Skip to main content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

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.

04-22-2020
Texas Physician Agrees to Voluntary Exclusion
On April 22, 2020, in connection with the resolution of his False Claims Act liability, Maaz Abbasi, M.D., Houston, Texas, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for three years. The investigation revealed that in exchange for illegal remuneration: (1) Dr. Abbasi signed Medicare Home Health Certifications and Plans of Care certifying patient eligibility for home health services without any knowledge of the patients' medical condition or homebound status; and (2) Dr. Abbasi signed another physician's signature on Medicare Home Health Certifications and Plans of Care certifying patient eligibility for home health services without the physician's authorization, permission, or knowledge, and without any knowledge of the patients' medical condition or homebound status. Senior Counsel Ellen Slavin represented OIG.
04-20-2020
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On April 20, 2020, DeKalb Medical Center, Inc. (DeKalb), Decatur, Georgia, entered into a $260,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, DeKalb violated the Emergency Medical Treatment and Labor Act (EMTALA), when it failed to provide an adequate screening examination and stabilizing treatment for twenty-one individuals. The following are examples of such incidents.

Patient N.R.A., a 25-year-old female, presented to DeKalb's Emergency Department (ED) on January 18, 2015, with complaints of acute gastric pain, nausea, and vomiting. The medical records also listed possible pregnancy as her chief complaint. N.R.A. had a prior history of peptic ulcer disease and gastric ulcers. The medical records indicated that N.R.A. was seen by a registered nurse and was triaged using an emergency severity level index at level 4 (indicating a non-urgent patient). The triage nurse recorded N.R.A.'s vital signs and marked "no" next to nine questions on a non-patient specific checklist. Within six minutes of the nurse starting the triage process, N.R.A. was discharged from DeKalb's ED.

Patient B.B. a 29-year-old male, was brought to DeKalb's ED by an ambulance on February 2, 2015, with complaints of neck pain after suffering from a motor vehicle accident one hour prior to his arrival. B.B. rated his pain at a level 5 on a scale of 1 to 10 (with 10 being the worst). The medical records indicate that B.B. was seen by a registered nurse, who triaged him using the emergency severity level index at level 4 (indicating a non-urgent patient). The triage nurse recorded B.B.'s vital signs and marked "no" next to nine questions on a non-patient specific checklist. B.B. was then discharged from DeKalb's ED.

