT, and (2) PALMS did not provide medically necessary supplies and services at a level beyond the scope of the EMT-Paramedic.
02-14-2014
Medicus Laboratories, LLC (Medicus), Texas, agreed to pay $5,000,000 for allegedly violating the Civil Monetary Penalties Law. OIG contends that Medicus submitted false or fraudulent claims to Medicare as follows: 1) by inappropriately using Modifier 59 to submit claims for payment for multiple units of HCPCS code G0431 when only a single unit may be billed per patient encounter; and 2) by inappropriately submitting claims for HCPCs codes 83986 (pH of body fluid), 82570 (creatinine, other sources), 81005 (urinalysis, qualitative or semi-quantitative, except immunoassays), and 81003 (urinalysis, by dip stick or table reagent) when the testing was for screening purposes and was not medically reasonable and necessary.
02-11-2014
Physician Agrees to $1.5 Million Payment and 15-Year Exclusion To Settle Civil Monetary Penalty Case
Joseph A. Raia, MD, a physiatrist in New Jersey, agreed to pay $1,500,000 for allegedly violating the Civil Monetary Penalties Law and agreed to be excluded from participation in Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Dr. Raia had improperly used chiropractors to provide physical therapy services "incident to" his professional services. Further, OIG alleged that Dr. Raia submitted claims to Medicare for the provision or supervision of physical therapy and related services while he was not in the State where the services were allegedly performed. News Release
02-10-2014
Altru Health System (Altru), North Dakota, agreed to pay $241,137.76 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Altru employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-07-2014
Claiborne County Medical Center (CCMC), Mississippi, agreed to pay $25,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that CCMC failed to provide an adequate medical screening examination to a patient who presented to its emergency department.
02-04-2014
Arizona Bridge to Independent Living, Inc. (ABIL), Arizona, agreed to pay $85,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ABIL employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.
01-06-2014
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Amir Ghebranious - a Houston, TX family practice physician - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective January 6, 2014. The $195,016 settlement resolves allegations that Dr. Ghebranious received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement and from the benefit of a referral coordinator whose compensation was paid by Fairmont. OIG alleged that these financial arrangements took into account the value and volume of referrals made to Fairmont by Dr. Ghebranious. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Mary Campbell-Fox - a Houston, TX family practice physician - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective January 6, 2014. The $195,016 settlement resolves allegations that Dr. Campbell-Fox received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from a Medical Director Agreement and from the benefit of a referral coordinator whose compensation was paid by Fairmont. OIG alleged that these financial arrangements took into account the value and volume of referrals made to Fairmont by Dr. Campbell-Fox. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.

2013

12-30-2013
In connection with the resolution of False Claims Act liability, an individual who was the former president, CEO, and board chair of a nationwide provider of geriatric care agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the individual submitted, or caused to be submitted, claims to Medicare for allegedly engaging in upcoding by billing for services provided to beneficiaries in their homes when the services were instead provided in Assisted Living Facilities.
12-23-2013
Humana Inc. (Humana), Kentucky, agreed to pay $1,814,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Humana submitted prescription drug event date (PDE claims) that included sales tax from Louisiana pharmacies to the Centers for Medicare & Medicaid Services (CMS) even though Medicare Part D drugs were not taxable under Louisiana law as of July 1, 2006. OIG further alleged that Humana knowingly submitted or caused to be submitted PDE claims to CMS that improperly claimed Louisiana sales tax costs and the CMS used Humana's PDE claims to calculate Medicare Part D payments.
12-19-2013
East Los Angeles Dialysis Center (ELADC), California, agreed to pay $56,094.23 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ELADC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-15-2013
Ronald Goldberg, M.D. (Goldberg), and Haverhill Family Practice (HFP), Massachusetts, agreed to pay $162,676.94 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Goldberg and HFP submitted claims under Goldberg's billing number for services provided to nursing home patients that had been provided by nurse practitioners. OIG also alleged that Goldberg and HFP submitted claims for services that were not provided to patients because the patients were either hospitalized or no longer living.
12-13-2013
A physician assistant (PA) agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the PA knowingly and willfully received illegal remuneration in exchange for referring patients for the furnishing of items or services for which payment may be made in whole or in part under a Federal health care program. OIG further alleged that the PA referred patients to health care entities for physical therapy and home health care services in exchange for illegal kickbacks in violation of the Anti-Kickback Statute.
12-04-2013
Carolinas Medical Center (Carolinas), North Carolina, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. OIG alleged that Carolinas failed to provide an appropriate medical screening examination or stabilizing treatment to a patient that needed psychiatric treatment.
12-03-2013
A durable medical equipment (DME) company and its owner, agreed to pay $5,000, and to relinquish funds being held in suspension, for allegedly violating the Civil Monetary Penalties Law (CMPL) and provisions of the CMPL applicable to physician self-referrals and kickbacks. The DME company and its owner also agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the DME company in connection with their contract with a telemarketing company, made unsolicited telephone calls to Medicare beneficiaries to obtain orders for the furnishing of DME for which Medicare pays. OIG alleged that the DME company used the information obtained to submit claims to Medicare for the DME allegedly provided to the beneficiaries. OIG further contends that the DME company knew or should have known that they submitted false or fraudulent claims because they obtained the orders for the DME through telephone solicitations prohibited by the Social Security Act's DME Telemarketing Provisions. Those provisions prohibit suppliers of DME from making unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of a covered item, except in three circumstances. OIG alleged that the telemarketing calls made on behalf of the DME company did not fall into these exceptions. OIG contends that the DME company violated the CMPL by knowingly submitting Medicare claims that they knew or should have known were false or fraudulent for DME ordered pursuant to prohibited telephone solicitations. OIG also contends that the DME company offered or paid remuneration in the form of monetary payments to induce the telemarketing company to refer individuals for the provision of DME for which Medicare would pay or to arrange for or recommend ordering DME for which Medicare would pay.
11-19-2013
Best Choice Home Health Care Agency (Best Choice), Kansas, agreed to pay $93,990.32 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Best Choice employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-19-2013
IASIS Healthcare Corporation (IASIS), Utah, agreed to pay $318,035.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that IASIS employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.
11-13-2013
Spectrum Private Care Services, Inc. (Spectrum), Kansas, agreed to pay $39,033.35 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.
10-25-2013
In connection with the resolution of False Claims Act liability, a pediatrician agreed to be excluded from participating in Federal health care programs for a period of twenty years under 42 U.S.C. § 1320a-7(b)(7). The OIG alleged that the pediatrician: (1) billed for urinalysis testing employing the CPT code 81001 for automated urinalysis with microscopy when no microscopy was performed and (2) billed CPT code 92585 for comprehensive auditory evoked response testing when the comprehensive test was not actually being performed.
10-24-2013
In connection with the resolution of False Claims Act liability, the CEO of a corporation that provides hospice services agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the CEO caused the submission of false claims to Medicare for hospice care provided to 19 patients who did not meet the eligibility requirements for the Medicare hospice benefit because each of these patients, during some, or all, of the period they received hospice care, did not have a medical prognosis of six months or less if their illnesses ran their normal course.
10-21-2013
In connection with the resolution of False Claims Act liability, two owners of a durable medical equipment company agreed to be excluded from participating in Federal health care programs for a period of twenty years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the owners, through their company, entered into contracts with marketing companies whereby, in violation of the Anti-Kickback Statute, the company paid for referrals from marketing companies when Medicare beneficiaries ordered diabetic supplies.
10-18-2013
Regional Medical Center at Memphis (RMC), Tennessee, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that RMC failed to provide a medical screening examination to a patient who was refused access to the emergency department and told to go instead to a nearby hospital.
