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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.

01-23-2018
Chiropractor and his Practice Management Company Agree to Voluntary Exclusion
On January 23, 2018, Matthew Anderson and PMC Management Company, LLC (PMC), Tennessee, 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 alleged that Anderson and PMC caused pharmacies to submit requests for payment to Part D Plan Sponsors and TennCare for medications, including controlled substances that were not dispensed for a legitimate medical purpose and/or that were dispensed without obtaining valid prescriptions under Tennessee law. OIG also alleged that Anderson and PMC submitted, or caused the submission of claims to Medicare that were : (1) coded with CPT code 99214 and modifier -25 when those claims were not payable as such; and (2) provided by a nurse practitioner who was not collaborating with a physician as required by Tennessee law. Senior Counsel Andrea Treese Berlin represented OIG.
01-12-2018
Virginia Hospital Settles False and Fraudulent Medicare Claims Case
On January 12, 2018, Carilion Medical Center, Inc. d/b/a Carilion Roanoke Memorial Hospital, Carilion Services, Inc., and Carilion Clinic (collectively, "Carilion"), Virginia, entered into a $403,960.75 settlement agreement with OIG. The settlement agreement resolves allegations that Carilion submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99201-99205 when the patients at issue were actually "established patients" and, thus, Carilion should have submitted those claims using the generally lower-paying HCPCS codes 99211-99215. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
12-29-2017
Texas Mental Health and Drug Treatment Facility Settles Case Involving Excluded Individual
On December 29, 2017, Turtle Creek Recovery Center (Turtle Creek), Dallas, Texas, entered into a $24,428.58 settlement agreement with OIG. The settlement agreement resolves allegations that Turtle Creek employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a counselor, provided items or services to Turtle Creek's patients that were billed to Federal health care programs. Deputy Branch Chief Nicole Caucci represented OIG with the assistance of Paralegal Specialist Eula Taylor.
12-29-2017
Virginia Physician and Practice Settle False and Fraudulent Claims Case
On December 29, 2017, The Female Pelvic Medicine Institute of Virginia, P.C., and Nathan Guerette, M.D. (collectively, Dr. Guerette), a urogynecology practice and physician with locations in Richmond and North Chesterfield, Virginia, entered into a $1,401,344 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that Dr. Guerette submitted claims to Federal health care programs for items or services that he knew or should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended that Dr. Guerette submitted claims for: (1) pelvic floor therapy services that were provided by unqualified individuals; (2) diagnostic electromyography services under CPT Code 51784 that had not been performed according to the requirements of the indicated code; (3) unbundled biofeedback and physical therapy procedures; and (4) "incident to" services that lacked the required level of physician supervision. OIG also contended that Dr. Guerette submitted claims for electromyography services under CPT Code 51784 and anorectal manometry services under CPT Codes 91120 and 91122 that were not supported by adequate medical record documentation. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Michael Torrisi and David Traskey with the assistance of Paralegal Specialist Mariel Filtz, collaborated to achieve this settlement.
12-26-2017
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On December 26, 2017, Phoebe Putney Memorial Hospital (Phoebe Putney), Albany, Georgia, entered into a $50,000 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 54-year-old man presented to another hospital's Emergency Department (ED) suffering from a subdural hematoma. A CT scan showed that this subdural hematoma was on top of a previous hematoma. The patient needed to be evaluated by a neurosurgeon, which was not available at that hospital. Accordingly, the ED physician at the transferring hospital attempted to transfer the patient to Phoebe Putney for neurosurgical services. Phoebe Putney treated the patient approximately one week earlier for the previous hematoma. Phoebe Putney refused to accept the transfer when it had both the capabilities and capacity to treat the patient. Subsequently, the patient was transferred to another hospital and immediately admitted to its neuro ICU, where he remained for several days before being discharged. Senior Counsel Sandra Sands represented OIG.
12-12-2017
Massachusetts Hospital Settles Case Involving Patient Dumping Allegation
On December 12, 2017, Cambridge Health Alliance (Cambridge), Cambridge, Massachusetts, entered into a $90,000 settlement agreement with OIG. The settlement agreement resolves allegations that based on OIG's investigation, Cambridge violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination to a patient who presented to Cambridge's Somerville Hospital campus (Somerville). The patient was experiencing an acute asthma attack, a life-threatening condition needing immediate medical attention. OIG contends that the patient tried unsuccessfully to gain entry to Somerville's Emergency Department (ED) at its ambulance bay entrance, but the door was locked and unattended. The patient then called 911 and alerted the dispatcher that she was having an asthma attack and could not enter the hospital's ED. The dispatcher then called the Somerville ED and notified the responding registered nurse (RN) that the patient was experiencing an asthma attack outside the ED doors. Three minutes after this notification, the OIG further contends, the RN opened the ambulance bay door and looked around for the patient but did not let go of the door, search the area outside the entrance, or send another staff member to continue the search. Police and Fire Department emergency responders later found the patient collapsed on a bench adjacent to the Ambulance Bay door in full cardiac arrest with no signs of breathing. The Fire Department emergency responders began life-saving techniques before the patient was brought into the ED. The patient died six days later of hypoxic brain injury. OIG alleged that Cambridge failed to conduct a reasonable search for the patient and therefore failed to provide her with an appropriate medical screening examination after she presented to Cambridge's Somerville ED. Senior Counsels Kenneth Kraft and Sandra Sands represented OIG.