In each of the incidents described above, DeKalb's ED was capable of providing an appropriate medical screening examination to determine whether the patients had an emergency medical condition and providing stabilizing treatments in the event patients had such conditions, but OIG contends that DeKalb failed to do so. Similar incidents occurred for the following 19 individuals who presented to DeKalb's ED: C.R.B. (1/24/2015); B.N.C. (1/30/2015); D.M.A. (2/2/2015); T.R. (2/3/2015); D.M. (2/6/2015); D.C.W. (2/10/2015); T.D. (2/11/2015); T.M.M. (2/24/2015); A.A.H. (3/1/2015); M.C.B. (3/2/2015); R.S.M. (3/3/2015); W.P.H. (3/6/2015); F.D.R. (3/7/2015); K.D. (4/5/2015); T.M.C. (4/9/2015); T.K. (4/9/2015); R.L.M. (4/9/2015); T.B. (4/10/2015); and L.D.C. (9/1/2015). In each of these cases, OIG determined that DeKalb failed to provide an appropriate medical screening examination or stabilizing treatment to these individuals within the capability of its ED. Senior Counsel Srishti Sheffner represented OIG.
04-06-2020
New Mexico Physician and Practice Settle Case Involving False Claims
On April 6, 2020, Gopal Reddy, M.D. and Gopal Reddy M.D., P.C. (collectively, "Dr. Reddy"), Albuquerque, New Mexico, entered into a $199,705.36 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Reddy submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Reddy submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
03-30-2020
North Carolina Ambulance Company Settles Case Involving False Claims
On March 30, 2020, Bertie Ambulance Service, Inc. (Bertie), Windsor, North Carolina, entered into a $342,208.22 settlement agreement with OIG. The settlement agreement resolves allegations that Bertie presented claims to Medicare Part B for ambulance transportation to and from skilled nursing facilities (SNFs) where such transportation was covered by the SNF consolidated billing payment under Medicare Part A. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
03-23-2020
Massachusetts Ambulance Company Settles Case Involving False Claims
On March 23, 2020, STAT Ambulance Service of New England, Inc. (STAT), New Bedford, Massachusetts, entered into a $75,228.16 settlement agreement with OIG. The settlement agreement resolves allegations that STAT presented claims to Medicare Part B for ambulance transportation to and from skilled nursing facilities (SNFs) where such transportation was already covered by the SNF consolidated billing payment under Medicare Part A. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
03-12-2020
Arkansas Assisted Living Facility Excluded for Default
On March 12, 2020, OIG excluded Whispering Knoll, Pine Bluff, Arkansas, for defaulting on payment obligations under a settlement agreement with OIG wherein OIG alleged that Whispering Knoll employed an individual who was excluded from participating in any Federal health care program. Whispering Knoll's exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates Whispering Knoll's participation in Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
03-12-2020
Colorado Physicians and Practice Settles Case Involving Kickbacks
On March 12, 2020, Chad E. Boekes, M.D., Louis B. Kasunic, D.O., and Castle Rock Family Physicians, P.C. (collectively, "Castle Rock"), Castle Rock, Colorado, entered into a $54,982 settlement agreement with OIG. The settlement agreement resolved allegations that Castle Rock solicited and received remuneration from laboratory companies Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), in the form of "process and handling" payments related to the collection of blood. OIG alleged that Castle Rock solicited and received the remuneration from HDL and Singulex in exchange for Castle Rock and Castle Rock employees referring patients for laboratory testing services to HDL and Singulex, for which the Medicare program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
03-06-2020
Illinois Independent Diagnostic Testing Facility Settles Case Involving False Claims
On March 6, 2020, Dav-Kim Portable X-Ray Services Co. (Dav-Kim), Skokie, Illinois, entered into a $126,628.76 settlement agreement with OIG. The settlement agreement resolves allegations that Dav-Kim submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dav-Kim submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
02-18-2020
Texas Physician and Practice Settle Case Involving False Claims
On February 18, 2020, Mark R. Robbins, M.D. and Mark Robbins M.D., PA d/b/a Vascular Tyler (collectively, "Dr. Robbins"), Tyler, Texas, entered into a $71,168.20 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Robbins submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Robbins submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
02-10-2020
Maryland Hospital Settles Case Involving Patient Dumping Allegation
On February 10, 2020, Maryland General Hospital, Inc. d/b/a UM Medical Center Midtown Campus (UMMC), Baltimore, Maryland, entered into a $106,965 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, UMMC violated the Emergency Medical Treatment and Labor Act (EMTALA), when it failed to provide an adequate medical screening examination and stabilizing treatment for a 22-year old female patient. Specifically, the patient presented to UMMC's Emergency Department (ED) on January 9, 2018, via ambulance. The patient was diagnosed with a contusion of the face and lip abrasion, and was discharged. The patient refused to sign the discharge forms, stated that she was homeless, and refused to exit the premises. The patient was escorted by security off of UMMC's property wearing only a hospital gown and socks. The following day, the patient retuned to UMMC's ED via ambulance after a bystander called 911. The bystander found the patient at a bus stop outside the hospital in 30-degree weather. A nurse told the patient that she would need to go to a shelter if she did not have a place to stay. The patient was then discharged without receiving a medical screening examination or being stabilized. Associate Counsel Candace Ashford represented OIG.
02-03-2020
Kentucky Medical Group Settles Case Involving False Claims
On February 3, 2020, Kentucky Pain Management Services, LLC (KPMS), Hazard, Kentucky, entered into a $230,685.82 settlement agreement with OIG. The settlement agreement resolves allegations that KPMS submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.

Read more icon Read more Civil Monetary Penalties and Affirmative Actions