10-17-2013
Henry Schein, Inc. (Henry Schein), New York, agreed to pay $1,140,260 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Henry Schein offered and paid remuneration to customers that are members of its Henry Schein Medical Privileges Program in the form of points redeemable for products and services, which do not qualify as "discounts" or "rebates" under the anti-kickback statute.
10-04-2013
The president/CEO of two urine drug testing facilities, agreed to be excluded from participating in Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the president/CEO knowingly submitted or caused to be submitted claims for urine drug testing that lacked an appropriate physician order, were medically unnecessary, and were fraudulently coded and for providing services that were reimbursable by Medicare in violation of the president/CEO's previous exclusion. OIG further alleged that the president/CEO knowingly submitted or caused to be submitted to Medicare: (1) claims for payment under a provider number that was obtained by knowingly submitting false information to the State of Michigan and the Medicare Administrative Contractor for the State of Michigan; (2) claims for payment for urine diagnostic tests that were not ordered by a physician; (3) separate claims for payment for urine diagnostic tests under separate CPT codes when only one CPT was allowed; and (4) claims for payment that were coded to circumvent computer edits in order to fraudulently increase payments from Medicare for services that were not ordered or provided.
10-02-2013
A physician agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician unbundled injections to the origin/insertion site of a tendon in a single office visit under CPT code 20551, when Medicare and Medicaid laws and regulations require such injections to be bundled and billed as a single claim under CPT code 20553.
09-19-2013
Anchor Safe Healthcare, Inc. (Anchor Safe), Texas, agreed to pay $47,324 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Anchor Safe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-06-2013
Catherine Odo Ekereuke, d/b/a Bukate Medical Supplier (Bukate), Arizona, agreed to pay $29,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bukate submitted or caused to be submitted claims to Medicare for power mobility devices and other durable medical equipment that Bukate failed to provide to beneficiaries.
09-03-2013
Northeast Georgia Medical Center (Northeast), Georgia, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Northeast refused to accept an appropriate transfer of a patient who required Northeast's specialized capabilities.
08-28-2013
Texas Doctor and Medical Practice Enters Settlement Agreement with OIG on Kickback Allegations
Dr. Victor Van Phan - a Houston, TX orthopedist, and his orthopedic practice Victor Van Phan, D.O., P.A. - entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective August 28, 2013. The $188,000 settlement resolves allegations that Dr. Van Phan and his practice received remuneration from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation from personal services agreements and employment compensation for Dr. Phan to serve as a Medical Director for Fairmont. OIG alleged that these financial arrangements took into account the value and volume of referrals made to Fairmont by Dr. Van Phan and his practice. Senior Counsels Kristen Schwendinger and Robert M. Penezic represented OIG.
08-15-2013
The Finley Hospital (Finley), Iowa, agreed to pay $30,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Finley violated the requirements of the patient dumping statute when it delayed the provision of stabilizing treatment to a patient when it transferred him to another facility based in part upon his status as an IowaCare patient.
08-12-2013
Radius Specialty Hospital LLC (Radius), Massachusetts, agreed to pay $333,647.25 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Radius employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-07-2013
Two ambulance company owners agreed to be excluded from participating in Federal health care programs for ten years under 42 U.S.C. § 1320a-7(b)(7) and 42 U.S.C. § 1320a-7(b)(16). OIG alleged that the ambulance company owners (1) knowingly made or caused to be made false statements, omissions, and misrepresentations of material fact on an application to enroll as a provider of services or supplier in the Medicare program; (2) knowingly made or caused to be made false statements, omissions, and misrepresentations of a material fact in a bid to contract with a provider to furnish ambulance services and to submit claims for payment for ambulance services furnished under a Federal health care program; and (3) knowingly made or caused to be made or used a false record or statement material to a false or fraudulent claim for payment for items and services furnished under a Federal health care program.
St. Luke's Hospital (St. Luke's), Iowa, agreed to pay $25,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that St. Luke's violated the requirements of the patient dumping statute when it failed to provide an appropriate medical screening examination by transferring the patient to another facility based in part upon his status as an IowaCare patient.
07-26-2013
Bravo Health Pennsylvania, Inc. (Bravo), Pennsylvania, agreed to pay $225,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bravo provided medical records to the OIG's Office of Audit Services (OAS) in connection with an OAS audit that were intentionally altered prior to their submission or resubmission.
An employee of a durable medical equipment (DME) company agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the DME company employee caused unsolicited telephone calls to be made to Medicare beneficiaries to obtain orders for the furnishing of DME. The DME company later submitted claims to Medicare for DME allegedly provided to beneficiaries who had received the unsolicited telephone calls. OIG contends that the DME company employee knew or should have known that they were causing the submission of false or fraudulent claims because the orders for the DME were based on telephone solicitations prohibited by the Social Security Act's DME Telemarketing Provisions. OIG also contends that the DME company employee offered or paid remuneration in the form of monetary payments to telemarketing companies for the referral of individuals for the provision of DME that would be paid for by Medicare. OIG contends that the DME company employee's offering and paying for remuneration described above violated the Federal Anti-Kickback Statute.
A telemarketing company and its owner agreed to pay $347,000 for allegedly violating the Civil Monetary Penalties Law and provisions of the Civil Monetary Penalties Law applicable to physician self-referrals and kickbacks. The telemarketing company and its owner also agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the telemarketing company, in connection with their contract with a durable medical equipment (DME) company, made unsolicited telephone calls to Medicare beneficiaries to obtain orders for the furnishing of DME that Medicare would pay for. OIG alleged that the DME company in turn used the information to submit claims to Medicare for DME allegedly provided to beneficiaries. OIG contends that the telemarketing company knew or should have known that they were causing the submission of false or fraudulent claims because they obtained the orders for the DME through telephone solicitations prohibited by the Social Security Act's DME Telemarketing Provisions. OIG also contends that the telemarketing company solicited or received remuneration in the form of monetary payments in return for referring individuals for the provision of DME that would be paid for by Medicare.
07-24-2013
Mahaska Health Partnership (Mahaska), Iowa, agreed to pay $20,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Mahaska failed to provide appropriate medical screening, stabilizing treatment, or an appropriate transfer for an individual who presented to Mahaska with a serious emergency medical condition.
07-19-2013
In connection with the resolution of False Claims Act liability, the owner of a lymphedema wound center agreed to be excluded from participating in Federal health care programs for ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the owner of the lymphedema wound center submitted claims to Medicare: (1) for physical therapy treatments that were performed by therapists who were not qualified to perform those treatments; (2) for physical therapy treatments in excess of the Medicare caps and limitations on the number of physical therapy treatments; (3) that violated the rules for "bundling" strapping/bandaging services with physical therapy treatments; and (4) for prescribing pneumatic compression pumps for Medicare beneficiaries when those pumps were not medically necessary.
07-15-2013
East Texas Medical Center Carthage (ETMC Carthage), Texas, agreed to pay $20,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that ETMC Carthage violated the requirements of the patient dumping statute when it failed to provide an adequate medical screening examination to a patient who was 24 weeks pregnant. The patient presented to ETMC Carthage with complaints of uterine contractions and abdominal pain. The patient was told to seek care in Henderson Texas because ETMC Carthage did not have obstetrical (OB) service and did not have an OB doctor on staff. The patient then left ETMC Carthage by private vehicle.
07-01-2013
Mercy Hospital of Franciscan Sisters (Mercy), Iowa, agreed to pay $20,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Mercy violated the requirements of the patient dumping statute when it failed to provide an adequate medical screening examination, stabilizing treatment, or an appropriate transfer for a patient who presented to Mercy's emergency department after ingesting window de-icer, a product containing the toxin methanol.
