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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.

06-28-2019
Kentucky Laboratory Settles Case Involving False Claims
On June 28, 2019, Ethos Laboratory (Ethos), Newport, Kentucky, entered into a $1,345,959.74 settlement agreement with OIG. The settlement agreement resolves allegations that Ethos 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 Andrea Treese Berlin represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
Alabama Ambulance Provider Settles Case Involving False Claims
On June 28, 2019, Samaritan EMS, Inc. (Samaritan), Union Grove, Alabama, entered into a $942,373.67 settlement agreement with OIG. The settlement agreement resolves allegations that Samaritan submitted basic and advanced life support ambulance claims where the trips were to destinations for which ambulance services are not covered by Medicare, such as trips to diagnostic and therapeutic sites (and the associated "return" trip was to a residence). Senior Counsels Geoffrey Hymans and Andrea Treese Berlin represented OIG.
06-26-2019
North Carolina Hospital Settles Case Involving Patient Dumping Allegation
On June 26, 2019, Transylvania Regional Hospital (TRH), MH Transylvania Regional Hospital, LLLP, and Transylvania Community Hospital, Inc., Brevard, North Carolina, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, TRH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for a patient. The patient presented to TRH's Emergency Department (ED) complaining of abdominal pain and pain radiating bilaterally to his lower extremities. In addition, the patient had an elevated blood pressure and respiratory rate. Despite this presentment, TRH discharged the patient without providing an adequate medical screening examination or stabilizing treatment. The patient returned to TRH's ED later the same day via ambulance, complaining of paralysis of the lower extremities, leg pain, and leg swelling. TRH ultimately transferred the patient to another hospital. Under EMTALA, the maximum penalty for hospitals with fewer than 100 beds at time of this alleged violation was $25,000. Senior Counsel Geeta Taylor represented OIG.
06-17-2019
Florida Physician Practice Settles Case Involving Kickbacks
On June 17, 2019, Midland Medical, Inc. and its subsidiary, Midland Medical-Broward, Inc. (collectively, "Midland"), Oakland Park, Florida, entered into a $102,204 settlement agreement with OIG. The settlement agreement resolves allegations that Midland received remuneration from laboratory companies Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), in the form of "process and handling" payments related to the collection of blood. OIG alleged that Midland received the remuneration from HDL and Singulex in exchange for Midland and Midland employees referring patients for laboratory testing services to HDL and Singulex, for which the Medicare program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
06-14-2019
Massachusetts Physician Practice Settles Case Involving Kickback and Stark Allegations
On June 14, 2019, HKD Treatment Options, P.C. (HKD), Lowell, Massachusetts, entered into an $87,650 settlement agreement with OIG. The settlement agreement resolves allegations that HKD received 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 HKD 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.
06-06-2019
New Mexico Federally Qualified Health Center Settles Case Involving Grant Fraud
On June 6, 2019, Pecos Valley Medical Center, Inc. (PVMC), Pecos, New Mexico, entered into a $70,000 settlement agreement with OIG. The settlement agreement resolves allegations that PVMC knowingly presented to the Department of Health and Human Services (HHS) a specified claim under an HHS grant that PVMC knew or should have known was false or fraudulent. Specifically, OIG alleged that PVMC made drawdowns from a Health Resources and Services Administration Health Infrastructure Investment grant and used the funds for unallowable operating costs not related to the grant. Senior Counsels David Traskey and Kirk Sripinyo represented OIG.
Florida Physician Group Settles Case Involving False Claims
On June 6, 2019, Southeastern Integrated Medical, PL (SIM), a physician group practice with multiple locations in North Central Florida, entered into an $62,727.88 settlement agreement with OIG. The settlement agreement resolves allegations that SIM 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 Andrea Treese Berlin and Kirk Sripinyo represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
05-31-2019
Kentucky Laboratory Settles Case Involving False Claims
On May 31, 2019, Commonwealth Pain Associates, PLLC (Commonwealth), Louisville, Kentucky, entered into an $88,214.88 settlement agreement with OIG. The settlement agreement resolves allegations that Commonwealth 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.
05-28-2019
Missouri Physician Agrees to Voluntary Exclusion
On May 28, 2019, in connection with the resolution of his False Claims Act liability, William Blake Rodgers, M.D., Jefferson City, Missouri, agreed to be excluded from participation in all Federal health care programs for a period of four years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Dr. Rodgers, a spine surgeon, submitted and caused submission of claims to Federal health care programs for surgical procedures not rendered and for neurophysiological monitoring services that were not properly performed. Senior Counsel David Fuchs represented OIG.
Maryland Dentist Settles Case Involving Excluded Individual
On May 28, 2019, Ryan D. Pensyl, DMD (Dr. Pensyl), Cumberland, Maryland, entered into a $10,941.60 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Pensyl 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.
05-22-2019
Diagnostic Services Provider Settles Case Involving False Claims
On May 22, 2019, On-Site Imaging, LLC (On-Site), Morganville, New Jersey, entered into an $82,065.08 settlement agreement with OIG. The settlement agreement resolves allegations that On-Site submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which On-Site submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends 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.
