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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.

02-18-2020
Texas Physician and Practice Settle Case Involving False Claims
On February 18, 2020, Mark R. Robbins, M.D. and Mark Robbins M.D., PA d/b/a Vascular Tyler (collectively, "Dr. Robbins"), Tyler, Texas, entered into a $71,168.20 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Robbins submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Robbins submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
02-10-2020
Maryland Hospital Settles Case Involving Patient Dumping Allegation
On February 10, 2020, Maryland General Hospital, Inc. d/b/a UM Medical Center Midtown Campus (UMMC), Baltimore, Maryland, entered into a $106,965 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, UMMC violated the Emergency Medical Treatment and Labor Act (EMTALA), when it failed to provide an adequate medical screening examination and stabilizing treatment for a 22-year old female patient. Specifically, the patient presented to UMMC's Emergency Department (ED) on January 9, 2018, via ambulance. The patient was diagnosed with a contusion of the face and lip abrasion, and was discharged. The patient refused to sign the discharge forms, stated that she was homeless, and refused to exit the premises. The patient was escorted by security off of UMMC's property wearing only a hospital gown and socks. The following day, the patient retuned to UMMC's ED via ambulance after a bystander called 911. The bystander found the patient at a bus stop outside the hospital in 30-degree weather. A nurse told the patient that she would need to go to a shelter if she did not have a place to stay. The patient was then discharged without receiving a medical screening examination or being stabilized. Associate Counsel Candace Ashford represented OIG.
02-03-2020
Kentucky Medical Group Settles Case Involving False Claims
On February 3, 2020, Kentucky Pain Management Services, LLC (KPMS), Hazard, Kentucky, entered into a $230,685.82 settlement agreement with OIG. The settlement agreement resolves allegations that KPMS submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
01-22-2020
New York Ambulance Company Settles Case Involving False Claims
On January 22, 2020, SeniorCare Emergency Medical Services, Inc. (SeniorCare), Bronx, New York, entered into a $1,231,854.09 settlement agreement with OIG. The settlement agreement resolves allegations that SeniorCare presented claims to Medicare Part B for ambulance transportation to and from skilled nursing facilities (SNFs) where such transportation was already covered by the SNF consolidated billing payment under Medicare Part A. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
Illinois Physician Settles Case Involving False Claims
On January 22, 2020, Dominic Tolitano, M.D., Wood Dale, Illinois, entered into a $130,253.98 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Tolitano submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which Dr. Tolitano submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
12-31-2019
Pennsylvania Mental Health Facility and Owners Agree to Voluntary Exclusion
On December 31, 2019, in connection with the resolution of their False Claims Act liability, Tree of Life Behavioral Health Services, Inc., Tree of Life Professional Behavioral Health Services, Inc., Tree of Life Professional Behavioral Health Systems (collectively, "Tree of Life"), Ada Vidal, and Victor Vidal, Philadelphia, Pennsylvania, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7). Tree of Life agreed to be excluded for 25 years. Ada Vidal and Victor Vidal each agreed to be excluded for 20 years. The investigation revealed that Tree of Life, Ada Vidal, and Victor Vidal: (1) knowingly submitted or caused the submission of thousands of fraudulent Medicaid claims for outpatient mental health services for services never rendered or falsely inflated, services that were based on false patient progress notes and billing sheets and forged signatures of psychiatrists and therapists, and services provided by unqualified individuals; and (2) knowingly submitted or caused the submission of fraudulent outpatient mental health Medicaid claims that resulted from their payment of remuneration to a social worker for referrals of patients, including Medicaid patients. Senior Counsel Sarah Kessler represented OIG.
12-26-2019
Maryland Dentist Case Involving Excluded Individual
On December 26, 2019, Lynne S. Brodell, DDS (Dr. Brodell), Cumberland, Maryland, entered into a $94,096.64 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Brodell employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a dentist, provided items or services that were billed to Federal health care programs. OIG's Office of Investigations and Office of Counsel to the Inspector General, represented by Senior Counsels Katie Fink and Jennifer Leonardis, collaborated to achieve this settlement.
Nevada Hospital Settles Case Involving Patient Dumping Allegation
On December 26, 2019, St. Rose Dominican Hospital - Siena Campus (St. Rose), Henderson, Nevada, entered into a $90,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, St. Rose violated the Emergency Medical Treatment and Labor Act (EMTALA), when it failed to provide an appropriate medical screening examination, stabilizing treatment and transfer for a patient. On May 22, 2016, the patient presented to St. Rose's Emergency Department (ED) complaining of dizziness, black stool, yellow skin and stiff muscles. He was transferred with low blood pressure and without having received any blood products, and went into cardiac arrest and died shortly after arriving at the receiving hospital. Senior Counsel Sandra Sands represented OIG.
California Hospital Settles Case Involving Patient Dumping Allegation
On December 26, 2019, San Mateo Medical Center (San Mateo), a small hospital in San Mateo, California, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, San Mateo violated the Emergency Medical Treatment and Labor Act (EMTALA), when it failed to provide an appropriate medical screening examination, stabilizing treatment, and transfer for a 23-year old pregnant woman. On August 24, 2016, the patient presented to San Mateo's Emergency Department (ED) complaining of abdominal pain for about four hours, with some vaginal discharge and bleeding. She was approximately 25 weeks pregnant. San Mateo did not perform a vaginal exam and did not determine if the patient was in labor. San Mateo's ED physician arranged for the patient to be transferred to another hospital for a higher level of care. The ED physician was informed that it would take 45 minutes for ambulance transport to arrive at San Mateo's ED, so he recommended that the patient be transferred by private vehicle. The patient delivered her baby in her car on the way to the receiving hospital and the patient self-diverted to a different hospital, where she arrived 26 minutes later. The baby was not breathing upon arrival to the hospital and the Neonatal Intensive Care Unit was unable to resuscitate the baby. Senior Counsel Sandra Sands represented OIG.
12-16-2019
Florida Hospital Settles Case Involving Patient Dumping Allegation
On December 16, 2019, Florida Hospital Heartland Medical Center (FHHMC), Sebring, Florida, entered into a $35,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, FHHMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for an almost 18-year-old male. On January 30, 2015, the patient presented to FHHMC's Emergency Department (ED) complaining of left testicular pain and swelling for the past three days and rated his pain as a 5 out of ten. His scrotum was swollen and tender. After an examination by an ED physician, the patient was discharged with instructions to follow up with a pediatric urologist. The patient was not seen or evaluated by the on-call urologist before being discharged. OIG alleged that the patient did not receive an appropriate medical screening examination or stabilizing treatment for his emergency medical condition. Senior Counsel Sandra Sands represented OIG.
12-12-2019
Tennessee Laboratory Settles Case Involving False Claims
On December 12, 2019, American Toxicology Lab, LLC (ATL), Johnson City, Tennessee, entered into a $175,889.72 settlement agreement with OIG. The settlement agreement resolves allegations that ATL submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and David Traskey with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.
12-11-2019
New York Physician and Practice Settle Case Involving False Claims
On December 11, 2019, Enrico Fazzini, D.O. and Enrico Fazzini, D.O., Ph.D., P.C. (collectively, "Dr. Fazzini"), with multiple locations in New York, entered into a $191,209.96 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Fazzini submitted claims: (1) using CPT code 95937 (neuromuscular junction (NMJ) testing) when he did not perform NMJ testing; and (2) for CPT code 95913 (for thirteen or more nerve conduction studies (NCS)) when he only performed twelve or fewer NCS. Senior Counsels Srishti Sheffner and Geoffrey Hymans represented OIG with the assistance of Program Analyst Mariel Filtz.

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