06-28-2013
In connection with the resolution of False Claims Act liability, an oncology medical group practice agreed to be excluded from participating in Federal health care programs for ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the oncology medical group practice purchased drugs from a foreign drug distributor in Canada that obtained the drugs from foreign sources. OIG alleged that these drugs, sometimes with labeling in foreign languages or without dosage information, were not manufactured in establishments that were registered with the United States Food and Drug Administration (FDA). OIG alleged that the versions of the drugs that the oncology medical group practice purchased were not the subject of, and did not comply with, a new drug application, abbreviated new drug application, or biologics license application approved by the FDA for commercial marketing and, therefore, the drugs were not covered by Federal health care programs because the drugs had not received final marketing approval from the FDA.
06-21-2013
In connection with the resolution of False Claims Act liability, a physical rehabilitation and pain management clinic (clinic) agreed to be excluded from participating in Federal health care programs for twenty years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the clinic: (1) submitted claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care services that were referred to companies that were owned or operated by the clinic's owner in exchange for illegal remuneration and/or kickbacks and (2) submitted claims to Medicare and Medicaid using medical billing codes that reflected more complex and expensive services than the services that were actually rendered to patients.
06-19-2013
In connection with the resolution of False Claims Act liability, an oncologist and hematologist agreed to be excluded from participating in Federal health care programs for fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the oncologist and hematologist knowingly submitted false and/or fraudulent claims to Federal health care programs for: (1) quantities of drugs greater than those actually administered to patients; (2) overstating chemotherapy drug infusion times; and (3) double-billing for medications.
In connection with the resolution of False Claims Act liability, an allergist and the allergy clinic he owned agreed to be excluded from participating in Federal health care programs for a period of twenty years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the allergist through his allergy clinic submitted false claims related to Healthcare Common Procedure Codes 95004, 05165 and 99214 including: misrepresentation of services and diagnoses, overutilization of procedures, billing for unapproved hormone therapy treatments, billing for services that were not medically necessary, billing for services not rendered, and misrepresenting the provider who rendered treatment.
06-13-2013
A former pharmaceutical sales representative and sales manager for Sanofi, agreed to be excluded from participating in Federal health care programs for five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the sales representative provided samples of the viscosupplement Hyalgan to physicians with the expectation that the physicians would bill Medicare for the samples. OIG further alleged that the sales representative provided an agreed number of samples with each order of a specified size, that these off-the-books discounts constituted remuneration under the Anti-Kickback statute (42 U.S.C. § 1320a-7b(b)(2)), and that these alleged kickbacks were provided for the purpose of assuring the physicians' continued use of the product.
05-29-2013
OIG Issues Cease and Desist Letter to MedicareWire.com
On May 29, 2013, OIG notified MedicareWire.com (MedicareWire) that MedicareWire was potentially in violation of section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and Departmental emblems. Specifically, MedicareWire inappropriately, and without authorization, used words and symbols belonging to the United States Department of Health and Human Services, and used other misleading language on MedicareWire's "Medicare" webpage located at http://medicarenursing.com (may or may not be functional). Before OIG initiated litigation, MedicareWire agreed to: (1) remove the inappropriate words and symbols from its website; (2) add header and footer disclaimers to its website; and (3) refrain from using any words or names in reference to Social Security or Medicare in a manner that might convey the false impression that MedicareWire or its programs and services are approved, endorsed, connected to or authorized by Medicare, Medicaid, Social Security or the United States Department of Health and Human Services.
05-22-2013
Trustees of Tufts College and Tufts University School of Dental Medicine (TUSDM), Massachusetts, agreed to pay $841,120.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that TUSDM submitted claims to Medicare for various services from four of their clinics. The OIG contends that these claims were improper because the services were provided by dentists who were not credentialed by Medicare and/or the services or the code level billed were not supported by sufficient medical record documentation.
05-21-2013
Carolyn Murray-Burton, M.D. (Murray), New Jersey, agreed to pay $136,777.59 for allegedly violating the Civil Monetary Penalties Law. The OIG contends that Murray caused her employer to submit claims for reimbursement to Medicaid and Medicaid HMOs for items and services furnished by her while she did not possess a valid medical license.
05-17-2013
Dr. Matthew James Britton and C.F. Health Management, Inc. d/b/a Gainesville Pain Management (Gainesville), Georgia, agreed to pay $1,577,597 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Gainesville submitted false or fraudulent claims: 1) by inappropriately using Modifiers 76 and 59, to submit claims for payment for multiple units of Healthcare Common Procedure Coding System (HCPCS) codes G0431 and G0434 when only a single unit may be billed per patient encounter; and 2) by inappropriately using Modifier QW and billing for HCPCS G0431 when the less expensive services represented by HCPCS code G0434 were actually provided.
05-02-2013
Visiting Nurse Association (VNA), Johnson County, Iowa, agreed to pay $33,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that VNA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-26-2013
Evergreen Oregon Healthcare Salem, LLC (Evergreen), Oregon, agreed to pay $19,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Evergreen employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Emory University Hospital (Emory), Georgia, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Emory refused to accept appropriate transfer of a patient who required Emory's specialized capabilities.
04-08-2013
Sergey Lugina and Executive Medical Care, P.C., (EMC), New York, agreed to pay $74,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that EMC submitted or caused to be submitted claims for medical services that were not provided as claimed and/or were false or fraudulent. The OIG alleges that these services were not provided as claimed because Sergey Lugina was on travel outside the United States during the periods when he claimed that he rendered services to beneficiaries.
04-04-2013
Donalsonville Hospital, Inc. (Donalsonville), Georgia, agreed to pay $25,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Donalsonville failed to provide an adequate medical screening examination to a patient who presented to their emergency department complaining of shortness of breath and chest pain. The patient did not receive any medical examination from a physician and was told he was required to pay a minimum fee of $100 to continue further treatment. The patient chose not to pay the fee and was discharged without receiving an appropriate medical screening examination. The delay in the provision of an appropriate medical screening examination and the imposition of a minimum fee to receive an appropriate medical screening examination were inappropriate.
04-03-2013
Paul Lux, M.D., Missouri, agreed to pay $63,900 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Dr. Lux received remuneration from a medical device manufacturer in the form of payments made under a clinical registry contract.
03-07-2013
OIG Issues Cease and Desist Letter to Policy Issues Institute
On March 7, 2013, OIG notified Policy Issues Institute (PII) that PII's unauthorized and inappropriate use of the word "Medicare" in its "Emergency Committee to Save Medicare" mailings was potentially in violation of section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and Departmental emblems. Before OIG initiated litigation, PII agreed to: (1) discontinue sending the "Emergency Committee to Save Medicare" mailing; and (2) refrain from using any words or names in reference to Social Security or Medicare in a manner that might convey the false impression that PII or its programs and services are approved, endorsed, connected to or authorized by Medicare, Medicaid, Social Security or the United States Department of Health and Human Services.
OIG issues Cease and Desist Letter to The National Center for Public Policy Research
On March 7, 2013, OIG notified The National Center for Public Policy Research (NCPPR) that NCPPR was potentially in violation of section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and Departmental emblems. Specifically, NCPPR inappropriately, and without authorization, used the words "Medicare", "Medicaid", "Social Security", and "Health and Human Services" and other misleading language in its Health Care Reform Task Force mailings to Medicare beneficiaries. Before OIG initiated litigation, NCPPR agreed to: (1) cease mailing the Health Care Reform Task Force letter; and (2) refrain from using any words or names in reference to Social Security or Medicare in a manner that might convey the false impression that NCPPR or its programs and services are approved, endorsed, connected to or authorized by Medicare, Medicaid, Social Security or the United States Department of Health and Human Services.
03-07-2013
In connection with the resolution of False Claims Act liability, a pharmacy owner agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the pharmacy owner submitted claims for payment for drugs that were never dispensed.
