Civil Fines and Positive Exclusions | Office of the Inspector General (2023)

Table of Contents
2020 2019 2018 2017 2016 2015 2014 2013 Videos

2020

22.12.2020
Aeon Global Health agreed to pay $75,000 for allegedly violating the Civil Penalties Act by filing claims for uncovered services
On December 22, 2020, Peachstate Health Management, LLC d/b/a Aeon Global Health ("Aeon Global Health"), headquartered in Gainesville, Georgia, entered into a $75,000 settlement agreement with OIG. The Settlement Agreement resolves allegations that Aeon Global Health filed trial validity testing (SVT) claims with Medicare in connection with urine drug testing claims when SVT was an uncovered service. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans, worked together to achieve this resolution.
21.12.2020
Frye Regional Medical Center agreed to pay $100,000 for alleged patient-dumping statute violations by failing to provide adequate medical screening and stabilizing treatment
On December 21, 2020, Frye Regional Medical Center (FRMC), Hickory, North Carolina, entered into a $100,000 settlement agreement with OIG. The settlement agreement eliminates allegations that FRMC, based on the OIG's investigation, violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide a 53-year-old individual with adequate medical screening and stabilizing treatment. Specifically, the subject presented to the FRMC Emergency Department (ED) at 7:37 am on January 10, 2016, complaining of chest pains. The person immediately received an electrocardiogram (ECG), which was read by a doctor two minutes later. The ECG was normal. The triage sister documented “chest pain since last night, as well as nausea, vomiting and diarrhea” as the main complaints. The person was sent to the waiting room without drawing any labs. The person's spouse then repeatedly asked for medical help as the person was lying on the floor due to increasing chest pain. When a nurse finally answered, she told the spouse that they would have to wait. No re-evaluation of the person was performed. At 11:21 a.m., the medical record noted that the individual had left without treatment. The individual was presented at a second hospital at 11:25 am where the individual received emergency cardiac catheterization and was diagnosed with triple vessel disease. The subject required an urgent coronary artery bypass graft and was sent back to the FRMC where the subject underwent a triple coronary artery bypass graft the next day. Senior Counsel Sandra Sands represented OIG.
17.12.2020
Steven Yohay has agreed to be disfellowshipped for 15 years for tricking Medicaid beneficiaries into bribing Medicaid patients into substance abuse treatment
On December 17, 2020, Steven Yohay, of Oak Beach, New York, consented, pursuant to 42 U.S.C. 1320a-7(b)(7) for 15 years. The investigation found and the OIG alleged that Yohay, as the majority owner, president and former CEO of A.R.E.B.A.-CASRIEL, Inc. d/b/a addiction treatment interventions Chemical Dependency Treatment Centers (ACI), was involved in an illegal kickback program involving the use of hired drivers to solicit and recruit Medicaid beneficiaries for enrollment in ACI's treatment programs, resulting in false Medicaid payment claims. OIG further alleged that Yohay employed and paid a person - allegedly for translation services - to induce that person to refer patients to ACI, resulting in false claims for payment from Medicaid. OIG also claimed that Yohay knew that ACI had enrolled Medicaid patients into its inpatient treatment program who were not evaluated by a qualified healthcare professional in accordance with applicable state laws and forged records with false signatures, but failed to recover funds obtained using of incorrect documentation was received to repay to Medicaid. OIG was represented by Senior Counsel Andrea Treese Berlin and David Fuchs.
14.12.2020
dr Milan Chakrabarty and the Hemet Endoscopy Center agreed to pay $66,000 for alleged violations of the Civil Penalty Law by failing to return and falsely confirming their eligibility to receive CARES Law assistance funds.
On December 14, 2020, Milan S. Chakrabarty, M.D. (Dr. Chakrabarty) and the Hemet Endoscopy Center (Hemet Endoscopy), Hemet, Calif., entered into a $66,715.47 settlement agreement with OIG. The settlement agreement eliminates allegations that Dr. Chakrabarty and Hemet Endoscopy have knowingly misrepresented, used or made any document required to be produced in order to obtain or withhold, directly or indirectly, any or all of the funds provided by the HHS Secretary. Specifically, OIG alleges that Hemet Endoscopy, an outpatient surgery center owned by Dr. Chakrabarty, received a payment from the Provider Relief Fund under the CARES Act on April 17, 2020. On April 27, 2020, an employee of Dr. Chakrabarty on the HHS Provider Relief Fund Portal that Hemet Endoscopy was eligible to receive this payment because, among other things, it was treating patients after January 31, 2020 and its Medicare billing privileges had not been revoked. However, Hemet Endoscopy did not treat patients after January 31, 2020, and HHS had revoked its Medicare billing privileges on November 22, 2019. Hemet Endoscopy subsequently withheld its April 17, 2020 Provider Relief Fund payment and a subsequent May 26, 2020 Provider Relief Fund payment, although you do not have the right to withhold those payments. Senior Counsel Michael Torrisi, assisted by Chief Investigator Amber Mahmood, represented OIG.
