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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.

12-09-2016
New York Physician Agrees to 5 Year Exclusion
On December 9, 2016, Dr. Michael Esposito agreed to be excluded from participation in all Federal health care programs for a period of five years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Dr. Esposito forged the signature of another physician on prescriptions for medications for himself and another person that were paid for by the Medicare program. Senior Counsel David Blank and Associate Counsel Jennifer Leonardis represented OIG.
11-30-2016
New York Skilled Nursing Facility Settles Case Involving Excluded Individual
On November 30, 2016, Ditmas Park Rehab/Care Center (Ditmas Park), Brooklyn, New York, entered into a $205,089.22 settlement agreement with OIG. The settlement agreement resolves allegations that Ditmas Park 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 Ditmas Park patients that were billed to Federal health care programs. Senior Counsel Katie Fink represented OIG with the assistance of Paralegal Specialist Eula Taylor.
Florida Hospital Settles Case Involving a Patient Dumping Allegation
On November 30, 2016, Okaloosa Hospital, Inc. d/b/a Twin Cities Hospital (Twin Cities), a small hospital in Niceville, Florida, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that Twin Cities violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment of a 56-year-old male patient who was experiencing difficulty breathing and was unstable. Twin Cities' Emergency Department staff met the emergency medical transport in the ambulance bay and redirected the transport to another hospital, where the patient previously received treatment. Twin Cities failed to provide the patient with a medical screening examination or stabilizing treatment before redirecting the emergency medical transport. The patient died shortly after arriving at the other hospital. Twin Cities self-reported the incident shortly thereafter. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Senior Counsel Geeta Taylor represented OIG.
New Jersey Doctor Enters Settlement Agreement with OIG on Kickback Allegations
On November 30, 2016, Dr. Robert Collin, a Newark, New Jersey, internist, entered into a $111,415 settlement agreement with OIG. The settlement resolves allegations that Dr. Collin received remuneration from Orange Community MRI, LLC, an imaging facility in Orange, New Jersey, in exchange for patient referrals. Senior Counsels David M. Blank and Lauren E. Marziani represented OIG.
11-28-2016
Missouri Hospital Settles Case Involving Patient Dumping Allegations
On November 28, 2016, Research Medical Center (RMC) in Kansas City, Missouri, entered into a $360,000 settlement agreement with OIG. The settlement agreement resolves allegations that RMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and improperly transferred a patient. The patient presented to RMC's Emergency Department (ED) with a psychiatric emergency medical condition. Without providing stabilizing treatment, RMC transferred the patient to a nearby facility by private vehicle; en route, the patient exited the vehicle and was struck by another vehicle. RMC self-disclosed the incident involving this patient. Based on its investigation, OIG concluded that RMC implemented a transfer policy applicable to patients who presented to RMC's ED with psychiatric emergency medical conditions that also resulted in multiple violations of EMTALA. Specifically, OIG found seventeen occasions where RMC failed to provide adequate medical screening examinations and improperly transferred or discharged, without providing stabilizing treatment, patients who presented to RMC's ED with psychiatric emergency medical conditions. At the time each patient presented, RMC had the capacity to treat, stabilize, or admit each patient. Senior Counsel Geeta Taylor represented OIG.
Illinois Ambulance Company Settles Case Involving False Claims
On November 28, 2016, Mitchell-Jerdan Funeral Home, Ltd. (MJFH), an ambulance company in Mattoon, Illinois, entered into a $126,425.02 settlement agreement with OIG. The settlement agreement resolves allegations that MJFH 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.
11-15-2016
New York Skilled Nursing Facility Settles Case Involving Excluded Individuals
On November 15, 2016, Fort Tryon Rehabilitation and Healthcare Facility, LLC (Fort Tryon), New York, New York, entered into a $110,223.36 settlement agreement with OIG. The settlement agreement resolves allegations that Fort Tryon employed two individuals who were excluded from participating in Federal health care programs. OIG's investigation revealed that one excluded individual was a registered nurse supervisor and the other was a licensed practical nurse. While excluded, both individuals provided items or services to Fort Tryon patients that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Eula Taylor.
New Jersey Physician and Practice Settles False and Fraudulent Medicare Claims Case
On November 15, 2016, Lawrence C. Antonucci, M.D., Clifford Sebastian, M.D., and Lawrence C. Antonucci MD LLC, entered into a $60,884.90 settlement agreement with OIG. The settlement agreement resolves allegations that they submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
11-07-2016
Tennessee Hospital Settles Case Involving a Patient Dumping Allegation
On November 7, 2016, Metro Knoxville HMA, LLC (Metro Knoxville), in Knoxville, Tennessee, entered into a $45,000 settlement agreement with OIG. The settlement agreement resolves allegations that Metro Knoxville violated the Emergency Medical Treatment and Labor Act when it discharged a patient without having provided an adequate medical screening examination or treatment sufficient to stabilize the patient. OIG's investigation revealed that blood test results indicated the presence of an emergency medical condition; however, Metro Knoxville discharged the patient without confirming that such blood levels had stabilized. Senior Counsel Katherine Matos represented OIG.
