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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.

12-20-2018
California Physician and Practice Settle Case Involving False Claims
On December 20, 2018, Michael Jadali, D.O., and the Center for Pain & Rehabilitation Medicine (collectively, "Dr. Jadali"), San Jose, California, entered into a $60,406.30 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Jadali submitted claims to Medicare for Healthcare Common Procedure Coding System codes 80500 (clinical pathology consultation; limited, without review of patient's history and medical records) and 80502 (clinical pathology consultation, comprehensive, for a complex diagnostic problem, with review of patient's history and medical records), where no consultation request had been made, no written narrative report by a consultant pathologist was produced, and no exercise of medical judgement by a consultant pathologist was required. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
12-12-2018
Connecticut Hospital Settles Case Involving Patient Dumping Allegation
On December 12, 2018, Hartford Hospital (Hartford), Hartford, Connecticut, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that Hartford violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination to a woman who was 23.5 weeks pregnant when she presented to Hartford's Emergency Department with symptoms of preeclampsia, an emergency medical condition. Senior Counsels Joan Matlack and Srishti Sheffner represented OIG.
11-27-2018
Louisiana Clinic and Physician Settle False and Fraudulent Medicare Claims Case
On November 27, 2018, Michael L. Drerup, M.D., and the Alexandria Neurosurgical Clinic (collectively, "Drerup"), Alexandria, Louisiana, entered into an $80,941.82 settlement agreement with OIG. The settlement agreement resolves allegations that Drerup submitted claims to Medicare 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 settlement.
Maine Mental Health Services Provider Settles Case Involving Excluded Individual
On November 27, 2018, Spurwink Services (Spurwink), Portland, Maine, entered into a $61,461.00 settlement agreement with OIG. The settlement agreement resolves allegations that Spurwink employed an individual who was excluded from participating in MaineCare, Maine's Medicaid program. OIG's investigation revealed that the excluded individual, a residential treatment specialist, provided items or services to Spurwink's patients that were billed to MaineCare.
11-19-2018
Connecticut Diagnostic Services Provider Settles Case Involving False Claims
On November 19, 2018, Southern Connecticut Vascular Center, LLC (SCVC), Stratford, Connecticut, entered into a $792,076.76 settlement agreement with OIG. The settlement agreement resolves allegations that SCVC submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965 when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which SCVS submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the submission of claims 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.
11-13-2018
Texas Laboratory Excluded for Default
On November 13, 2018, OIG excluded Medicus Laboratories, LLC (Medicus), a Dallas, Texas, laboratory, for defaulting on payment obligations under a settlement agreement with OIG wherein OIG alleged that Medicus submitted false or fraudulent claims to Medicare. Medicus' exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates Medicus' participation in Federal health care programs. Senior Counsel Geoffrey Hymans represented OIG.
11-07-2018
Illinois Hospital Settles Case Involving Excluded Individual
On November 7, 2018, the University of Chicago Medical Center (UCMC), Chicago, Illinois, entered into a $253,671.20 settlement agreement with OIG. The settlement agreement resolves allegations that UCMC, through a staffing agency, 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 UCMC's patients that were billed to Federal health care programs.
11-01-2018
Ohio Nursing Home Settles Case Involving Excluded Individual
On November 1, 2018, Wayside Farm, Inc. (Wayside), Peninsula, Ohio, entered into a $293,842.58 settlement agreement with OIG. The settlement agreement resolves allegations that Wayside employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a state tested nurse aide, provided items or services to Wayside's patients that were billed to Federal health care programs.
10-30-2018
Texas Physician and Practice Settle Case Involving False Claims
On October 30, 2018, Angela Smith, M.D., and Willow Wellness Center, P.A. (collectively, "Dr. Smith"), Tyler, Texas, entered into a $629,264.14 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Smith submitted claims to Medicare for Healthcare Common Procedure Coding System code 80502 (clinical pathology consultation, comprehensive, for a complex diagnostic problem, with review of patient's history and medical records), where no consultation request had been made, no written narrative report by a consultant pathologist was produced, and no exercise of medical judgement by a consultant pathologist was required. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
10-30-2018
Illinois Diagnostic Services Provider Settles Case Involving False Claims
On October 30, 2018, Cal-Devon Urgent Care, Inc. (CDUC), Chicago, Illinois, entered into a $224,151.48 settlement agreement with OIG. The settlement agreement resolves allegations that CDUC submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965 when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which CDUC submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the submission of claims 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.