05-21-2019
California Physician Settles False and Fraudulent Claims Case
On May 21, 2019, Yousef Mehrabi, M.D. (Dr. Mehrabi), Encino, California, entered into a $52,799.61 settlement agreement with OIG. OIG's investigation revealed that Dr. Mehrabi submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare. 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.
05-20-2019
Tennessee Hospital Settles Case Involving Excluded Individual
On May 20, 2019 Jackson-Madison County General Hospital District d/b/a West Tennessee Healthcare (WTH), Jackson, Tennessee, entered into a $102,714 settlement agreement with OIG. The settlement agreement resolves allegations that a subsidiary that WTH acquired, Tennova Regional Hospital (TRH), 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 TRH's patients that were billed to Federal health care programs. Senior Counsel Kenneth Kraft represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
Missouri Physicians and Practice Settle Case Involving Kickbacks
On May 20, 2019, Paul S. Moniz, D.O., Guy D. Roberts, D.O., and Midwest Health Group, LLC (collectively, "Midwest Health"), Farmington, Missouri, entered into a $96,880 settlement agreement with OIG. The settlement agreement resolves allegations that Midwest Health received remuneration from Health Diagnostic Laboratory, Inc. (HDL), a laboratory company, in the form of "process and handling" payments related to the collection of blood. OIG alleged that Midwest Health received the remuneration from HDL in exchange for Midwest Health and Midwest Health employees referring patients for laboratory testing services to HDL, for which the Medicare Program paid. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG with the assistance of Program Analyst Mariel Filtz.
05-07-2019
Kansas Physician Agrees to Voluntary Exclusion
On May 7, 2019, in connection with the resolution of his False Claims Act liability, Joseph P. Galichia, M.D. (Dr. Galichia), Kansas, 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)(6)(B). OIG alleged that Dr. Galichia submitted claims to Federal health care programs for surgical procedures he performed implanting coronary arterial stents that were not medically necessary. Senior Counsel David Fuchs represented OIG.
05-06-2019
Florida Hospital Settles Case Involving Patient Dumping Allegation
On May 6, 2019, Park Royal Hospital (Park Royal), Fort Meyers, Florida, entered into a $52,414 settlement agreement with OIG. The settlement agreement resolves allegations that, based on OIG's investigation, Park Royal violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to accept a transfer of a patient with an unstablilized emergency medical condition, from the emergency department of another hospital. The patient presented to that hospital's emergency department following a suicide attempt and was diagnosed with lacerations to the wrist and an emergency psychiatric condition. Park Royal is a hospital with specialized psychiatric capabilities. OIG alleged that Park Royal refused to accept a transfer of the patient, despite having the specialized capabilities to stabilize the patient and the capacity at the time of transfer, because the patient's insurance was out of network. Senior Counsel Geeta Taylor represented OIG.
04-25-2019
Georgia Urology Practice Settles Case Involving Excluded Individual
On April 25, 2019, Morganstern Urology (Morganstern), Atlanta, Georgia, entered into an $18,810.40 settlement agreement with OIG. The settlement agreement resolves allegations that Morganstern employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a physician, provided items or services to Morganstern's patients that were billed to Federal health care programs.
04-12-2019
Texas State Agency and Living Center Settle Case Involving Excluded Individual
On April 12, 2019, Texas Health and Human Services Commission and Lufkin State Supported Living Center (Lufkin SSLC), entered into a $121,068.42 settlement agreement with OIG. The settlement agreement resolves allegations that Lufkin SSLC 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 Lufkin SSLC's patients that were paid for by Federal health care programs. Senior Counsel Katie Fink represented OIG with the assistance of Program Analyst Mariel Filtz.
04-12-2019
California Physician and Practice Settle False and Fraudulent Claims Case
On April 12, 2019, Complete Women Care, Inc., and Miriam Mackovic-Basic, M.D. (collectively, "CWC"), with multiple locations in Los Angeles County, California, entered into a $258,045 settlement agreement with OIG. The settlement agreement resolves allegations that CWC submitted claims to Medicare for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that CWC submitted claims for: (1) diagnostic electromyography services using CPT Code 51784 and diagnostic anorectal manometry (ARM) services using CPT Code 91122 when therapeutic, not diagnostic services, had been provided; (2) ARM services using CPT Code 91122 that were not performed according to CMS guidelines; (3) pelvic floor electrical stimulation that was not preceded by a four-week course of failed pelvic muscle exercise training; and (4) in 13 instances, evaluation and management services using CPT Code 99214 that did not meet the criteria for billing under that code. OIG's Division of Data Analytics and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Michael Torrisi, with the assistance of Program Analyst Mariel Filtz, collaborated to achieve this settlement.
04-04-2019
Maine Mental Health Service Provider Settles Case Involving Excluded Individual
On April 4, 2019, Aroostook Mental Health Services, Inc. (AMHS), Caribou, Maine, entered into a $17,750.12 settlement agreement with OIG. The settlement agreement resolves allegations that AMHS employed an individual who was excluded from participating in MaineCare, Maine's Medicaid program. OIG's investigation revealed that the excluded individual, a counselor, provided items or services to AMHS's patients that were billed to MaineCare.

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