02-25-2013
Edward Desser (Desser), a Florida resident, agreed to pay OIG $120,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that Desser owned and operated International Orthopedic Solutions (IOS), an orthopedic medical device distributorship that sold Ortho Development Corporation products, and ECM Solutions, LLC (ECM), a medical consulting/business development company. OIG alleged that Desser, by and through ECM, received remuneration from for the purpose of recommending the ordering of Zimmer, Inc. (Zimmer), orthopedic products by a Florida-based physician. OIG also alleged that Desser paid remuneration to two individuals to induce them to recommend the purchasing of medical devices by Florida orthopedic surgeons. OIG contends that Desser knowingly and willfully solicited and received the remuneration described above to induce a person(s) to order Zimmer orthopedic products for which payment was made by Federal health care programs. OIG also contends that Desser knowingly and willfully offered and paid remuneration to two individuals to induce them to recommend the ordering of orthopedic products for which payment may have been made by Federal health care programs.
02-22-2013
Sacred Heart Hospital (SHH), IL, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that SHH failed to provide a medical screening examination for a 63-year old woman who presented to the emergency department and was not breathing. SHH provided no screening and called the Chicago Fire Department who transferred her to another hospital where she was pronounced dead.
02-11-2013
In connection with the resolution of False Claims Act liability, a dermatologist agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the dermatologist performed medically unnecessary adjacent tissue transfers on Medicare beneficiaries and billed Medicare for evaluation and management services that were not performed.
01-28-2013
Holmes Regional Medical Center (HRMC), FL, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that HRMC failed to provide a medical screening examination and to adequately stabilize a 30-year old pregnant woman who presented to their emergency department experiencing chest pains, in potential cardiac arrest, and became unresponsive. Both the patient and her baby died.
01-09-2013
Heritage Medical Partners, LLC, Thomas Lenns, M.D., Paul Long, M.D., Michael Mayes, M.D., and William Petty II, M.D. (collectively Heritage), South Carolina, agreed to pay $170,260 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Heritage knowingly presented or caused to be presented to Medicare beneficiaries requests for payment that were in violation of an assignment agreement.

2012

12-21-2012
In connection with the resolution of False Claims Act liability, a physician agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician submitted claims to Medicare and Medicaid for a more comprehensive and complex evaluation and management service than he actually provided.
11-14-2012
In connection with the resolution of False Claims Act liability, a diagnostic testing facility agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the diagnostic testing facility: (1) paid remuneration to physicians in connection with the referral of Medicare patients to the diagnostic testing facility for diagnostics tests; (2) submitted provider enrollment documents that were false or contained material omissions; and (3) submitted or caused to be submitted claims for payment for diagnostic tests requiring that a qualified physician be present in the office suite in order for the tests to be payable by Medicare that either were not supervised, or were supervised by physicians who did not have the requisite qualifications to supervise the tests and/or had not been approved by Medicare.
11-13-2012
University of Chicago Medical Center (UCMC), IL, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that UCMC failed to provide appropriate medical screening and stabilizing treatment within its capabilities to a male patient who presented to their emergency department complaining of severe jaw pain as a result of a physical assault. The results of a CT scan taken by UCMC revealed injuries that needed corrective surgery. UCMC did not provide further treatment and discharged the patient with instructions to go to another hospital for further care.
Safeway, Inc., Wyoming, agreed to pay $56,994 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Safeway, Inc. submitted claims to Medicare Part D for the branded drug Protonix when it dispensed the authorized Protonix generic drug known as pantoprazole.
11-02-2012
ForTec Medical, Inc., ForTec Litho, LLC, ForTec Litho Florida, LLC, ForTec Litho Central, LLC, and ForTec Litho NY, LLC (collectively, ForTec), Illinois, agreed to pay $126,249.30 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that ForTec provided customers (including physicians) an all-expense paid trip to the Masters Golf Tournament. The OIG concluded that the trips were intended to induce referrals.
10-19-2012
Hackley Hospital (Hackley), Michigan, agreed to pay $90,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Hackley failed to provide stabilizing treatment within its capabilities to a woman in labor and her unborn child prior to transferring her to another hospital for treatment.
10-17-2012
In connection with the resolution of False Claims Act liability, a chiropractic medical group and its four owners agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the chiropractic medical group and its four owners knowingly submitted claims to Medicare for multiple units of therapeutic activities (CPT Code 95730) for treatment sessions that did not reflect the actual time that patients were treated.
10-09-2012
Southcoast Hospital Group (Southcoast), Massachusetts, agreed to pay $45,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Southcoast failed to provide stabilizing treatment prior to transferring a patient that presented to its emergency department experiencing labored breathing.
09-05-2012
Duke University Health System d/b/a Duke University Hospital (Duke), North Carolina, agreed to pay $180,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Duke failed to accept five appropriate transfers of individuals with unstable psychiatric emergency medical conditions.
07-25-2012
Stephan P. Babirak, Ph.D. M.D. (Babirak) and Metabolic Leader, LLC, PA (Metabolic Leader), Maine, agreed to pay $17,087.58 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Babirak and his medical practice, Metabolic Leader, improperly billed Medicare for: (1) new patient Evaluation & Management (E&M) office visits for pre-existing patients; (2) upcoded E&M office visits; and (3) services provided by nurse practitioners that were billed under Babirak's provider number when he was not in the office.
07-23-2012
In connection with the resolution of False Claims Act liability, the owner of a diagnostic testing facility agreed to be excluded from participating in Federal health care programs for a period of four years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the diagnostic testing facility owner: (1) paid remuneration to physicians in connection with the referral of Medicare patients for diagnostic tests; (2) submitted provider enrollment documents that were false or contained material omissions; and (3) submitted or caused to be submitted claims for payment for diagnostic tests requiring that a qualified physician be present in the office suite in order for the tests to be payable by Medicare that either were not supervised, or were supervised by physicians who did not have the requisite qualifications to supervise the tests and/or had not been approved by Medicare.
07-16-2012
In connection with the resolution of False Claims Act liability, a radiologist and a diagnostic testing facility agreed to be excluded from participating in Federal health care programs for a period of six years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the radiologist, through the diagnostic testing facility, entered into prohibited financial relationships with physicians. Specifically, OIG alleged that these prohibited financial relationships included: (1) sham personal services contracts (Medical Directorships) that took into account the value of referrals from the Medical Directors; and (2) contracts to pay the salaries of employees in physicians' offices that took into account the value of referrals from those physicians.
07-11-2012
Dr. Jorge Zamora-Quezada, Texas, agreed to pay $83,481.22 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Jorge Zamora-Quezada employed an individual that he knew or should have known was excluded from participation in Federal health care programs.
06-27-2012
Cooperative Home Care (Cooperative), Missouri, agreed to pay $121,010 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Cooperative employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-19-2012
In connection with the resolution of False Claims Act liability, a physician agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician submitted or caused to be submitted claims to Medicaid: (1) by issuing prescriptions for Tramadol to patients that were without legitimate medical purpose or not in the usual course of professional treatment; and (2) for office visits with patients that were for services that were not medically necessary and/or not adequately supported by medical record documentation.
Hy-Vee, Inc., Iowa, agreed to pay $831,871.61 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Hy-Vee, Inc. employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-15-2012
Hendricks Community Hospital (Hendricks), Minnesota, agreed to pay $20,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Hendricks failed to provide a medical screening examination and stabilization treatment to a patient that presented to its emergency department. The patient previously had surgery at another hospital and was in serious pain, could not urinate, and needed a catheter placement. An emergency department physician instructed hospital staff to tell the patient he would need to seek treatment at the hospital where his surgery was performed. Hendricks provided no screening or treatment for the patient, even though the patient's pain level was such that it was difficult for him to ambulate.
