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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.

03-27-2018
Ohio Home Health Company Settles Case Involving Excluded Individual
On March 27, 2018, ASAP Home Nurses, Inc. (ASAP), located in Wadsworth, Ohio, entered into a $11,406.26 settlement agreement with OIG. The settlement agreement resolves allegations that ASAP 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 ASAP's patients that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Eula Taylor.
03-26-2018
Wisconsin Independent Living Support Provider Settles Case Involving Excluded Individual
On March 26, 2018, Community Care, Inc. (CCI), located in Brookfield, Wisconsin, entered into a $208,585.20 settlement agreement with OIG. The settlement agreement resolves allegations that CCI, a care management organization, contracted with an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual provided for residential items or services to CCI's patients that were billed to Federal health care programs. Associate Counsel Jonathan Culpepper represented OIG.
03-23-2018
Florida Hospital Settles Case Involving Patient Dumping Allegation
On March 23, 2018, Peace River Regional Medical Center (Peace River), Port Charlotte, Florida, entered into a $42,500 settlement agreement with OIG. The settlement agreement resolves allegations that based on OIG's investigation, Peace River violated the Emergency Medical Treatment and Labor Act when it failed to accept an appropriate transfer of a patient. Specifically, the patient, a 17-year-old female, presented to another hospital's Emergency Department (ED), 6 weeks pregnant, complaining of abdominal pain continuing for approximately one week. An ultrasound confirmed the intrauterine fetus with a heartbeat and a left ectopic ruptured mass. The patient needed obstetric care, which was not available at that hospital. Accordingly, the ED contacted the Hospital Corporation of America Transport Center (TC) and requested transfer for a possible ruptured ectopic pregnancy. When TC communicated to Peace River's ED that it was trying to facilitate an ED-to-ED transfer, Peace River's representative replied that it did not accept ED-to-ED transfers and hung up. TC called Peace River back and the call was transferred to the ED, where it was reiterated that Peace River did not accept ED-to-ED transfers. The ED employee also mentioned that they had given the transferring hospital the contact information for Peace River's on-call OB/GYN. The transferring hospital called Peace River's on-call OB/GYN who requested all of the patient medical reports be faxed to him before he would consider accepting the patient. During this conversation the doctor learned that the patient was "out of county" and he did not accept the transfer. Senior Counsel Sandra Sands represented OIG.
03-21-2018
New Jersey Pharmacy and Owner Settle Case Involving Excluded Individual
On March 21, 2018, Pharmex Pharmacy, LLC, and Israel Weber (collectively, "Pharmex"), Lakewood, New Jersey, entered into a $314,205.76 settlement agreement with OIG. The settlement agreement resolves allegations that Pharmex 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 Pharmex patients that were billed to Federal health care programs. Associate Counsel Srishti Sheffner represented OIG.
03-08-2018
Ohio Hospital Settles Case Involving Patient Dumping Allegation
On March 8, 2018, Paulding County Hospital (PCH), Paulding, Ohio, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that PCH violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening and effectuate an appropriate transfer for a patient. The patient, a 33-week pregnant woman, presented to PCH's Emergency Department (ED) complaining of leaking fluids, pelvic pain, and vomiting. A nurse at PCH's ED brought the patient to an examination room. The nurse told the patient that the hospital did not have an obstetrician on-site, and that the patient could either start treatment at PCH and be transferred later, or that her male companion could drive her immediately to another hospital, where her obstetrician practiced. After being told this, the patient left PCH by private vehicle to another hospital, a thirty-minute drive. PCH never provided the patient or her unborn child a medical screening examination. At the receiving hospital, the patient underwent an emergency C-Section and delivered a male infant without a heartbeat. The receiving hospital's efforts to revive the infant were unsuccessful. Associate Counsel James Hansen represented OIG.
02-28-2018
Florida Drug and Alcohol Rehab Center and Owners Settle Case Involving Kickback and Stark Allegations
On February 28, 2018, The Pain Institute, Inc. d/b/a Space Coast Pain Institute, Stanley Golovac, M.D. and Richard Gayles, M.D. (collectively, "Space Coast"), Merritt Island, Florida, entered into a $95,302.50 settlement agreement with OIG. As a result of its investigation, OIG alleged that Space Coast 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 Space Coast 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.
