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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.

06-11-2018
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.
05-30-2018
Virginia Non-Profit and Federally Qualified Health Center Settles Case Involving Grant Fraud
On May 30, 2018, St. Charles Health Council, Inc. (St. Charles), Pennington Gap, Virginia, entered into a $115,000 settlement agreement with OIG. The settlement agreement resolves allegations that St. Charles knowingly presented to the Department of Health and Human Services (HHS) a specified claim under an HHS grant that St. Charles knew or should have known was false or fraudulent and knowingly and improperly avoided an obligation to transmit funds to HHS with respect to such grant. Specifically, OIG alleged that St. Charles drew down $500,000 from a Health Resources and Services Administration Capital Development Grant and used the funds for unallowable operating costs unrelated to the grant. OIG further alleged that St. Charles improperly failed to return such funds for over three months. Senior Counsels Michael Torrisi and David Traskey, assisted by Chief Investigator Jennifer Trussell, represented OIG.
05-24-2018
Michigan Drug and Alcohol Rehab Center Settles Case Involving Kickback and Stark Allegations
On May 24, 2018, Recovery Pathways, LLC (Recovery Pathways), Essexville, Michigan, entered into a $64,555 settlement agreement with OIG. The settlement agreement resolves allegations that Recovery Pathways received improper 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 that Recovery Pathways 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.
05-21-2018
Missouri Ambulance District Settles Case Involving False Claims
On May 21, 2018, Pettis County Ambulance District (Pettis), Sedalia, Missouri, entered into a $66,580.10 settlement agreement with OIG. The settlement agreement resolves allegations that Pettis 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. 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.
05-17-2018
Pennsylvania Home Health Company Settles Case Involving Excluded Individual
On May 17, 2018, Immediate Home Care (IHC) in Bensalem, Pennsylvania, entered into a $189,445.68 settlement agreement with OIG. The settlement agreement resolves allegations that IHC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a home health nurse, provided items or services to IHC's patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG.
05-07-2018
Georgia Medical Assistant Agrees to Voluntary Exclusion
On May 7, 2018, in connection with the resolution of his False Claims Act liability, Robert Gennaro (Gennaro), Woodstock, Georgia, agreed to be excluded again from participation in all Federal health care programs for a period of ten years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Gennaro worked at pain management clinics in Georgia and Kentucky that were owned by Dr. Robert Windsor (Dr. Windsor) and operated under the umbrella of National Pain Care, Inc. Dr. Windsor contracted with a company to provide online, real time intraoperative monitoring (IOM) of surgeries. IOM is a medical procedure in which a physician monitors nerve and spinal cord activity during surgical procedures in order to minimize potential adverse effects to a patient's nervous system during surgery. The company billed federal health care programs on behalf of Dr. Windsor for the professional component of the IOM services when Gennaro was performing IOM on Dr. Windsor's behalf. Senior Counsel Lisa Veigel represented OIG.
05-04-2018
Tennessee Hospital Settles Case Involving Patient Dumping Allegation
On May 4, 2018, Houston County Community Hospital (HCCH) in Erin, Tennessee, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegations that HCCH violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination or treatment to stabilize an emergency medical condition for a 58-year-old patient. Specifically, after the patient presented to HCCH's Emergency Department (ED) seeking examination and treatment for blurred vision and dizziness, HCCH failed to provide an appropriate medical screening examination within the capability of the hospital's ED, including ancillary services routinely available to the ED, to determine whether the patient had an emergency medical condition. Instead, an ED nurse directed to the patient to a local eye doctor, delaying provision of an appropriate medical screening examination ultimately performed by another hospital later that same day. Additionally, HCCH failed to provide medical treatment to stabilize the patient's emergency medical condition, a cerebral infarction. Senior Counsel Ellen Slavin represented OIG.
05-04-2018
California Health System Settles Case Involving Excluded Individual
On May 4, 2018, Alameda Health System (AHS), California, entered into a $257,874 settlement agreement with OIG. The settlement agreement resolves allegations that AHS employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an eligibility clerk, provided items or services to AHS's patients that were paid for by Federal health care programs.