06-07-2012
Jennings Healthcare Center (Jennings), Indiana, agreed to pay $81,704.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Jennings employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-06-2012
On With Life, Iowa, agreed to pay $77,586 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that On With Life employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-05-2012
The owner of a company that supplies durable medical equipment (DME) agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the DME supply company owner knowingly submitted or caused to be submitted false or fraudulent claims to the Medicare program. Specifically, OIG alleged that the DME supply company owner: (1) billed for an item of durable medical equipment that was never provided to the beneficiary; (2) billed for 13 motorized wheelchairs when less expensive power scooters were actually provided to beneficiaries; and (3) billed for items of durable medical equipment before the items were actually provided to the beneficiaries.
05-31-2012
Texas County Memorial Hospital (TCMH), Texas, agreed to pay $20,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that TCMH failed to provide an adequate medical screening examination for a minor. Specifically, the minor presented to TCMH's emergency department (ED) and was accompanied by a family member. TCMH's registration clerk informed the family member that the minor should be treated by her family physician rather than be admitted to TCMH's ED. The minor left TCMH without receiving a medical screen.
05-25-2012
In connection with the resolution of False Claims Act liability, the owner of a company that supplies durable medical equipment (DME) agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the DME supply company owner knowingly submitted or caused to be submitted claims when he was not approved by Medicare and was ineligible to receive Medicare and TRICARE reimbursements.
In connection with the resolution of False Claims Act liability, two co-owners of a hospice agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the hospice co-owners submitted claims for payment to Medicare for some patients who were either completely or partially hospice ineligible or were provided a higher level of hospice care than was necessary or allowable.
05-09-2012
Halls Physicians Services (HPS), Tennessee, agreed to pay $51,972.20 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HPS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-27-2012
Bloomington Podiatry Center (BPC), Indiana, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BPC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-16-2012
Baypointe Nursing Home, Inc. d/b/a Baypointe Rehabilitation & Skilled Care Center (Baypointe), Massachusetts, agreed to pay $351,255.44 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Baypointe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-02-2012
The manager of a medical group practice agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the medical group practice manager caused the submission of claims to Medicare for medically unnecessary diagnostic tests that were not ordered by a physician.
03-20-2012
Ronald V. Myers, Sr., M.D. (Myers), Mississippi, agreed to pay $25,500 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Myers caused improper claims to be submitted to Medicare from Select Care, Inc. and Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Myers did not personally render or did not directly supervise.
03-07-2012
Northside Hospital (Northside), Florida, agreed to pay $38,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Northside failed to provide an appropriate medical screening examination and stabilizing treatment to a patient with a history of mitral valve replacement. Specifically, the patient presented to Northside's emergency department (ED) by ambulance with flu symptoms and a high fever. A triage nurse instructed the patient to go home and to follow his primary care physician's orders. Two days later the patient presented again to Northside's ED and was admitted to their intensive care unit. On August 8, 2009, the patient died due to influenza A (H1N1).
03-01-2012
In connection with the resolution of False Claims Act liability, a physician agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician improperly billed Medicare for medically unnecessary pain injections that were administered by an unlicensed medical assistant. As part of the False Claims Act settlement, the physician admitted that he allowed his unlicensed medical assistant to administer at least 80% of the pain injections.
02-20-2012
In connection with the resolution of False Claims Act liability, the marketing director of a mobile ultrasound company agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the mobile ultrasound company marketing director knowingly caused the submission of false claims for ultrasound services that were never ordered or performed.
02-10-2012
Fort Lauderdale Hospital, Inc. (FLH), Florida, agreed to pay $45,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that FLH failed to provide an appropriate medical screening examination and stabilizing treatment to an autistic patient that presented to FLH's emergency department after physically attacking his mother. A clinical psychologist asked for the patient's insurance information. FLH did not accept the patient's insurance and the patient's mother was instructed to take the patient to another facility. The patient was seen at another facility and admitted for six days due to a diagnosis of depression.
01-25-2012
A radiation oncologist agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the radiation oncologist knowingly submitted or caused the submission of false or fraudulent claims to Medicare, under various CPT codes, by: (1) excessively billing; (2) lacking documentation justifying the level of services billed; (3) billing for professional components of tests when only technical components were provided; and (4) billing under more complex CPT codes when less complex procedures were actually performed.
01-19-2012
LP Lexington Pimlico, LLC d/b/a Bluegrass Care and Rehabilitation Center (Bluegrass), Kentucky, agreed to pay $11,994.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bluegrass employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-17-2012
Buchanan County Health Center (BCHC), Iowa, agreed to pay $406,030 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BCHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-06-2012
Nathaniel Brown, M.D. (Brown), Mississippi, agreed to pay $108,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Brown caused improper claims to be submitted to Medicare from Mississippi Care Partners, Inc., for physical therapy and related health care items or services that Brown did not personally render or did not directly supervise.

2011

12-22-2011
Princeton Baptist Medical Center (PBMC), Alabama, agreed to pay $170,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that PBMC failed to provide care, within its capabilities, to four individuals who were suffering from emergency medical conditions. Three of the individuals presented to PBMC's emergency department with intracranial hemorrhages and one of the individuals presented with multiple fractures of the spinal column.
The owner of a pain clinic agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the pain clinic owner improperly billed or caused to be billed claims using CPT Code 97032 rather than G0329 for the provision of Microvas treatment. OIG alleged that Microvas and other electrical stimulation/electromagnetic therapy (ES/ET) devices are only covered for treatment of chronic Stage III or Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that have not healed within 30 days after occurrence following appropriate standard wound therapy. OIG alleged that Medicare was billed for treatment of patients with neuropathy, rather than with ulcer/wound conditions contained in the National Coverage Determination. Further, OIG alleged that ES/ET is covered by Medicare, if performed by a physician, physical therapist, or incident to a physician service. OIG alleged that many of the Microvas procedures billed to Medicare were performed by the pain clinic owner or other unlicensed office staff.
12-20-2011
Matthew Pearson, M.D., Tennessee, agreed to pay $35,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Dr. Pearson, while on call at Vanderbilt University Medical Center (Vanderbilt), refused to accept an appropriate transfer of an individual with an unstable emergency medical condition who required the specialized capabilities that were available at Vanderbilt. The patient was transferred to another facility and died shortly thereafter.
Vanderbilt University Medical Center (Vanderbilt), Tennessee, agreed to pay $45,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Vanderbilt refused to accept an appropriate transfer of an individual with an unstable emergency medical condition who required the specialized capabilities that were available at Vanderbilt. The patient was transferred to another facility and died shortly thereafter.
12-19-2011
An Alabama non-profit organization agreed to pay $25,000 to resolve its liability for violating the select agent regulations by failing to comply with authorized transferred requirements as it pertained to receiving an international shipment of select agents without prior Center for Disease Control authorization.
12-16-2011
Sandoz, Inc., New Jersey, agreed to pay $230,000 to resolve Civil Monetary Penalties liability under the Medicaid Drug Rebate Program. Sandoz, Inc. failed to timely submit required drug pricing information.
11-15-2011
Schoolcraft Memorial Hospital (SMH), Michigan, agreed to pay $20,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that SMH failed to provide stabilizing treatment to a 15-year-old male who came to SMH's emergency department (ED) for examination and treatment of psychiatric and medical emergencies. The patient presented to SMH's ED after a suicide attempt. The medical screening examination revealed that the patient was suffering from hypotension and abnormal heart rhythm. SMH provided the patient with a psychological assessment and intravenous fluids but did not provide further medical treatment needed to stabilize the patient's medical condition. SMH transferred the patient to a psychiatric facility 169 miles away without stabilizing the patient's vital signs. Forty minutes into the transfer, the patient began experiencing hypotensive episodes.
