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.
Iowa Chiropractor Agrees to 3-Year Exclusion
- On March 13, 2017, Elizabeth Kressin, D.C. (Kressin), an Iowa chiropractor, agreed to be excluded from participation in 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 Kressin caused claims to be submitted to Iowa Medicaid for chiropractic services performed on children, which were not provided as claimed and were for treatment of conditions for which payment is not allowed under applicable rules. Associate Counsel Jennifer Leonardis represented OIG.
Michigan Physician Agrees to 3-Year Exclusion
- On March 8, 2017, Dr. Vinod Sharma, (Dr. Sharma) a Michigan physician and pain management specialist, agreed to be excluded from participation in Medicare and the State health care programs for a period of three years under 42 U.S.C. § 1320c-5 following a referral to OIG by Kepro, the Beneficiary and Family Centered Care Quality Improvement Organization (QIO). OIG's investigation determined that Dr. Sharma substantially violated the obligation to provide services (1) of a quality that met professionally recognized standards of health care, and (2) that were supported by evidence of medical necessity and quality in such form and fashion and at such time as was reasonably required by the QIO in the exercise of its duties and responsibilities. Specifically, OIG alleged that Dr. Sharma failed to sufficiently document his response to the results of urine drug screenings and any discussions he had with patients regarding the urine drug screening results when these patients (1) tested positive for illicit drugs; (2) tested positive for controlled substances Dr. Sharma did not prescribe; (3) tested positive for noncontrolled substances Dr. Sharma did not prescribe; or (4) tested negative for controlled substances Dr. Sharma prescribed. Senior Counsel Kristen Schwendinger, Senior Counsel Geoffrey Hymans and Associate Counsel Srishti Sheffner represented OIG.
Iowa Hospital Settles Case Involving a Patient Dumping Allegations
- On January 17, 2017, Covenant Medical Center (Covenant) in Waterloo, Iowa, entered into a $100,000 Settlement Agreement with OIG. The Settlement Agreement resolves allegations that Covenant violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate psychiatric screening examination or stabilizing treatment for three patients who presented to the emergency department (ED) when an on-call psychiatrist was available. A woman presented to the ED complaining of depression and suicidal thoughts, but was later discharged with instructions to follow-up with her primary care physician. A child presented to the ED following violent outbursts, but was later discharged with instructions to follow-up with his primary care physician. A man presented to the ED stating his mind was "disturbed," but later eloped from the ED into single degree weather wearing paper scrubs while his discharge was processed. His body was found about 300 feet from Covenant with the cause of death attributed to hypothermia. Senior Counsel Henry Green and Associate Counsel Madeline Bainer represented OIG.
Michigan Physician Agrees to Voluntary Exclusion
- On January 13, 2017, in connection with the resolution of his False Claims Act liability, Dr. Sotero Ureta, Lake City, Michigan, 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). OIG's investigation revealed that Dr. Ureta caused the submission of false claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care services that he referred in exchange for illegal remuneration or kickbacks. Senior Counsel David Traskey represented OIG.
New Jersey Dentist Agrees to $1.1 Million Payment and 50-Year Exclusion To Settle Civil Monetary Penalty Case
- Roben Brookhim, an unlicensed Dentist in New Jersey, agreed to pay $1,134,000 for allegedly violating the Civil Monetary Penalties Law and agreed to be excluded from participation in Federal health care programs for a period of fifty years under 42 U.S.C. § 1320a-7a and 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Brookhim owned, controlled, and managed Associated Dental NP, LLC (ADNP), a New Jersey dental practice with multiple locations, in violation of his exclusion from Federal health care program participation in August 2000. OIG further alleged that as part of his fraud scheme, Brookhim assumed the identity of a licensed New Jersey dentist (Dentist A), to provide services to ADNP patients. Brookhim assumed Dentist A's identity because Brookhim's license to practice dentistry was suspended in 1999 and revoked in 2004. OIG contends that Brookhim presented claims for services to various New Jersey Medicaid Managed Care Organizations identifying Dentist A as having providing services; in fact, Dentist A never rendered services to ADNP patients. Brookhim continued to pose as Dentist A and submit claims in his name -- even after Dentist A died. Senior Counsels David Blank and Michael Torrisi represented OIG with the assistance of Paralegal Specialist Mariel Filtz. News Release
North Carolina Hospital Settles Case Involving Patient Dumping Allegation
- On January 10, 2017, Cape Fear Medical Center (Cape Fear) in Fayetteville, North Carolina, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that Cape Fear violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination and stabilizing treatment for a woman who presented to Cape Fear's Emergency Department in labor with her third child. The patient was discharged a little over one hour after she presented to Cape Fear. OIG alleged that Cape Fear did not properly examine the patient (including checking the progress of her labor) before the patient was discharged. The patient drove home and immediately gave birth to her child at home. Senior Counsel Sandra Sands represented OIG.