10-30-2018
Kansas Financial Management Services Provider Settles Case Involving Excluded Individual
On October 30, 2018, Resource Center for Independent Living, Inc. (RCIL), Osage City, Kansas, entered into a $232,610 settlement agreement with OIG. The settlement agreement resolves allegations that RCIL employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a direct service worker, provided items and services to RCIL patients that were billed to Kansas Medicaid. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
10-24-2018
Florida Physicians and Practice Settle False and Fraudulent Claims Case
Jaime L. Sepulveda, MD, LLC (d/b/a Miami Urogynecology Center), Jaime L. Sepulveda, M.D., and Sujata Yavagal, M.D. (collectively, "Miami Urogynecology Center"), South Miami, Florida, entered into a $173,768.08 settlement agreement with OIG. The settlement agreement resolves allegations that Miami Urogynecology Center submitted claims to Medicare for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that Miami Urogynecology Center submitted claims for: (1) diagnostic electromyography services using CPT code 51784 when therapeutic, not diagnostic, services had been provided; (2) pelvic floor physical therapy services using CPT codes 97032 and 97110 when those services were provided by an unqualified individual; and (3) evaluation and management (E&M) services using CPT codes 99213 and 99214 that were billed in conjunction with pelvic floor therapy procedures when no separate and identifiable E&M services were provided. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Srishti Sheffner and Michael Torrisi, with the assistance of Program Analyst Mariel Filtz, collaborated to achieve this settlement.
10-16-2018
Pennsylvania Community Mental Health Clinics and Owners Agree to Voluntary Exclusions
On October 16, 2018, in connection with the resolution of their False Claims Act liability, Melchor Martinez (Martinez), Melissa Chlebowski (Chlebowski), Lehigh Valley Community Health Centers, Inc. (Lehigh Valley), Northeast Community Mental Health Centers, Inc. (Northeast), and Carolina Community Mental Health Centers, Inc. (Carolina), collectively ("MM"), agreed to be excluded from participation in all Federal health care programs under 42 U.S.C. 1320a-7(b)(7). Martinez is presently excluded and agreed to be excluded for an additional 10-years. Chlebowski, Lehigh Valley, Northeast, and Carolina agreed to be excluded for 5 years. OIG alleged that MM submitted or caused to be submitted false claims to Medicare and Medicaid arising from: (1) Martinez's undisclosed management of Northeast, Lehigh Valley, and Carolina in violation of his exclusion from Federal health care programs; (2) Northeast's, Lehigh Valley's, and Carolina's use of unqualified and/or unsupervised mental health therapists; and (3) the submission and payment of Medicaid claims for medication management visits that were upcoded to reflect longer visits. Senior Counsel Nancy Brown represented OIG.
10-11-2018
Nevada Medical Biller Agrees to 25 Year Exclusion
On October 11, 2018, Tymekka Greenough (Greenough), the in-house medical biller for First Initiative, LLC (First Initiative), a Nevada behavioral health services provider, agreed to be excluded for a period of 25 years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Greenough knowingly submitted or caused to be submitted claims to the Nevada Medicaid Program on behalf of First Initiative that were false or fraudulent or were not provided as claimed, including: (1) individual psychotherapy services using CPT Codes 90832, 90834, and 90837; (2) individual psychotherapy services utilizing biofeedback training using CPT Code 90876; (3) case management services using CPT Code T1016; and (4) skills training and development services using CPT Code H2014. Senior Counsels Srishti Sheffner and Michael Torrisi represented OIG.
10-05-2018
Arkansas Assisted Living Facility Settles Case Involving Excluded Individual
On October 5, 2018, Whispering Knoll, Pine Bluff, Arkansas, entered into a $35,195.95 settlement agreement with OIG. The settlement agreement resolves allegations that Whispering Knoll 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 Whispering Knoll's patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
10-05-2018
New York Pharmacy Settles Case Involving Excluded Individual
On October 5, 2018, Healthways Worldwide Inc. d/b/a Healthways Pharmacy and Surgical (Healthways), Brooklyn, New York, entered into a $204,426.64 settlement agreement with OIG. The settlement agreement resolves allegations that Healthways employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded pharmacist provided items or services to Healthways patients that were billed to Federal health care programs. Senior Counsel Jennifer Leonardis represented OIG.
10-03-2018
Arizona Physician Settles Case Involving Kickback and Stark Allegations
On October 3, 2018, Ronald Burns, M.D. (Dr. Burns), Phoenix, Arizona, entered into a $75,409.15 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Burns, in his capacity as then owner of a pain management practice, entered into contracts on behalf of the pain management practice and received 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 Dr. Burns 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.

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