11-12-2011
In connection with the resolution of False Claims Act liability, an individual who was the owner, president and CEO of an intra-operative neurophysiology testing service agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the individual submitted, or caused to be submitted, claims to Medicare for intraoperative neurophysiology testing services, billed pursuant to CPT code 99920, that contained an excessive number of units/hours and/or were provided by the same monitoring physician to multiple patients simultaneously, contrary to the relevant Medicare policy.
11-01-2011
Phillip L. Barnes, D.O. (Barnes), Mississippi, agreed to pay $49,419 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Barnes caused improper claims to be submitted to Medicare from Select Care, Inc. and Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Barnes did not personally render or did not directly supervise.
Reginald W. Stewart, (Stewart), Mississippi, agreed to pay $88,810 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Stewart caused improper claims to be submitted to Medicare from Mississippi Care Partners, Inc. and Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Stewart did not personally render or did not directly supervise.
10-12-2011
In connection with the resolution of False Claims Act liability, a physician agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician caused the submission of claims to Medicare and Medicaid for his office visits that were false or fraudulent because they did not accurately reflect the level of professional service that he provided to the beneficiaries.
10-04-2011
Piedmont Hospital (Piedmont), Georgia, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Piedmont failed to provide an appropriate medical screening examination and stabilizing treatment to a patient that presented with an emergency medical condition. Specifically, the patient presented to Piedmont after being diagnosed with a deep vein thrombosis (DVT) by her private physician. The patient made repeated requests for treatment for eight hours without success. The patient left Piedmont and presented to another hospital where she was diagnosed and treated for a pulmonary embolus in addition to the DVT.
10-03-2011
Springhill Medical Center (SMC), Alabama, agreed to pay $45,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that SMC failed to accept an appropriate transfer of a patient with acute upper gastrointestinal bleeding. The patient was accepted by another hospital approximately 100 miles away and expired the next day.
In connection with the resolution of False Claims Act liability, the chief operating officer (COO) of an ambulance company agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the ambulance company COO caused to be submitted for payment claims falsely representing to Medicare and Medicaid that Advanced Life Support (ALS) services were appropriate and furnished by ambulance personnel when in fact no ALS-service was rendered and/or the patient did not require an ALS transport.
09-15-2011
Jenq-Sheng Liu, Jenq-Sheng Liu, M.D., P.S.C. d/b/a Blue Grass Women's Clinic, and Su-Mei Liu, (defendants), Kentucky, agreed to pay $58,952.57 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the defendants fraudulently billed Medicaid for six different Current Procedural Terminology codes. Su-Mei Liu agreed to a five-year period of exclusion from all Federal health care programs.
In connection with the resolution of False Claims Act liability, the biller for a clinic specializing in obstetrics and gynecology (OB/GYN) agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the biller for the OB/GYN clinic unbundled services or billed for different services than actually provided.
08-31-2011
Beatrice Community Hospital and Health Center (Beatrice), Nebraska, agreed to pay $30,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Beatrice failed to provide an appropriate medical screening examination and stabilizing treatment to two patients that presented with emergency medical conditions. Specifically, a patient presented to Beatrice complaining of discomfort after removing a feeding tube. The patient was not appropriately screened or stabilized before discharge. Another patient presented complaining of a loss of consciousness and difficulty moving his extremities after falling and hitting his head. The patient was not appropriately screened or stabilized before discharge. The patient later received treatment at another hospital but died as a result of his injury.
08-29-2011
Jewish Hospital & St. Mary's HealthCare (Jewish Hospital), Kentucky, agreed to pay $42,500 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Jewish Hospital failed to provide a medical screening examination or stabilizing treatment to a patient that presented to two of its emergency departments (ED). The patient was suffering from a wrist laceration with arterial bleeding. Emergency Medical Services (EMS) transported the patient to two of Jewish Hospital's ED's that are located on the same property. Both ED's instructed the EMS to transport the patient to another hospital.
Mainstream Living, Inc. (Mainstream), Iowa, agreed to pay $132,925.49 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mainstream employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-23-2011
Savient Pharmaceuticals, Inc. (Savient), New Jersey, agreed to pay $100,000 to resolve Civil Monetary Penalties liability under the Medicaid Drug Rebate Program. Savient failed to timely submit required drug pricing information.
Savient Pharmaceuticals, Inc. (Savient), New Jersey, agreed to pay $100,000 to resolve Civil Monetary Penalties liability under the Medicaid Drug Rebate Program. Savient failed to submit pricing information and to pay a rebate to state Medicaid programs for covered drugs that the state Medicaid programs reimburse.
08-17-2011
Santa Clara Valley Medical Center (Santa Clara), California, agreed to pay $48,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Santa Clara failed to provide a medical screening examination or stabilizing treatment to a patient that presented to its emergency department (ED) after receiving a referral from a nearby urgent care facility which diagnosed him with severe abnormal hemoglobin results. It was suspected that the patient had some sort of internal bleeding. Upon arrival to Santa Clara's ED, the patient showed a nurse the referral papers and complained of dizziness, blurred vision, and fatigue. The patient was categorized as non-emergent and waited in the waiting room for seven hours. The patient expired in the ED.
07-18-2011
In connection with the resolution of False Claims Act liability, a medical group practice agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that a physician at the medical group practice represented in patient medical records and reimbursement claims to Medicare and Medicaid that he examined and evaluated numerous patients using CPT Code 99214, although the requirements set forth in CPT Code 99214 were not met. OIG also alleged that the physician did not write prescriptions that authorized routine refills, which resulted in unnecessary and or upcoded office visits.
07-08-2011
Dallas County Hospital District d/b/a Parkland Health and Hospital System (Parkland), California, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Parkland failed to provide an appropriate medical screening examination to a patient that presented with an emergency medical condition. Specifically, Parkland failed to provide a physician ordered EKG or intravenous monitoring to a 58-year old cardiac diabetic patient. The patient expired of a heart attack.
06-29-2011
A California registered entity entered into a settlement for $50,000 to resolve its liability under the Public Health Security and Bioterrorism Preparedness and Response Act, 42 U.S.C. § 262a, and 42 C.F.R. § 73.21, which authorizes a civil monetary penalty for violations of the select agent regulations, 42 C.F.R. Part 73. The alleged violations related to the entity's possession, use, or transfer of a regulated toxin without a valid certificate of registration; receipt of a regulated toxin without prior approval; unauthorized access to a regulated toxin; and failure to have an inventory system that accurately accounted for the regulated toxin inventory.
06-24-2011
An anesthesiologist agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the anesthesiologist billed for a consultation every time he performed a catheterization for another physician and that the consultations were not ordered by the other physician, as required by Medicare, or performed by the anesthesiologist.
06-23-2011
In connection with the resolution of False Claims Act liability, a psychotherapy practice and its two owners, a social worker and a psychologist, agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the psychotherapy practice and its two owners submitted claims for payment to Medicare for social worker consultation services that were falsely represented to have taken place face to face.
06-21-2011
Daniel Herrington, the owner of One Source Medical Services a durable medical equipment (DME) company, Florida, agreed to pay $124,141.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Herrington, through the DME company, billed Medicare for custom molded diabetic shoe inserts when in fact only prefabricated inserts were provided to beneficiaries.
05-31-2011
In connection with the resolution of False Claims Act liability, a physician and his practice agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician and his practice submitted, or caused to be submitted, improper claims to Medicare and Medicaid for: (1) nursing facility care services allegedly performed on patients located in nursing homes when, in fact, those patients were not present in the nursing homes but were instead hospital inpatients; and (2) hospital care services in which the medical note in the patient's chart reflected that the services in question were performed by hospital residents or Advanced Practice Registered Nurses, and the physician merely countersigned the note and did not include his own note to reflect any services he allegedly performed as the attending physician.
