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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.

06-16-2017
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
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.
04-20-2017
Health Care Administrator Agrees to Voluntary Exclusion
On April 20, 2017, in connection with the resolution of his False Claims Act liability, Yogesh K. Pancholi (Pancholi), Michigan, agreed to be excluded from participation in all Federal health care programs for a period of five years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Pancholi caused the submission of false claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care services that were referred in exchange for illegal remuneration or kickbacks paid by Pancholi. Senior Counsel David Traskey represented OIG.
04-18-2017
Connecticut Hospital Settles False and Fraudulent Medicare Claims Case
On April 18, 2017, Hartford Hospital (Hartford), Connecticut, entered into a $2,469,374 settlement agreement with OIG. The settlement agreement resolves allegations that Hartford submitted claims where patients received home health services within three days of the patients' release from Hartford that were improperly coded as discharged rather than as a post-acute care transfer. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Nancy Brown, collaborated to achieve this settlement.
Connecticut Hospital Settles False and Fraudulent Medicare Claims Case
On April 18, 2017, Midstate Medical Center (Midstate), Connecticut, entered into a $436,748 settlement agreement with OIG. The settlement agreement resolves allegations that Midstate submitted claims where patients received home health services within three days of the patients' release from Midstate that were improperly coded as discharged rather than as a post-acute care transfer. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Nancy Brown, collaborated to achieve this settlement.
Texas Independent Diagnostic Testing Facility Settles False and Fraudulent Medicare Claims Case
On April 18, 2017, Frontera Strategies, LP (Frontera), Texas, entered into a $510,938.74 settlement agreement with OIG. The settlement agreement resolves allegations that Frontera submitted claims to Medicare for nerve conduction studies (NCS) that are considered screening exams and not covered by Medicare. Medicare Administrative Contractor Local Coverage Determinations specified that an electromyography must be performed as well as NCS for diagnostic purposes. 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 settlement.
04-14-2017
Mental Health Services Company Owner Agrees to Voluntary Exclusion
On April 14, 2017, in connection with the resolution of her False Claims Act Liability, Teri Dimond (Dimond), Minnesota, agreed to be excluded from participation in all Federal health care programs for a period of eight years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Dimond, through her company, caused to be presented false claims for mental health services to the Minnesota Medicaid program. OIG alleged the claims were false for one or more of the following reasons: (1) the services were provided by unlicensed practitioners without adequate clinical supervision; and (2) claims for reimbursement were submitted for the time spent maintaining patient records and/or the preparation of reports, in violation of state Medicaid regulations. Senior Counsel Geeta Taylor and Associate Counsel David Fuchs represented OIG.

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