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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.

08-02-2018
Ohio Skilled Nursing Facility Settles Case Involving Excluded Individual
On August 2, 2018, Ireland Health Care Center, Inc. d/b/a Singleton Health Care Center (SHCC), Cleveland, Ohio, entered into a $45,735.42 settlement agreement with OIG. The settlement agreement resolves allegations that SHCC 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 SHCC's patients that were billed to Federal health care programs. Senior Counsel Nancy Brown, with the assistance of Paralegal Specialist Eula Taylor, represented OIG.
08-02-2018
Maine Chiropractic Practice Settles Case Involving Excluded Individual
On August 2, 2018, Gerrish Chiropractic Center (GCC), Bar Harbor, Maine, entered into a $7,019.10 settlement agreement with OIG. The settlement agreement resolves allegations that GCC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an office manager and chiropractic assistant, provided items or services to GCC's patients that were billed to Federal health care programs.
07-02-2018
Vermont Physician and Practice Settle Case Involving Excluded Individual
On July 2, 2018, William H. Newman, M.D., and Allergy & Asthma Specialists of Northern Vermont, P.C. (collectively, "Dr. Newman"), entered into a $61,142.96 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Newman employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a registered nurse, provided items or services to Dr. Newman's patients that were billed to Federal health care programs. OIG's Office of Audit Services, Office of Investigations and Office of Counsel to the Inspector General, represented by Senior Counsel John O'Brien, collaborated to achieve this settlement.
07-02-2018
New Jersey Pediatrician Settles Case Involving False Claims
On July 2, 2018, Rashmi Sandeep, MD (Dr. Sandeep), Brick, New Jersey, entered into a $336,298.52 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Sandeep knowingly presented to Medicaid, through certain New Jersey Medicaid Managed Care Organizations (MCOs), claims for items or services that she knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG alleged that Dr. Sandeep: (1) submitted or caused to be submitted claims for items or services provided to Medicaid beneficiaries, who were enrolled with certain MCOs, in which Dr. Sandeep failed to personally perform or directly supervise services billed under her NPI number because she was either not present in the United States or was otherwise not in the State of New Jersey; (2) caused the resubmission of previously denied claims for items or services provided to Medicaid beneficiaries enrolled with a particular MCO by identifying herself as the rendering provider when, in fact, she was not; and (3) submitted or caused to be submitted claims for items or services provided to Medicaid beneficiaries enrolled with a particular MCO under her NPI number for services performed by non-credentialed providers who were not supervised by Dr. Sandeep. Associate Counsel Srishti Sheffner represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
06-29-2018
Florida Company Settles Case Involving Select Agent Regulations
On June 29, 2018, a Florida company agreed to pay $100,000 to resolve its liability for violating the select agent regulations. OIG alleged that the laboratory violated the select agent regulations when it transferred a select toxin to an entity that was not registered to possess, use, or transfer that toxin, and the company did not obtain prior authorization from the Centers for Disease Control and Prevention for this transfer. OIG contends this conduct subjects the company to civil money penalties under the Public Health Security and Bioterrorism Preparedness and Response Act, 42 U.S.C. 262a(i), and 42 C.F.R. 1003.102(b)(16).
06-11-2018
Oklahoma Ambulance Authority Settles Case Involving False Claims
On June 11, 2018, Comanche County Hospital Authority d/b/a Comanche County Memorial Hospital, (Comanche), Lawton, Oklahoma, entered into a $566,806 settlement agreement with OIG. The settlement agreement resolves allegations that Comanche 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. In addition, during the course of OIG's investigation, Comanche discovered and disclosed that it submitted claims to Medicare for emergency ambulance transportation that were not medically reasonable or necessary. Comanche also disclosed that it submitted claims to Medicare for transports where the documentation for the transport was not consistent with the patient's condition, and therefore did not support the documented medical necessity for the transport. 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.
California Physician and Practice Settle False and Fraudulent Claims Case
On June 11, 2018, James S. Dunn, Jr., MD, and James S. Dunn Jr., MD, Inc. d/b/a Auburn Urogynecology and Women's Health (collectively, "Dr. Dunn"), Auburn, California, entered into a $419,578 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Dunn submitted claims to Medicare for items or services that he knew or should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended that Dr. Dunn submitted claims for: (1) diagnostic electromyography services using CPT Code 51784 and diagnostic anorectal manometry using CPT Code 91122 when therapeutic, not diagnostic, services had been provided; (2) pelvic floor electrical stimulation that was not preceded by a four-week course of failed pelvic muscle exercise training; and (3) pelvic floor physical therapy services that were provided by an unqualified individual. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Michael Torrisi, Associate Counsel Srishti Sheffner, and Associate Counsel Jonathan Culpepper, with the assistance of Paralegal Specialist Mariel Filtz, collaborated to achieve this settlement.

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