05-12-2011
Beth Israel Deaconess Medical Center in Boston, Massachusetts (BIDMC) agreed to pay $233,932.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BIDMC improperly billed Medicare for Lupron drug injections to male patients under HCPCS Code J1950 when BIDMC should have known that the proper code for these claims was the lower reimbursed HCPC Code J9217.
05-12-2011
Beth Israel Deaconess Hospital in Needham, Massachusetts (BIDH-N) agreed to pay $59,701.60 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BIDH-N improperly billed Medicare for Lupron drug injections to male patients under HCPCS Code J1950 when BIDH-N should have known that the proper code for these claims was the lower reimbursed HCPCS Code J9217.
04-29-2011
Gary Sinopoli, Jr., M.D. (Sinopoli), Mississippi, agreed to pay $133,333.16 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Sinopoli caused improper claims to be submitted to Medicare from Progressive Physical Medicine, Inc., for physical therapy and related health care items or services that Sinopoli did not personally render or did not directly supervise.
03-31-2011
In connection with the resolution of False Claims Act liability, the owner of a company that sold diabetic shoe inserts agreed to be excluded from participating in Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that diabetic shoe insert company owner: (1) sold custom diabetic shoe inserts that were not, in fact, custom as defined by Medicare because they were not created with a unique image of each foot; and (2) sold heat moldable diabetic shoe inserts that did not comply with the Medicare requirements for those inserts and did not conform to the heat moldable diabetic inserts that were submitted to Medicare for coding verification.
03-21-2011
Betty J. Feir, PhD, Texas, agreed to pay $61,270 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Feir submitted claims to Medicare for initial diagnostic services performed by auxiliary personnel instead of her and for services performed by auxiliary personnel while she was not present and did not provide direct supervision.
03-21-2011
Betty J. Feir, PhD, Texas, agreed to pay $61,270 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Feir billed Federal health care programs for services provided by auxiliary personnel instead of her and for services performed by the auxiliary personnel while she was not present.
03-11-2011
Deaconess Hospital (Deaconess), Indiana, agreed to pay $76,592.52 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Deaconess employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-09-2011
Herman T. Palmer, M.D. (Palmer), Mississippi, agreed to pay $29,200 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Palmer caused improper claims to be submitted to Medicare from Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Palmer did not personally render or did not directly supervise.
02-07-2011
Logan Emergency Ambulance Service Authority (Logan), West Virginia, agreed to pay $79,176 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Logan employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2010

12-23-2010
North Fulton Hospital (North Fulton), Georgia, agreed to pay $40,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that North Fulton failed to provide a medical screening examination or stabilizing treatment to a patient that presented to its emergency department (ED). The patient was 30 weeks pregnant and reported with complaints of labor pain to North Fulton's ED upon the advice of her physician.
12-21-2010
Edward D. Henderson, Jr., M.D. (Henderson), Mississippi, agreed to pay $68,100 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Henderson caused improper claims to be submitted to Medicare from Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Henderson did not personally render or did not directly supervise.
Chadley T. Vega, M.D. (Vega), Mississippi, agreed to pay $46,200 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Vega caused improper claims to be submitted to Medicare from Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Vega did not personally render or did not directly supervise.
11-22-2010
Mobile Infirmary (MI), Alabama, agreed to pay $45,000 to resolve its liability for civil monetary penalties under the patient dumping statute. The OIG alleged that MI refused to accept an appropriate transfer to its hospital of a patient in need of specialized capabilities available at MI. The refusal of the transfer request delayed care and treatment for a patient's gastrointestinal bleed. Two hours after the request to MI, the patient was finally transferred to another hospital approximately 60 miles away. En route, the patient's condition deteriorated and the patient had to be transported by helicopter to the receiving hospital. The patient subsequently died that day.
Long Term Care, Inc. (LTC), North Carolina, agreed to pay $170,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that LTC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-16-2010
Houston Northwest Medical Center (HNMC), Texas, agreed to pay $40,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that HNMC failed to provide appropriate medical screening or stabilizing treatment for a pregnant female who came to HNMC's emergency department while having labor contractions.
11-04-2010
November 4, 2010 - Port St. Lucie Hospital (PSLH), Florida, agreed to pay $19,000 to resolve its liability for civil monetary penalties under the patient dumping statute. The OIG alleged that PSLH refused to accept an appropriate transfer to its hospital of a patient in need of specialized capabilities available at PSLH. Specifically, the OIG alleged that PSLH refused to accept the patient based on an erroneous belief that the patient was uninsured. A second transfer request transfer was made the next day and the same nurse at PSLH again denied transfer.
10-21-2010
Steven J. Lancaster, M.D., Florida, agreed to pay $101,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Dr. Lancaster solicited kickbacks from a medical device manufacture. Dr. Lancaster sought to leverage his product usage and ability to influence purchasing decisions in exchange for a consulting agreement with a guaranteed payment. In addition, he sought to obtain a personal service agreement.
10-18-2010
Signature Healthcare, LLC (Signature), California, agreed to pay $104,747.06 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Signature employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-07-2010
Providence Hospital, Alabama, agreed to pay $45,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that Providence refused to accept an appropriate transfer to its hospital of a patient in need of specialized capabilities available at Providence. The patient's condition deteriorated and, as a result, the patient was transported by helicopter to another hospital and died that day.
08-19-2010
Hackley Professional Pharmacy, Inc. (Hackley), Michigan, agreed to pay $158,565.97 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Hackley employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-09-2010
Beechwood Rehabilitation and Nursing Center (BRNC), Connecticut, agreed to pay $42,203 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BRNC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-08-2010
United Shockwave Services, United Urology Centers, and United Prostate Centers (collectively, United), Illinois, agreed to pay $7,359,500 and entered into a five year CIA for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that United and certain physician-investors used their ability to control patient referrals to obtain contract business from various hospitals. Specifically, United threatened hospitals that it would refer patients to competing hospitals if the respective hospital did not agree to a contract with United, or promised hospitals that did contract with United additional referrals. The relationships between United's physician-investors and the hospitals raised Stark concerns regarding the financial relationships between United's physician-investors and the hospitals to which they made referrals. Also, United sold more shares to physicians who produced more referrals or other business for the company. United had processes for having physicians divest if they did not use United's services sufficiently and offered huge returns on investment with virtually no business risk.
06-14-2010
Lake Region Lutheran Home d/b/a Heartland Care Center (Heartland), North Dakota, agreed to pay $133,973.28 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Heartland employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
University of Chicago Medical Center (UCMC), Illinois, agreed to pay $50,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that UCMC failed to provide a medical screening examination or stabilizing treatment to a patient that presented to its emergency department (ED). The liability stems from UCMC failing to log the patient into their system after he presented via ambulance. The patient was left in the waiting area. Approximately three hours later, the patient's daughter approached the triage desk and informed the ED staff that her father still had not been seen. The triage nurse approached the patient and saw that he was non-responsive and had rigor mortis. The ED physician, upon examining the patient, pronounced him dead.
06-03-2010
Cochlear Americas, Colorado, agreed to pay $880,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Cochlear Americas paid various forms of illegal remuneration to physicians who prescribed the use of their manufactured implant system for Medicare and Medicaid patients.
05-25-2010
A South Dakota laboratory agreed to pay $40,000 to resolve its liability for violating the select agent regulations. The OIG alleged that the laboratory allowed several individuals unauthorized access to areas where select agents and toxins were stored and failed to secure a refrigerator and freezer containing select agents and toxins.
05-20-2010
Elder Service Plan of the North Shore (ESPNS) agreed to pay $308,709.00 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ESPNS contracted with a dentist that ESPNS should have known was excluded from participation in Federal health care programs. ESPNS participates in the Program of All-Inclusive Care for the Elderly (PACE), which receives funding from the Medicare and Medicaid programs.