11-04-2016
Physician Agrees to 20-Year Exclusion To Resolve Civil Monetary Penalty Case
Labib Riachi, M.D., a New Jersey based OB/GYN with a subspecialty in urogynecology, agreed to be excluded from participation in Federal health care programs for a period of twenty years under 42 U.S.C. 1320a-7(b)(7) for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Riachi knowingly submitted claims to Medicare and Medicaid for pelvic floor therapy services that he knew or should have known were not provided as claimed or were false or fraudulent. These claims were not provided as claimed or were false or fraudulent for one or more of the following reasons: (1) Dr. Riachi failed to personally perform or directly supervise services while he was traveling outside the United States or State of New Jersey; (2) Dr. Riachi failed to personally supervise the performance of a diagnostic procedure performed by his medical assistants; (3) services were not actually provided; (4) physical therapy services were provided by unlicensed and unqualified individuals; (5) services were not documented; and (6) diagnostic services were not reasonable and necessary. David Blank, Tamara Forys, and Jennifer Leonardis represented OIG with assistance from Paralegal Specialist Mariel Filtz. News Release
11-02-2016
Arizona Physician and Practice Settles False and Fraudulent Medicare Claims Case
On November 2, 2016, A. Clark Ruttinger, DO, and A. Clark Ruttinger DO, PLLC (Ruttinger), entered into a $52,961.20 settlement agreement with OIG. The settlement agreement resolves allegations that Ruttinger claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
10-31-2016
Colorado Health System Settles Case Involving False Claims
On October 31, 2016, UCH-MHS d/b/a Memorial Health System (Memorial) entered into a $58,512.00 settlement agreement with OIG. The settlement agreement resolves allegations that Memorial submitted claims to Medicare for health care items and services provided to individuals who were in the custody of penal authorities and which were not eligible for payment under Medicare Part A or B. Senior Counsel Geeta Taylor represented OIG.
10-27-2016
Missouri Ambulance Company Settles Case Involving False Claims
On October 27, 2016, American Paramedical Services, Inc. (APS), entered into a $187,480.12 settlement agreement with OIG. The settlement agreement resolves allegations that APS 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.
Virginia Health System Settles Case Involving False Claims
On October 27, 2016, Centra Health, Inc. (Centra), entered into a $137,864.68 settlement agreement with OIG. The settlement agreement resolves allegations that Centra 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.
10-26-2016
California Hospital Settles Case Involving a Patient Dumping Allegation
On October 26, 2016, Sonoma Valley Hospital (Sonoma), a small hospital in Sonoma, California, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegations that Sonoma violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide needed stabilizing treatment and an appropriate transfer for a 59-year old woman. OIG's investigation revealed that the patient arrived at Sonoma's Emergency Department (ED) via ambulance. The patient had a fever, no palpable pulses or blood pressure, a low respiratory rate and severe pain. Ten days earlier she had undergone surgery for diversional ileostomy (surgical formation of an opening of the intestine to the surface of the abdomen, through which fecal matter is emptied). The patient was diagnosed with sepsis and needed immediate surgery. Although Sonoma had the capabilities to provide this surgery, Sonoma's doctors wanted to send the patient back to the surgeon who performed her original surgery. Approximately 7.5 hours after the patient arrived at Sonoma's ED, she was inappropriately transferred to another hospital. At that hospital she received immediate surgery and died soon after. Senior Counsel Sandra Sands represented OIG.
Illinois Physician Agrees to Voluntary Exclusion
On October 26, 2016, in connection with the resolution of False Claims Act liability, Duttala Obul Reddy, M.D., agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Dr. Reddy submitted claims to Medicaid and Medicare seeking payment for Evaluation and Management services billed at Current Procedural Terminology code 93310 purportedly provided at long-term care facilities that either had not been provided or had not been provided to the extent claimed. Senior Counsel Geeta Taylor represented OIG.
10-19-2016
North Carolina Hospital Settles Case Involving a Patient Dumping Allegation
On October 19, 2016, Park Ridge Health (Park Ridge), a small hospital in Hendersonville, North Carolina, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that Park Ridge violated the Emergency Medical Treatment and Labor Act when it inappropriately transferred a patient, who was pregnant and experiencing contractions, to another hospital without properly stabilizing her emergency medical condition. Senior Counsel Gregory Wellins represented OIG.
10-17-2016
DME Company Owner Agrees to 10 Year Exclusion
On October 17, 2016, Phillip A. Minga, the owner of a durable medical equipment (DME) company, agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. 1320a-7(b)(7) and 42 U.S.C. 1320a-7(b)(16). OIG's investigation revealed that Minga knowingly caused claims to be submitted to Medicare for diabetes supplies that were not delivered, were the result of unsolicited Medicare beneficiary contact, in violation of the Social Security Act's DME Telemarketing Provisions and not covered by applicable exceptions, or were the result of a kickback. OIG's investigation further revealed that Minga knowingly retained or caused the retention of an overpayment owed to the Center for Medicare and Medicaid Services as a result of a Medicare Benefit Integrity Post-Payment Review conducted by Zone Program Integrity Contractor AdvanceMed. OIG's investigation also revealed that Minga knowingly made or caused to be made an omission or misrepresentation of a material fact in the applications of a DME company and its affiliates to participate or enroll as a supplier under Medicare, including organizations under Part C and D, when: (a) Minga was omitted as a managing employee; and (b) as a managing employee, Minga was not disclosed as having been convicted of a felony offense within the 10 years preceding enrollment or revalidation of enrollment. Senior Counsel Kristen Schwendinger and Associate Counsel David Fuchs represented OIG.

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