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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.

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.
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.
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.

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