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Civil Monetary Penalties and Affirmative Exclusions

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

OIG Enforcement Cases

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

09-28-2018
Virginia Physician and Practice Settle False and Fraudulent Claims Case
On September 28, 2018, Atlantic Obstetrics & Gynecology, P.C. d/b/a Atlantic OB-GYN and Timothy J. Hardy, M.D. (collectively, "Atlantic OB-GYN"), with locations in Chesapeake and Virginia Beach, Virginia, entered into an $81,959.60 settlement agreement with OIG. The settlement agreement resolves allegations that Atlantic OB-GYN submitted claims to Medicare for items or services that it knew or should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended that Atlantic OB-GYN submitted claims for: (1) diagnostic electromyography services using CPT Code 51784 and diagnostic anorectal manometry services using CPT Code 91122 when therapeutic services, not diagnostic services, had been provided, and (2) pelvic floor electrical stimulation that was not preceded by a four-week course of failed pelvic muscle exercise training. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Michael Torrisi, with the assistance of Program Analyst Mariel Filtz, collaborated to achieve this settlement.
09-27-2018
New Jersey Health Center Settles Case Involving Excluded Individual
On September 27, 2018, Newark Community Health Centers, Inc. (NCHC), New Jersey, entered into a $98,750.36 settlement agreement with OIG. The settlement agreement resolves allegations that NCHC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a physician working in quality assurance and risk management, provided items and services to NCHC that were billed to Federal health care programs. Associate Counsel Srishti Sheffner represented OIG.
09-14-2018
Illinois Psychologist Agrees to 20 Year Exclusion
On September 14, 2018, Anthony D. Vertino, Psy.D. (Vertino), Illinois, agreed to be excluded from participation in all Federal health care programs for a period of twenty years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Vertino submitted claims for psychological services that were not provided as claimed or were false or fraudulent because the claims were for dates of service when patients were hospitalized or when Vertino was travelling out of state. Senior Counsel Joan Matlack represented OIG.
Tennessee Nurse Agrees to 10 Year Exclusion
On September 14, 2018, Cindy Scott, R.N., A.P.R.N. (Scott), Tennessee, 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)(6)(B) and 1320a-7(b)(7). OIG alleged Scott submitted or caused the submission of false claims for controlled substance prescriptions that were medically unnecessary, substantially in excess of the needs of her patients, and below the professionally recognized standards of care. Specifically, OIG alleged Scott prescribed monthly prescriptions to individual patients exceeding a daily dosage of five hundred (500) morphine milligram equivalents (MME), which included inappropriate combinations of long and short acting opioids often combined with high amounts of a benzodiazepine and/or carisoprodol. OIG also alleged Scott prescribed controlled substances and combinations of controlled substances and other medication without appropriately documenting: (1) a clear objective finding of a chronic pain source to justify the ongoing and increasing prescribing; (2) attempts to identify the etiology of reported pain; (3) a thorough history or adequately inquiring into potential substance abuse history; or (4) a written treatment plan with regard to the use of the prescriptions. Senior Counsels Andrea Treese Berlin, Katie Fink, and Joan Matlack represented OIG.
09-06-2018
Florida Pediatric Practice and Physicians Settle Case Involving Kickback and Stark Allegations
On September 6, 2018, Milind V. Tilak, M.D., Suwarna Tilak, M.D., Doctor's Inlet Pediatrics and Primary Care, P.A., and Avenues Pediatrics and Internal Medicine (collectively, "Doctor's Inlet"), Middleburg and Jacksonville, Florida, entered into a $58,370 settlement agreement with OIG. The settlement agreement resolves allegations that Doctor's Inlet 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 Doctor's Inlet 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.
09-05-2018
California Biotechnology Company Settles Case Involving False Grant Claims
On September 5, 2018, Sonata Biosciences, Inc. (Sonata), Auburn, California, entered into a $37,716.30 settlement agreement with OIG. The settlement agreement resolves allegations that Sonata knowingly presented to the Department of Health and Human Services (HHS) two specified claims under an HHS grant that Sonata knew or should have known were false or fraudulent. Specifically, OIG alleged that Sonata drew down $37,384.74 from a National Institutes of Health Small Business Innovation Research Grant for costs unrelated to the grant. Senior Counsels Michael Torrisi and David Traskey, assisted by Chief Investigator Jennifer Trussell, represented OIG.
08-24-2018
Maine Health System Settles Case Involving Excluded Individual
On August 24, 2018, St. Mary's Health System (St. Mary's), Lewiston, Maine, entered into a $68,497.32 settlement agreement with OIG. The settlement agreement resolves allegations that St. Mary's employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a call center patient scheduler, provided items and services to St. Mary's patients that were billed to Federal health care programs.
08-21-2018
Oklahoma Prosthetics Supplier Excluded for Default
On August 21, 2018, OIG excluded La Fuente Ocular Prosthetics, LLC (La Fuente), an Oklahoma City, Oklahoma, prosthetic supplier, for defaulting on payment obligations under a settlement agreement with OIG wherein OIG alleged that La Fuente submitted false or fraudulent claims to Medicare and created false records material to a false claim. La Fuente's exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates La Fuente's participation in Federal Health care programs. Senior Counsel Geoffrey Hymans represented OIG.
