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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.

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.
06-23-2017
South Carolina Hospital Settles Case Involving Patient Dumping Allegations
On June 23, 2017, AnMed Health (AnMed), in Anderson, South Carolina, entered into a $1,295,000 settlement agreement with OIG. The settlement agreement resolves allegations that, in 36 incidents investigated by OIG, AnMed violated the Emergency Medical Treatment and Labor Act (EMTALA). In these incidents, individuals presented to AnMed's Emergency Department (ED) with unstable psychiatric emergency medical conditions. Instead of being examined and treated by an on-call psychiatrist, and despite empty beds in its psychiatric unit to which the patients could have been admitted for stabilizing treatment, the patients were involuntarily committed and kept in AnMed's ED for between 6 and 38 days each. The following is an example of one such incident. A patient presented to AnMed's ED via law enforcement with psychosis and homicidal ideation and was involuntarily committed. The patient did not receive psychiatric examination or treatment by available AnMed psychiatrists and was not admitted to the psychiatric unit for stabilizing treatment. Instead, the patient was kept in the ED for 38 days and at one point was seen by a psychiatrist from another facility that was familiar with her condition. The psychiatrist prescribed a variety of medications for agitation. The patient eventually was discharged home. Senior Counsel Sandra Sands represented OIG.
06-21-2017
Louisiana Dentist Settles Case Involving Medically Unnecessary Claims
On June 21, 2017, Robert J. Edwards, DDS (Dr. Edwards), Baton Rouge, Louisiana, entered into a $80,070.10 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Edwards submitted claims for medically unnecessary root canals on permanent teeth, extractions, restorations, and stainless steel crowns for a number of pediatric Medicaid dental beneficiaries. OIG's Office of Evaluations and Inspections and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Geeta Tyalor, collaborated to achieve this settlement.
06-20-2017
Florida Pharmacy Settles Case Involving Excluded Individual
On June 20, 2017, Linton Square Pharmacy & Medical Supplies, Inc. (Linton Square), Delray Beach, Florida, entered into a $339,956.05 settlement agreement with OIG. The settlement agreement resolves allegations that Linton Square employed an individual who was excluded from participating in any Federal health care programs. OIG's investigation revealed that the excluded individual, a pharmacist, provided items or services to Linton Square patients that were billed to Federal health care programs. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
06-16-2017
UMass Medical Center Settles False and Fraudulent Medicare Claims Case
On June 16, 2017, UMass Memorial Medical Center, Inc. (UMass), entered into a $441,047.36 settlement agreement with OIG. The settlement agreement resolves allegations that UMass submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205 when the patients at issue were actually "established patients" and, thus, UMass should have submitted those claims using the lower-paying HCPCS codes 99213-99215. 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.
06-16-2017
Boston Medical Center Settles False and Fraudulent Medicare Claims Case
On June 16, 2017, Boston Medical Center Corporation d/b/a Boston Medical Center (BMC), entered into a $313,246 settlement agreement with OIG. The settlement agreement resolves allegations that BMC submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205 when the patients at issue were actually "established patients" and, thus, BMC should have submitted those claims using the lower-paying HCPCS codes 99213-99215. 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.
05-30-2017
Illinois Skilled Nursing Facilities Settle Case Involving Excluded Individual
On May 30, 2017, Heritage Robinson, LLC and Burnsides Community Health Center, Inc. (collectively, "Heritage"), entered into a $26,748.22 settlement agreement with OIG. The settlement agreement resolves allegations that Heritage 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 Heritage patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG.
05-17-2017
New York Physician Agrees to Another Voluntary Exclusion
On May 17, 2017, in connection with the resolution of his False Claims Act liability, Dr. Michael Esposito (Dr. Esposito), Albany, New York, agreed to be excluded again from participation in all Federal health care programs for a period of fifteen 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 December 9, 2016, for a period of five years, he forged another physician's signature on prescriptions, including opioids, in order to obtain medications for himself and another person. In the instant matter, Dr. Esposito presented claims for payment to Medicare for services that he furnished, ordered, and prescribed to Medicare beneficiaries while he was excluded. Senior Counsel David Traskey represented OIG.
05-15-2017
California Dentist Settles Case Involving Medically Unnecessary Claims
On May 15, 2017, Ana M. Gama, DDS and Ana M. Gama, DDS, Inc. (collectively, Dr. Gama), Ontario, California, entered into a $31,817.88 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that Dr. Gama submitted claims for medically unnecessary pulpotomies, extractions, restorations, and stainless steel crowns for a number of pediatric Medicaid dental beneficiaries. OIG's Office of Evaluations and Inspections and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Geeta Tyalor, collaborated to achieve this settlement.
05-15-2017
New York Physician Agrees to Voluntary Exclusion
On May 15, 2017, Dr. Haroutyoun Margossian (Dr. Margossian), a New York physician specializing in female urinary incontinence, agreed to be excluded from participation in all Federal health care programs for a period of seven years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Dr. Margossian knowingly presented or caused to be presented claims to Medicare and Medicaid relating to the treatment of patients suffering from urinary incontinence that he should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended Dr. Margossian failed to: (1) employ licensed individuals to perform the urodynamic and pelvic floor therapy (PFT) services; and (2) properly supervise the individuals performing the urodynamic and PFT services. Senior Counsel David Blank and Associate Counsel Jennifer Leonardis represented OIG.
05-12-2017
Georgia Hospital Settles Case Involving Patient Dumping Allegation
On May 12, 2017, Monroe County Hospital (MCH) in Forsyth, Georgia, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegation that MCH violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment for a woman who presented to MCH's Emergency Department (ED) complaining she was 36 weeks pregnant and her water had broken. The patient told a nurse that she wanted to see her physician in Macon, Georgia. Without providing a medical screening examination, ED staff decided that the patient could go see her physician in Macon. The patient was then escorted to her car and told to call 911. Emergency medical services arrived and found the patient in her car. She was brought to another hospital where she delivered her child within an hour of arriving. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Associate Counsel Srishti Sheffner represented OIG.

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