Manager of Oklahoma Behavioral Health Counseling Center Agrees to Voluntary Exclusion
- On January 6, 2017, Heather Doss agreed to be excluded from participation in all Federal health care programs for a period of two years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Doss knowingly submitted or caused to be submitted false or fraudulent claims to Medicaid for services not provided or provided by unqualified individuals, as well as claims with falsified dates or time of services. Senior Counsel Kenneth Kraft represented OIG.
Utah Nursing Home and Owner Agree to 30 Year Exclusion
- On January 6, 2017, Deseret Health Group and Jon Robertson (Robertson), Bountiful, Utah, agreed to be excluded from participation in all Federal health care programs for a period of thirty years under 42 U.S.C. §§ 1320a-7(b)(7) and 1320a-7(b)(6)(B). OIG alleged that Deseret Health Group and Robertson: (a) failed to provide adequate care planning and assessments of residents; (b) failed to provide medications, treatments, laboratory tests, physical therapy, and other services as ordered and/or prescribed by residents' physicians; (c) failed to properly use and/or administer psychotropic drugs; (d) failed to follow appropriate pressure ulcer and infection control protocols for some residents; (e) failed to follow appropriate fall protocols for some residents; (f) failed to properly administer medications to some of the residents to avoid medication errors; (g) failed to provide a safe living environment for residents; and (h) failed to answer some residents' call lights promptly. Senior Counsel Felicia Heimer represented OIG.
Georgia Hospital Settles Case Involving Patient Dumping Allegation
- On December 29, 2016, Phoebe Putney Memorial Hospital (Phoebe Putney) in Albany, Georgia, entered into a $40,000 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 73-year-old man was transported to another hospital by EMS and presented with hematuria, bleeding at the site of his Foley catheter and abdominal pain. The patient required urological services that were unavailable at that hospital. The hospital requested Phoebe Putney accept the transfer of this patient. OIG alleged that Phoebe Putney's on-call urologist refused the transfer when Phoebe Putney had both the capability and capacity to treat the patient. Senior Counsel Sandra Sands represented OIG.
South Carolina Hospital Settles Case Involving Patient Dumping Allegation
- On December 22, 2016, McLeod Medical Center (MMC), a small hospital located in Dillon, South Carolina, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that MMC violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment of a patient who presented to MMC after being assaulted and hit in the head. The patient resisted efforts by his mother to get him into a wheelchair to enter the Emergency Department (ED). Security guards observed the patient's behavior and told the patient's mother that if she brought her son into the ED the guard would have him locked up. OIG alleges that the mother explained to the security guard that her son had been hit in the head and was bleeding and that a guard allegedly answered by reasserting that he would call the police if her son entered the ED. At that point the mother left with her son and later took him to another hospital for evaluation and treatment. Senior Counsel Sandra Sands represented OIG.
Missouri Hospital Settles Case Involving a Patient Dumping Allegation
- On December 22, 2016, OIG entered into a settlement agreement with HCA Midwest Division d/b/a Belton Regional Medical Center (BRMC), Belton, Missouri. BRMC agreed to pay $40,000.00 to resolve its liability for civil money penalties under the patient dumping statute. Specifically, OIG alleged that BRMC violated the Emergency Medical Treatment and Labor Act by failing to provide an appropriate medical screening examination and stabilizing treatment to two patients who came to BRMC's emergency department with emergency psychiatric conditions. Senior Counsel Henry E. Green represented OIG.
Texas Doctors Settle Case Involving Kickback Allegations
- On December 21, 2016, Mark Sands, D.P.M., and Jeffrey Baxter, D.P.M., Houston, Texas, entered into an $85,000 settlement agreement with OIG. OIG's investigation revealed that Dr. Sands and Dr. Baxter each received remuneration from OneStep Diagnostic, Inc. (OneStep), in the form of compensation from Medical Directorship agreements. OIG contends that the medical directorship agreements took into account the value and volume of referrals made to OneStep by Dr. Sands and Dr. Baxter's podiatric practice. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
New York Chiropractor and Practices Agree to 40 Year Exclusion
- On December 16, 2016, Alexander Khavash, a chiropractor, and the two chiropractic practices he owned, Alexander Khavash, DC, P.C., and AK Chiropractic, P.C., agreed to be excluded from participation in all Federal health care programs for a period of forty years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Khavash and his practices submitted claims to Medicare for chiropractic services that were not medically necessary and not provided as claimed. Senior Counsels Michael Torrisi, Joan Matlack and Andrea Treese Berlin represented OIG.
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.
Let's start by choosing a topic
Priority recommendations summarized.
FY 2017 Work Plan
OIG projects planned for 2017.
Significant OIG activities in 6-month increments.