08-20-2018
Nevada Behavioral Health Services Provider and Owner Agree to Voluntary Exclusion
On August 20, 2018, First Initiative, LLC, a behavioral health services provider in Las Vegas, Nevada, and Shameika Amin, its owner (collectively, "First Initiative"), agreed to be excluded for a period of fifty years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that First Initiative knowingly submitted or caused to be submitted claims to the Nevada Medicaid program for: (1) individual therapy services using CPT Codes 90834 and 90837 when group therapy services had been provided; (2) individual psychotherapy services utilizing biofeedback training using CPT Code 90876 when no biofeedback training had been provided; and (3) behavioral health services that were billed under the names and national provider identifiers of providers who had not provided the services. Senior Counsel Michael Torrisi and Associate Counsel Srishti Sheffner represented OIG.
08-17-2018
ALJ Upholds OIG Exclusion Determination
On August 17, 2018, an Administrative Law Judge (ALJ) for the Departmental Appeals Board upheld OIG's 15-year exclusion of Karim Maghareh, Ph.D. (Maghareh), and BestCare Laboratory Services, LLC (BestCare), Webster, Texas, from participation in all Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). The ALJ found that Maghareh and BestCare submitted false claims to Medicare for reimbursement of travel costs associated with the collection of samples on which BestCare performed laboratory tests. Specifically, BestCare improperly billed Medicare for trained personnel travel, but instead used commercial airline flights to ship samples that were unaccompanied by trained personnel. Senior Counsels Lauren Marziani, Tamara Forys, and David Fuchs represented OIG. News Release
08-08-2018
California Independent Diagnostic Testing Facility and Owner Agree to Voluntary Exclusion
On August 8, 2018, CHJ Diagnostic, Inc., an independent diagnostic testing facility in Orange, California, and Andranik Tovmasyan, its owner (collectively, "CHJ"), agreed to be excluded for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that CHJ submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, collaborated to achieve this resolution.
08-06-2018
Hyperbaric Oxygen Therapy Operator Agrees to Voluntary Exclusion
On August 6, 2018, in connection with the resolution of his False Claims Act liability, Scott Warantz (Warantz), New York, 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 Warantz improperly submitted or caused to be submitted claims for hyperbaric oxygen therapy purportedly supervised by a physician even though the physician was not providing supervision at that facility and was instead performing services at an unrelated facility in New Jersey. Associate Counsel Srishti Sheffner represented OIG.
08-02-2018
Ohio Skilled Nursing Facility Settles Case Involving Excluded Individual
On August 2, 2018, Ireland Health Care Center, Inc. d/b/a Singleton Health Care Center (SHCC), Cleveland, Ohio, entered into a $45,735.42 settlement agreement with OIG. The settlement agreement resolves allegations that SHCC 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 SHCC's patients that were billed to Federal health care programs. Senior Counsel Nancy Brown, with the assistance of Paralegal Specialist Eula Taylor, represented OIG.
08-02-2018
Maine Chiropractic Practice Settles Case Involving Excluded Individual
On August 2, 2018, Gerrish Chiropractic Center (GCC), Bar Harbor, Maine, entered into a $7,019.10 settlement agreement with OIG. The settlement agreement resolves allegations that GCC 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 and chiropractic assistant, provided items or services to GCC's patients that were billed to Federal health care programs.
07-02-2018
Vermont Physician and Practice Settle Case Involving Excluded Individual
On July 2, 2018, William H. Newman, M.D., and Allergy & Asthma Specialists of Northern Vermont, P.C. (collectively, "Dr. Newman"), entered into a $61,142.96 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Newman employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a registered nurse, provided items or services to Dr. Newman's patients that were billed to Federal health care programs. OIG's Office of Audit Services, Office of Investigations and Office of Counsel to the Inspector General, represented by Senior Counsel John O'Brien, collaborated to achieve this settlement.
07-02-2018
New Jersey Pediatrician Settles Case Involving False Claims
On July 2, 2018, Rashmi Sandeep, MD (Dr. Sandeep), Brick, New Jersey, entered into a $336,298.52 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Sandeep knowingly presented to Medicaid, through certain New Jersey Medicaid Managed Care Organizations (MCOs), claims for items or services that she knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG alleged that Dr. Sandeep: (1) submitted or caused to be submitted claims for items or services provided to Medicaid beneficiaries, who were enrolled with certain MCOs, in which Dr. Sandeep failed to personally perform or directly supervise services billed under her NPI number because she was either not present in the United States or was otherwise not in the State of New Jersey; (2) caused the resubmission of previously denied claims for items or services provided to Medicaid beneficiaries enrolled with a particular MCO by identifying herself as the rendering provider when, in fact, she was not; and (3) submitted or caused to be submitted claims for items or services provided to Medicaid beneficiaries enrolled with a particular MCO under her NPI number for services performed by non-credentialed providers who were not supervised by Dr. Sandeep. Associate Counsel Srishti Sheffner represented OIG with the assistance of Paralegal Specialist Mariel Filtz.

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