04-11-2018
New York Group Home Owner Agrees to Voluntary Exclusion
On April 11, 2018, in connection with the resolution of his False Claims Act liability, Benard Rorie (Rorie), Brooklyn, New York, agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. 1320a-7(b)(7). OIG's investigation revealed that Rorie accepted kickbacks in the form of cash payments from Narco Freedom, Inc. (Narco Freedom), an operator of outpatient substance abuse rehabilitation programs, to refer the residents of group homes managed by Rorie's company, Joining Hands, to Narco Freedom for outpatient programs and to enforce the residents' attendance at those programs regardless of the need for outpatient treatment. Senior Counsels David Fuchs and Geeta Taylor represented OIG.
04-02-2018
North Carolina Hospital Settles Case Involving Patient Dumping Allegations
On April 2, 2018, Southeastern Regional Medical Center (SRMC), Lumberton, North Carolina, entered into a $200,000 settlement agreement with OIG. The settlement resolves allegations that, based on OIG's investigation, SRMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate medical screening exam, stabilizing treatment, and/or an appropriate transfer for four individuals.

Specifically, in the following two instances, SRMC failed to provide an appropriate medical screening examination and/or stabilizing treatment. The first patient, a 71-year-old male who had been living independently, presented to SRMC's Emergency Department (ED) on January 21, 2016, complaining of leg pain, weakness, inability to walk, and a drastic change in behavior and functioning. His daughter reported that he was occasionally disoriented, but that he had just made a trip to visit her and was in good health. The ED physician ordered labs and IV fluids. After about ten hours, the patient was discharged with a diagnosis of dehydration and weakness. Less than six hours later, the patient returned to the ED with similar symptoms and complaints. This time, another ED physician diagnosed the patient with a traumatic subdural hemorrhage and transferred the patient for brain surgery. At the receiving hospital, the patient remained in critical condition for two weeks with diagnoses of acute respiratory failure, possible stroke, and seizures. The patient passed away the following week. The second patient, a 49-year-old male, presented to SRMC's ED on August 27, 2015, with lethargy and overdose of multiple medications. The patient said he was depressed and expressed suicidal ideations. The ED physician ordered blood and urine tests, an EKG, and a head CT, and noted the patient had a history of depression and chronic back pain. The patient was placed on suicide precaution watch, but no psychiatric evaluation was ordered. The patient was discharged about 4.5 hours later with diagnoses of polypharmacy and asthenia with discharge instructions for near-syncope and weakness. Four days later, the patient died due to a self-inflicted gunshot wound to the head.

In two additional instances, SRMC failed to meet its EMTALA obligations when it failed to re-evaluate the patient at the time of transfer to determine whether: (1) the benefits to each patient continued to outweigh the risks, (2) the previous arrangements for appropriate personnel and transportation equipment were appropriate given the patient's deterioration, and (3) additional medical treatment was needed to minimize the risks to the individual's health, and in the case of a woman in labor, the health of the unborn child. The third patient, a 44-year-old female, presented to SRMC's ED on February 28, 2014 at 3:38 p.m. for evaluation of an altered mental status when she was found unresponsive with an empty bottle of butalbital beside her. A CT scan revealed an extensive acute subarachnoid hemorrhage with possible artery aneurysm bleed. At 9:30 p.m., the ED physician certified that the medical benefits of neurosurgery at a hospital over 122 miles away outweighed the risks of transfer. However, the patient was not transferred until 2:16 a.m. the following day, when her condition had significantly deteriorated. The fourth patient, a 26-year-old who was 28 weeks pregnant, presented to the ED on March 13, 2014 with a complaint of ruptured membranes and lower back discomfort. The ED physician examined the patient at 11:15 a.m. and determined that her unborn child required tertiary services not available at SRMC and certified that the medical benefits of delivery at a hospital over 80 miles away outweighed the risks of transfer. However, the patient was not transferred until 1:00 p.m. Between the time of the ED physician's certification and the patient's transfer, the patient continued to have contractions. Senior Counsel Sandra Sands and Associate Counsel Matthew J. Westbrook represented OIG.
