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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.

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
09-18-2017
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.
09-15-2017
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.
09-08-2017
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.
08-15-2017
Utah Laboratory Settles Case Involving Select Agent Regulations
On August 15, 2017, a Utah laboratory agreed to pay $250,000 to resolve its liability for violating the select agent regulations. OIG alleged that the laboratory violated the select agent regulations by allowing access to select agents or toxins maintained in registered laboratory space to an individual who lacked a security risk assessment approval, and who was later identified as a restricted person. OIG contends this conduct subjects the laboratory to civil money penalties under the Bioterrorism Preparedness Act, 42 U.S.C. 262a(i) and 42 C.F.R. 1003.102(b)(16).
08-14-2017
Michigan Laboratory Settles Case Involving Select Agent Regulations
On August 14, 2017, a Michigan laboratory agreed to pay $55,000 to resolve its liability for violating the select agent regulations. OIG alleged that the laboratory violated the select agent regulations by allowing access to select agents or toxins maintained in registered laboratory space to an individual who lacked a security risk assessment approval, and who was later identified as a restricted person. OIG contends this conduct subjects the laboratory to civil money penalties under the Bioterrorism Preparedness Act, 42 U.S.C. 262a(i) and 42 C.F.R. 1003.102(b)(16).
07-21-2017
Utah Pain Doctor and Medical Practice Settle False and Fraudulent Medicare Claims Case
On July 21, 2017, Jahan Imani, M.D. (Imani), and Intermountain Medical Management, P.C. (IMM), a Utah based pain management specialist and his practice, entered into a $399,895.92 settlement agreement with OIG. The settlement agreement resolves allegations that IMM, through Imani, submitted false or fraudulent claims for payment by inappropriately using modifier 59 for multiple units of HCPCS code G0431 when only a single unit may be billed per patient encounter. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, collaborated to achieve this settlement.
07-06-2017
Pennsylvania Hospice CEO Agrees to Voluntary Exclusion
On July 6, 2017, Malvina Yakobashvili, the President, CEO, and owner of a Pennsylvania hospice company, agreed to be excluded for a period of ten years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Yakobashvili's company, Home Care Hospice, Inc.: (1) submitted claims to Medicare for hospice services that were provided to beneficiaries who did not qualify under the Medicare guidelines for (a) routine hospice care because patients were improperly certified as terminally ill or (b) continuous care; and (2) engaged in a cover-up scheme that included falsification of documents to conceal the fraud.

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