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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.

11-06-2017
Ohio Home Health Agency Settles Case Involving Excluded Individual
On November 6, 2017, Diamonds & Pearls Health Services, LLC (DPHS), Cleveland, Ohio, entered into a $75,471.92 settlement agreement with OIG. The settlement agreement resolves allegations that DPHS employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a scheduling/staffing coordinator, provided items or services to DPHS patients that were billed to Federal health care programs.
11-06-2017
Indiana Practice Settles Case Involving Excluded Individual
On November 6, 2017, Center for Ear, Nose Throat & Allergy, P.C. (CENTA), Carmel, Indiana, entered into a $51,564.14 settlement agreement with OIG. The settlement agreement resolves allegations that CENTA employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a medical records file clerk, provided items or services to CENTA's patients that were billed to Federal health care programs. Associate Counsel Srishti Sheffner represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
10-24-2017
California Independent Diagnostic Testing Facility and Owner Agree to Voluntary Exclusion
On October 24, 2017, Prohealth Neurodiagnostic, Inc., an independent diagnostic testing facility in Van Nuys, California, and Arsen Oganesyan, its owner (collectively, "Prohealth"), agreed to be excluded for a period of five years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Prohealth submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare, in violation of a Local Coverage Determination governing the medical necessity of such studies. 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 resolution.
10-19-2017
Florida Laboratory Agrees to Voluntary Exclusion
On October 19, 2017, in connection with the resolution of its False Claims Act liability, Total Lab Care, LLC (Total Lab Care), Jacksonville, Florida, agreed to be permanently excluded from participation in all Federal health care programs under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Total Lab Care knowingly billed Federal health care programs for urine toxicology samples that were not reimbursable. Specifically, OIG alleged that Total Lab Care sought reimbursement for urine toxicology samples referred by a physician whom Total Lab Care paid improper financial remuneration. Senior Counsel Felicia Heimer represented OIG.
10-17-2017
Alabama Ambulance Companies Settles Case Involving False Claims
On October 17, 2017, Lifeguard Ambulance Service, LLC, Lifeguard Ambulance Service of Florida, LLC, and Lifeguard Ambulance Service of Texas, LLC (collectively, "Lifeguard"), headquartered in Birmingham, Alabama, entered into a $110,813.69 settlement agreement with OIG. The settlement agreement resolves allegations that Lifeguard 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.
10-17-2017
Texas Mental Health Provider Settles Case Involving Excluded Individual
On October 17, 2017, MHMR of Tarrant County (MHMR), Fort Worth, Texas, entered into a $97,869.78 settlement agreement with OIG. The settlement agreement resolves allegations that MHMR employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a program director, provided items or services to MHMR clients who were receiving services funded by a Medicaid waiver program. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Eula Taylor.
10-17-2017
Missouri Hospital Settles Case Involving Patient Dumping Allegations
On October 17, 2017, Southeast Missouri Hospital (SEM), Cape Girardeau, Missouri, entered into a $100,000 settlement agreement with OIG. The settlement agreement resolves allegations that SEM violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination and stabilizing treatment for two patients who presented to SEM's Emergency Department (ED) in 2011. OIG alleged that instead of being properly evaluated and treated, the patients were discharged with unstabilized emergency medical conditions to the custody of police pursuant to a hospital policy: if a patient had a blood alcohol level (BAL) above 100, the patient was given to local law enforcement and taken to jail. The first patient was 25 years old when she called a crisis hotline and an ambulance was dispatched to her residence. She was transported to SEM's ED for evaluation of a possible suicide attempt by overdose. The patient's BAL was 422 and the ED physician discharged her into the custody of local law enforcement where she was detained in jail and expected to see a counselor. The second patient was 41 years old when he presented to SEM after attempting suicide by overdose. The patient was depressed, had a history of psychiatric problems, and had recently been admitted for electroconvulsive therapy. The patient's BAL was 288 and he was discharged into the custody of local law enforcement and taken to jail. The next day the patient was seen by a counselor in jail and then released from custody. The patient returned to SEM that evening after again attempting suicide by overdose. The patient had slurred speech, was lethargic and had a flat affect and was admitted to the intensive care unit in guarded condition. Senior Counsel Sandra Sands represented OIG.
10-11-2017
Illinois Case Management Provider Settles Case Involving Excluded Individual
On October 11, 2017, Shawnee Health Services (Shawnee), Carterville, Illinois, entered into a $107,761.08 settlement agreement with OIG. The settlement agreement resolves allegations that Shawnee employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a case manager, provided items or services to Shawnee clients that were receiving services under a Medicaid waiver program.
10-10-2017
Arkansas Department of Health Settles Case Involving Excluded Individual
On October 10, 2017, The Arkansas Department of Health (ADH) entered into a $39,343.61 settlement agreement with OIG. The settlement agreement resolves allegations that ADH employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a hospice social worker, provided items or services to patients of a community based hospice operated by ADH that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Eula Taylor.
09-27-2017
New Jersey Physician Agrees to Voluntary Exclusion
On September 27, 2017, in connection with the resolution of his False Claims Act liability, Dr. Dinesh Patel (Dr. Patel), Edison, New Jersey, agreed to be excluded again 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 despite previously having been excluded from participation in New Jersey Medicaid on March 17, 2012, and excluded from participation in all Federal health care programs on February 20, 2014, Dr. Patel continued to provide administrative and management services to Edison Adult Medical Daycare (EAMD) in violation of the terms of his exclusion. Dr. Patel had a previous ownership interest in EAMD, which he transferred to his wife around the time of his exclusion from New Jersey Medicaid. Senior Counsel David Fuchs represented OIG.