04-30-2018
Iowa Hospital Settles Case Involving Patient Dumping Allegation
On April 30, 2018, Covenant Medical Center (Covenant) in Waterloo, Iowa, entered into a $90,000 settlement agreement with OIG. The settlement agreement resolves allegations that Covenant violated the Emergency Medical Treatment and Labor Act when it failed to provide an adequate medical screening examination and stabilizing treatment for a patient and then inappropriately transferred them to another hospital. The patient, a 54-year-old man, arrived by ambulance to Covenant's Emergency Department (ED) complaining of shortness of breath, chest pain, and diaphoresis. The ED physician screened the patient and consulted the on-call cardiologist. The patient's condition worsened and he was intubated. On advice of the on-call cardiologist, the ED physician began transcutaneous pacing. The ED physician did not request the on-call cardiologist present to the ED nor did the on-call cardiologist present to the ED to examine and treat the patient. The ED physician requested transfer to a nearby hospital for placement of a transvenous pacemaker. The patient was transferred to the receiving hospital nearly three hours after he presented to Covenant's ED. The receiving hospital placed a transvenous pacemaker on the patient, but he expired shortly after. OIG alleged that Covenant's on-call cardiologist was capable of providing a transvenous pacemaker. Associate Counsel Madeline Bainer represented OIG.
04-23-2017
Alaska Disability Service Provider Settles False and Fraudulent Claims Case
On April 23, 2017, The Arc of Anchorage (the Arc), Anchorage, Alaska, entered into a $2,049,392.08 settlement agreement with OIG and the Alaska MFCU, and a 5-year corporate integrity agreement with OIG. The settlement agreement resolves allegations that the Arc knowingly submitted or authorized the submission of claims to the Alaska Medicaid program for items or services that the Arc knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG and Alaska MFCU alleged the Arc (1) billed for services not provided; (2) billed for individual and group services at the same time with the same servicing provider; and (3) billed for overlapping services with the same servicing provider. OIG and Alaska MFCU also alleged that the Arc knowingly retained an overpayment owed to the Alaska Medicaid program which was identified in audits performed by or at the direction of the Arc. Senior Counsel Katherine Matos represented OIG.
04-09-2018
North Carolina Hospital Settles Case Involving Patient Dumping Allegation
On April 9, 2018, CAH Acquisition Company 1 d/b/a Washington County Hospital (WCH), Plymouth, North Carolina, entered into a $52,414 settlement agreement with OIG. The settlement agreement resolves allegations that WCH violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination and stabilizing treatment for a patient. An ambulance was called to provide medical assistance to the patient, a 54-year-old woman, who was suffering from a worsening of the shortness of breath that she had been experiencing for two weeks. The emergency medical technicians (EMTs) arrived at the patient's residence and found that she was experiencing uncontrolled hypertension and increased shortness of breath with dyspnea on exertion. The EMTs drove the patient to WCH's Emergency Department (ED), which was located two minutes from the patient's residence. En route, the EMTs called WCH to report on the patient's condition and to notify WCH that the EMTs were bringing the patient to WCH's ED. When the ambulance carrying the patient was on WCH's property, the EMTs were asked to call WCH. Subsequently, WCH's ED staff informed the EMTs that WCH was on diversion and could not see the patient. WCH, however, was not on diversion and, even though WCH was aware that the ambulance was already on its property, WCH directed the EMTs to take the patient to another hospital located 22 miles away. Associate Counsel Srishti Sheffner represented OIG.
04-05-2018
Alabama Physician and Practice Settle Case Involving Kickback and Stark Allegations
On April 5, 2018, AMC - Affordable Medical Care f/k/a Andalusia Medical Center and Dr. Kevin Diel (collectively, "AMC"), Opp, Alabama, entered into a $40,500.50 settlement agreement with OIG. As a result of its investigation, OIG alleged that AMC received improper 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 that AMC 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.

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