05-11-2010
A Texas university agreed to pay $47,000 to resolve its liability for violating the select agent regulations. OIG alleged that the university allowed several individuals unauthorized access to a laboratory containing select agents or toxins and failed to secure a freezer contain select agents. The university self-disclosed the allegations to CDC, and fully cooperated in the investigation of the matter.
04-27-2010
Olive View UCLA Medical Center (Olive View), California, agreed to pay $25,000 to resolve its liability for Civil Monetary Penalties under the patient dumping statute. The OIG alleged that Olive View's emergency department (ED) did not provide an appropriate medical screening examination (MSE) or stabilizing treatment to a patient that presented to its ED. The liability stems from a 33-year-old patient who presented to Olive View's ED complaining of chest pains. After waiting for over three hours without receiving a MSE, the patient exited the ED, collapsed outside of the building, and despite attempts to resuscitate him, was pronounced dead within minutes.
02-16-2010
Harvey Montijo, M.D., Florida, agreed to pay $650,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Dr. Montijo solicited and received remuneration in the form of consulting payments from two medical device manufactures in exchange for using their orthopedic hip and knee products.
02-08-2010
Garden State Imaging (GSI), New Jersey, agreed to pay $83,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that GSI entered into a verbal agreement with two owners of a medical center. Under the terms of the verbal agreement, GSI agreed to provide mobile diagnostic imaging and related services to the medical center's patients and to split with the medical center 50% of the net proceeds that were generated.

2009

10-26-2009
A Wisconsin university agreed to pay $40,000 to resolve its liability for violating the select agent regulations. OIG alleged that the university conducted restricted experiments with a select agent without obtaining prior approval from CDC, as required by the select agent regulations. The university self-disclosed these unauthorized experiments to CDC, and fully cooperated in the investigation of this matter.
10-20-2009
Robert Diaz, M.D. (Diaz), Florida, agreed to pay $65,000 and to be excluded from participating in Federal health care programs for three years for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Diaz solicited and received remuneration in the form of consulting payments from a medical device manufacturer in exchange for using their orthopedic hip and knee products.
09-29-2009
Kaiser Foundation Hospitals - Santa Clara (Kaiser), California, agreed to pay $100,000 for allegedly violating the Patient Anti-Dumping Statute on two separate occasions. On both occasions, Kaiser failed to provide appropriate medical screening examinations and stabilizing treatment. On the first occasion, a 15-year old presented to Kaiser's emergency department (ED) doubled over, crying and complaining of severe abdominal pain. Kaiser discharged the patient and sent her to a pediatric physician group on the hospital's campus. On the second occasion, a 12-year old boy returned to Kaiser's ED after being sent home the night before. He presented with a high fever, continued pain and was lethargic with swollen eyes and face. He was also discharged to the pediatric physician group on the hospital's campus. Over six hours after he presented to the ED, he was admitted to Kaiser's Pediatric Intensive Care Unit where he died the next morning from staphylococcal sepsis.
09-25-2009
Michael Bakst, the former Executive Director of Community Memorial Hospital (CMH) of Ventura, California, agreed to pay $64,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Bakst caused the submission of claims to Medicare in violation of the physician self-referral (Stark) law. During the relevant time period Bakst was also identified as CMH's Compliance Officer.
09-10-2009
Robert Wood John University Hospital Hamilton (RWJ Hamilton), New Jersey, agreed to pay $65,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that RWJ Hamilton failed to provide a medical screening examination, stabilizing treatment or an appropriate transfer for a mother and her newborn child who came to RWJ Hamilton's emergency department for examination and treatment for a medical condition.
06-29-2009
Clifford Koon, Jeffrey Cowan, and William Dorvall (respondents), Florida, former owners and officers of Matrix, Diabetics, Inc. (a durable medical equipment (DME) company), agreed to pay $260,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the respondents caused Matrix to pay telemarketing firms to make unsolicited telephone calls to Medicare beneficiaries to market DME on behalf of the company. The DME company in turn submitted claims for these items for Medicare reimbursement. Section 1834(a)(17) of the Social Security Act prohibits DME suppliers from making unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of a covered item, except in certain situations that were not present in this case. Section 1834(a)(17)(B) of the Act prohibits payment to a supplier who knowingly submits a claim generated pursuant to prohibited telemarketing calls.
06-17-2009
Alexander Zeuli and Physical Therapy Health Services (Respondents), Massachusetts, agreed to pay $18,532 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents improperly billed Medicare under certain CPT codes for physical therapy services when lower reimbursed codes and/or fewer units of these codes should have been billed.
06-04-2009
Palms West Hospital (PWH), Florida, agreed to pay $50,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that on two separate occasions, PWH refused to accept an appropriate transfer to its hospital of a patient in need of specialized capabilities available at Palms.
06-02-2009
Plantation General Hospital (PGH), Florida, agreed to pay $40,000 to resolve its liability for CMPs under the patient dumping statute. The settlement resolved allegations that PGH failed to provide an appropriate medical screening examination, stabilizing treatment, and/or an appropriate transfer for a pregnant patient that presented to its emergency department in active labor. A friend drove the patient at very high speeds to another hospital where she delivered her baby minutes after arrival.
Ravenwood Nursing Home, Inc. (RNH), Maryland, agreed to pay $28,252.95 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that RNH employed an individual that RNH knew or should have known was excluded from participation in Federal health care programs.
05-27-2009
Claxton-Hepburn Medical Center (CHMC), New York, agreed to pay $168,597 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CHMC employed two individuals that CHMC knew or should have known were excluded from participation in Federal health care programs.
05-20-2009
Wayne Wittenberg, M.D. and his medical practice, Nature Coast Neurosurgery (Respondents), Florida, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
03-16-2009
Ediberto Soto-Cora, M.D., Texas, agreed to pay $534,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Soto-Cora submitted false or fraudulent claims by using CPT codes that would generate a higher reimbursement than justified by the medical documentation or that he submitted claims without any supporting medical documentation.
03-13-2009
West Valley Imaging Limited Partnership and two physicians (West Valley), Nevada, agreed to pay $2 million and to enter into a 5-year integrity agreement for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that West Valley performed radiology tests and exams that were not ordered by Medicare beneficiaries' treating physicians.
03-06-2009
A Missouri company agreed to pay $110,000 to resolve allegations that it violated the select agent regulations by engaging in three unauthorized transfers of select agents and by submitting documents to the CDC that indicated two of the transfers had not yet occurred when in fact the entity had already received the agents.
Research Medical Center (RMC), Missouri, agreed to pay $40,000 to resolve its liability for CMPs under the patient dumping statute. The settlement resolved allegations that RMC failed to appropriately screen and stabilize a patient who presented with severe abdominal pain resulting from an ectopic pregnancy.
02-25-2009
An Illinois physician agreed to pay $35,000 to resolve his liability for CMPs under the patient dumping statute. The OIG alleged that the on-call physician failed to respond to a request to come to the emergency department to treat a patient that presented with an open leg fracture. The patient was transferred to another facility and underwent emergency surgery.
02-17-2009
Stanly Memorial Hospital n/k/a Stanly Regional Medical Center (Stanly), North Carolina, agreed to pay $20,000 for allegedly violating the Patient Anti-Dumping Statute on two separate occasions: (1) Stanly failed to provide an appropriate medical screening examination or stabilizing treatment prior to transferring a patient that presented with symptoms of alcohol and polysubstance abuse and depression; and (2) Stanly failed to provide an appropriate medical screening examination or stabilizing treatment prior to discharging a patient that presented with symptoms of drug abuse.
01-06-2009
Methodist Health Care-Memphis Hospitals (Methodist), Tennessee, agreed to pay $136,627 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Methodist employed an individual that Methodist knew or should have known was excluded from participation in Federal health care programs.

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