09-27-2017
Arizona Pain Management Practice Settles Case Involving Kickback and Stark Allegations
On September 27, 2017, Advanced Pain Management (APM), a pain management practice with multiple locations in Arizona, entered into a $186,210.20 settlement agreement with OIG. As the result of its investigation, OIG alleged that APM 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 APM 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
09-22-2017
Podiatrist Agrees to Voluntary Exclusion
On September 22, 2017, Patricia Anne Chapman (Chapman), Liberty Lake, Washington, agreed to be excluded from participation in all Federal health care programs for a period of 10 years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that, in her Clinton, Iowa, podiatric practice, Chapman submitted false or fraudulent claims to Medicare using Current Procedural Terminology Code 97032: (1) for electrical stimulation services (e-stim) that were not medically reasonable or necessary, (2) for e-stim services not administered with "constant attendance" and "manual application," according to the requirements of the code, (3) for twice the number of e-stim units than documented in the beneficiaries' patient files, and (4) for using false records and statements to support the false e-stim claims. Senior Counsel Keshia Thompson represented OIG.
09-18-2017
New York Pharmacy Settles Case Involving Excluded Individual
On September 18, 2017, Century Pharmacy (Century), Brooklyn, New York, entered into a $10,000 settlement agreement with OIG. The settlement agreement resolves allegations that Century employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, who assisted in filling prescriptions in addition to performing other clerical tasks, provided items or services to Century patients that were billed to Federal health care programs. Senior Counsel Kenneth Kraft represented OIG with the assistance of Paralegal Specialist Eula Taylor.
09-18-2017
New York Addiction Treatment Center Settles Case Involving Kickback Allegations
On September 18, 2017, Parallax Center, Inc. (Parallax), New York, New York, entered into a $64,203.30 settlement agreement with OIG. As the result of its investigation, OIG alleged that Parallax 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 Parallax 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.
09-18-2017
North Shore Medical Center Settles Case Involving Patient Dumping Allegation
On September 18, 2017, North Shore Medical Center (NSMC), Lynn, Massachusetts, entered into a $60,000 settlement agreement with OIG. The settlement agreement resolves allegation that NSMC violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination for a fourteen-year-old patient and inappropriately transferred her to another hospital. The patient arrived at NSMC's Union Hospital emergency department by ambulance, secured to a stretcher and under police escort, for psychiatric evaluation after combative behavior at home and banging her head against a wall. Upon arrival at NSMC Union Hospital the patient was placed in a room, still secured to the stretcher. NSMC Union Hospital's emergency department physician came into the room and told the paramedics that the patient should be transported to NSMC's Salem Hospital emergency department for pediatric psychiatric evaluation. Before recommending transfer, NSMC failed to provide the patient with a medical screening exam. On route to NSMC Salem Hospital, the police instructed the ambulance to take the patient to a different hospital where her mother was waiting. Senior Counsel Kristen Schwendinger represented OIG.
09-15-2017
Texas Mental Health Facility Settles Case Involving Excluded Individual
On September 15, 2017, Sundance Behavioral Healthcare System (Sundance), Texas, entered into a $49,183.48 settlement agreement with OIG. The settlement agreement resolves allegations that Sundance employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a licensed vocational nurse, provided items or services to Sundance patients that were billed to Federal health care programs. Deputy Branch Chief Nicole Caucci represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
09-11-2017
West Virginia Physician Agrees to Voluntary Exclusion
On September 11, 2017, in connection with the resolution of her False Claims Act liability, Dr. Cheryl Wingate (Dr. Wingate), Fairmont, West Virginia, 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's investigation revealed that Dr. Wingate caused compounding pharmacies to submit false claims for compound creams and medications to TRICARE and the Medicare Program by issuing or approving prescriptions that were not legitimate because Dr. Wingate did not examine or evaluate the patients in question and did not have an established physician-patient relationship with them. OIG's investigation also revealed that Dr. Wingate issued and approved the medication prescriptions in exchange for compensation paid to her by the pharmacies, telemedicine entities, or other intermediaries acting on behalf of the pharmacies.
09-08-2017
California Independent Diagnostic Testing Facility and Owner Agree to Voluntary Exclusion
On September 8, 2017, Olive Sleep & EEG, Inc., an independent diagnostic testing facility, and Mariam Unjughulyan, its owner, (collectively, "Olive Sleep") agreed to be excluded for a period of five years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Olive Sleep submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare in violation of a Local Coverage Determination governing the medical necessity of such studies. 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 resolution.
09-05-2017
Montana Physician Agrees to Voluntary Exclusion
On September 5, 2017, in connection with the resolution of False Claims Act liability, Dr. Cory Lee Pickens, Billings, Montana, agreed to be excluded for a period of ten years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that despite previously having been excluded from participation in all Federal health care programs on September 20, 2011, Dr. Pickens provided services to beneficiaries of the Medicaid program while he was excluded. Senior Counsel David Traskey represented OIG.
08-31-2017
Florida Pharmaceutical Company Settles Case Involving Drug Price Reporting
On August 31, 2017, Stratus Pharmaceuticals Inc. (Stratus), Florida, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that Stratus failed to submit certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2014 and 2015. The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Mary Riordan represented OIG.
08-23-2017
Tennessee Transportation Service Provider and Owner Agree to Voluntary Exclusion
On August 23, 2017, in connection with the resolution of False Claims Act liability, Employment & Assessment Solutions, Inc., a transportation service provider, and Chris Manus, its owner (collectively, "EASI"), agreed to be excluded for a period of nine years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that EASI caused the submission of claims to Federal health care programs for services billed but not actually provided by EASI for patients, including transportation services not provided to patients who were incarcerated or hospitalized at the time of their purported transport. Associate Counsel Srishti Sheffner represented OIG.

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