02-13-2018
Arizona Physicians and Practice Settle False and Fraudulent Claims Case
On February 13, 2018, Modocurogyn, PLLC d/b/a AZ Urogynecology and Pelvic Health Center, a urogynecology practice with locations in Mesa, Scottsdale, and Glendale, Arizona, and its physician partners Dr. Mohamed Akl and Dr. Ahmed Akl (collectively, "AZ Urogynecology"), entered into an $877,474 settlement agreement with OIG. The settlement agreement resolves allegations that AZ Urogynecology 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 AZ Urogynecology submitted claims for: (1) diagnostic electromyography (EMG) services using CPT Code 51784 and diagnostic anorectal manometry (ARM) services using CPT Code 91122 when therapeutic services, not diagnostic services, had been provided; (2) evaluation and management (E&M) services billed in conjunction with pelvic floor therapy procedures when no separate and identifiable E&M services were provided; (3) unbundled biofeedback procedures; and (4) EMG- and ARM-aided biofeedback therapy 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 Counsel Michael Torrisi and Associate Counsel Srishti Sheffner with the assistance of Paralegal Specialist Mariel Filtz, collaborated to achieve this settlement.
02-13-2018
Management Company Settles Case Involving Excluded Individual
On February 13, 2018, Southwest Trinity Management, LLC (STM), entered into a $141,986.36 settlement agreement with OIG. The settlement agreement resolves allegations that STM, through a skilled nursing facility it owns and manages in Oklahoma City, Oklahoma, 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 that were billed to Federal health care programs.
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.
01-11-2018
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On January 11, 2018, Piedmont Newton Hospital (Piedmont), Covington, Georgia, entered into a $52,414 settlement agreement with OIG. The settlement agreement resolves allegations that Piedmont violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment for a patient and then inappropriately transferred the patient to another hospital. The patient, a 58-year-old woman, arrived at Piedmont's Emergency Department (ED) by private vehicle, complaining of left-sided pleuritic chest pain and abdominal pain. An ED physician examined the patient and noted that her abdomen was diffusely firm with hypoactive bowel sounds. The patient's blood samples revealed that her lactic acid and bleeding and clotting time were elevated. The patient's chest x-ray showed a large amount of intraperitoneal air under the right diaphragm, which suggested bowel perforation. The ED physician discussed the patient's condition with the on-call surgeon, who recommended that the patient be transferred to the other hospital where she had undergone a dilation and curettage procedure two days earlier. The other hospital agreed to accept the transfer and asked that the patient be air-lifted to its facility. Three hours and forty-seven minutes after her arrival at Piedmont's ED, the patient was transferred to the other hospital in critical condition. Upon arrival at the other hospital, the patient was in septic shock and on the verge of respiratory collapse. Even after receiving emergency surgery to repair the bowel perforation, the patient's condition continued to worsen and she died later that day. Associate Counsel Srishti Sheffner represented OIG.
01-10-2018
Tennessee Hospital Settles Case Involving Patient Dumping Allegation
On January 10, 2018, Clarksville Health System, f/k/a Gateway Medical Center (CHS), entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that CHS violated the Emergency Medical Treatment and Labor Act when it failed to accept an appropriate transfer. A 13-year-old presented to a hospital Emergency Department (ED) complaining of testicular pain. An ultrasound indicated no evidence of blood flow in the right testicle and a large amount of fluid surrounding the testicle. In order to access the needed specialized services of a urologist, which that hospital did not have, the ED requested that CHS accept the patient for transfer. CHS's on-call urologist, however, refused to accept the transfer of the patient, recommending instead that the patient be transferred to another facility. OIG alleged that CHS declined to accept the appropriate transfer when it had both the capability and capacity to stabilize the patient's emergency medical condition. Senior Counsel Sandra Sands represented OIG.

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