12-06-2017
Tennessee Hospital Settles Case Involving Patient Dumping Allegation
On December 6, 2017, Dyersburg Hospital Company, LLC d/b/a Dyersburg Regional Medical Center (DRMC), Dyersburg, Tennessee, entered into a $45,000 settlement agreement with OIG. The settlement agreement resolves allegations that based on OIG's investigation, DRMC violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment to a patient who presented to DRMC's Emergency Department (ED). The patient, a 58-year-old woman and resident of a long-term care facility, fell in the shower and was taken to DRMC's ED for evaluation and treatment. The ED physician initiated a medical screening examination and documented the patient's symptoms of head pain, altered mental state, and her reported symptom of near fainting. Lab work revealed an abnormal glucose level and abnormal hematocrit results. The ED physician planned to discharge the patient back to the nursing home. Before discharge, it was noticed that the patient's right arm was swollen compared to when she arrived. Her discharge was cancelled and x-rays were ordered which revealed no evidence of a fracture. Six hours after triage, a nurse reported that the patient required suctioning. Nine hours after triage the patient received a neurological check and the nurse documented that she was not oriented to time, place, person, or situation. The physician then ordered Narcan and a CT scan. Since DRMC's CT scan could not support the patient's weight, DRMC's ED contacted other hospitals to transfer the patient. Approximately 2.5 hours later the patient was admitted to another hospital where she received a CT scan. The CT scan showed a hematoma on her brain as well as Coumadin intoxication. The hospital then ordered an EEG, which showed no brain activity, and the patient died later that day. Senior Counsel Sandra Sands represented OIG.
12-05-2017
Ohio Addiction Treatment Providers Settle Case Involving Kickback and Stark Allegations
On December 5, 2017, Addiction Medical Care of Norwalk, Practice Management Associates Norwalk, LLC, Addiction Medical Care of Columbus, and Practice Management Associates, LLC (collectively, "AMC"), with locations in Norwalk and Columbus, Ohio, entered into a $79,880.50 settlement agreement with OIG. As the result of its investigation, OIG alleged that AMC 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 AMC 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
12-04-2017
Alabama Hospital Settles Case Involving Patient Dumping Allegation
On December 4, 2017, Greenville Hospital Corporation d/b/a L.V. Stabler Memorial Hospital (L.V. Stabler), Greenville, Alabama, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, L.V. Stabler violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination and stabilizing treatment for a 16-year-old female patient. The patient was 27-weeks pregnant and had presented by ambulance to L.V. Stabler's Emergency Department (ED), complaining of vaginal bleeding and a sharp pain in her lower abdomen. A nurse obtained the patient's vital signs and measured the fetal heart rate. An ED physician examined the patient and called the patient's obstetrician to discuss the patient's condition. Without providing an appropriate medical screening examination, the ED physician decided to send the patient for monitoring to another hospital where the patient's obstetrician was located. The ED physician discharged the patient and instructed her to go to the other hospital that was 55 miles away from L.V. Stabler. On the way to the other hospital, the patient's family members called emergency medical services (EMS). When EMS arrived, the patient was lying on the ground next to her car, experiencing severe abdominal pain, vaginal pain, and light bleeding. EMS drove the patient to a different hospital where she delivered a stillborn infant within minutes of arriving. Associate Counsel Srishti Sheffner represented OIG.
12-04-2017
North Carolina Physician and Practice Settle Case Involving False Claims, Kickback, and Stark Allegations
On December 4, 2017, Dr. Josette Maria (Dr. Maria) and Maria Medical Center (collectively, "MMC"), with offices in Dunn and Spring Lake, North Carolina, entered into a $60,000 settlement agreement with OIG. The settlement agreement resolves allegations that MMC: (1) billed for services provided "incident to" Dr. Maria's supervision despite her absence from the office suite; (2) routinely billed for services provided by unlicensed individuals; and (3) received remuneration from laboratory companies in the form of "process and handling" payments in exchange for referring patients for laboratory testing services, which were paid by Medicare. Deputy Branch Chief Tamara Forys and Senior Counsel Jennifer Leonardis represented OIG.
12-04-2017
Missouri Neurologist Agrees to Voluntary Exclusion
On December 4, 2017, Dr. Sherry Ma (Dr. Ma), a neurologist in Saint Louis, Missouri, 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) for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Ma received vials of Botox® and Myobloc® (Medications) at no charge that were supposed to be used for specific patients with private insurance. Instead of discarding the reminder of the Medications contained within vials labeled as single-dose vials, Dr. Ma kept and stored the remainder in excess of 24 hours. Subsequently, Dr. Ma used the remaining portion of the Medications on Medicare patients but submitted claims for payment to Medicare as if she had purchased new vials. Senior Counsel David Fuchs represented OIG.

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