08.12.2020
Teresita Alquero agreed to be disfellowshipped for 5 years for paying compensation in the form of a medical director's fee above fair market value in exchange for referrals and filed claims that misidentified the treating physician
Effective December 8, 2020, in connection with the resolution of her liability under the False Claims Act, Teresita Lumanas Alquero (Alquero), Sugar Land, Texas, consented pursuant to 42 U.S.C. 1320a-7(b)(7) for 5 years. The investigation found, and the OIG alleged, that Alquero knowingly and knowingly paid a physician improper compensation in excess of fair market value in the form of medical director's fees in order to facilitate its referrals of Medicare patients to homecare and hospice businesses operating earlier in the owned by Alquero and filed claims with Medicare related to those transfers. OIG also alleged that Alquero filed payment claims identifying another doctor as the treating physician, when in fact the doctor was not providing patient services because he was being held in a federal prison and his medical license was suspended. Senior Counsel Ellen Slavin represented OIG.
07.12.2020
James Carpenter and Solace Advancement have agreed to be banned for 20 years for causing false neurostimulator claims to be filed
On December 7, 2020, James Carpenter (Carpenter), of Rockledge, Florida, and Solace Advancement, LLC (Solace), Michigan, in connection with the resolution of their liability under the False Claims Act, consented pursuant to 42 U.S.C. 1320a-7(b)(7) for twenty years. The investigation found and the OIG alleged that Carpenter and Solace promoted and sold the P-Stim and Stivax devices by participating in a program to mislead medical providers that Medicare sold the Stivax and P-Stim devices and refunded the provider services associated with the devices. As part of the program, Carpenter, Solace and others misrepresented and advised healthcare providers in the United States that it was appropriate to file claims for reimbursement with Medicare for: (a) the Stivax device by filing the Healthcare Common Procedure Coding System ("HCPCS") codes, including L8679; and (b) for the services of the medical provider using the Stivax device by submitting a plurality of Current Procedural Terminology ("CPT") codes. However, these codes were at all times intended to reimburse materials and services related to surgically implanted neurostimulators, which are implanted under the skin by a surgeon in a surgical setting. The P-Stim and Stivax devices are not implantable neurostimulators, but electroacupuncture devices that are placed on the patient's ear in a doctor's office without anesthesia. Medicare does not reimburse for electroacupuncture devices and related services. Senior Counsel Katie Fink represented OIG.
04.12.2020
Barry McLeod-Hughes has agreed to be banned for 7 years for misrepresenting physical therapy services
On December 4, 2020, in connection with the resolution of his liability under the False Claims Act, Barry McLeod-Hughes (McLeod-Hughes), Byron, Georgia consented pursuant to 42 U.S.C. 1320a-7(b)(7) for 7 years. The investigation found, and the OIG alleged, that McLeod-Hughes and his practice, McLeod-Hughes and Associates Physical Therapy and Rehabilitation Clinic, d/b/a McLeod-Hughes and Associates Inc., filed claims with Medicare and TRICARE for physical therapy services they allegedly provided filed by McLeod-Hughes to Medicare and TRICARE beneficiaries when actual athletic trainers and other unlicensed or unrecognized individuals provided the physical therapy services. Senior Counsel Matthew Westbrook represented OIG.
02.12.2020
New Horizons Medical, Inc. agreed to pay $84,000 for alleged violations of the Civil Penalties Act by filing claims for uncovered services
On December 2, 2020, New Horizons Medical, Inc. (New Horizons), Framingham, Massachusetts, entered into a $84,393.68 settlement agreement with OIG. The Settlement Agreement resolves allegations that New Horizons Medicare made sample validity testing (SVT) claims in connection with urine drug testing claims when SVT was an uncovered service. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker, worked together to achieve this resolution.
17.11.2020
Mathias Berry, DC and Katherine Ross, DC have agreed to be disfellowshipped for making false claims about medically unnecessary knee braces that have been tainted by kickbacks
Effective November 17, 2020, Mathias Berry, DC (Berry), Puyallup, Wash., and Katherine Ross, DC (Ross), Kirkland, Wash., in connection with the resolution of their False Claims Act liability, pursuant to 42 U.S.C. 1320a-7(b)(7). Berry agreed to be barred for 8 years and Ross agreed to be barred for 5 years. The investigation found and the OIG alleged that Berry and Ross Medicare knowingly made false claims of medically unnecessary viscosupplementation and medically unnecessary knee braces made or submitted by the Osteo Relief Institute clinics, which were also tainted by kickbacks solicited by Berry and a and affiliated company known as Results Laboratories, LLC. Senior Counsel Keshia Thompson represented OIG.
13.11.2020
Israel Weber and Pharmex Pharmacy were disqualified for late payment
On November 13, 2020, OIG disbarred Israel Weber and Pharmex Pharmacy, LLC (collectively, "Pharmex"), Lakewood, New Jersey, for failure to meet payment obligations under a settlement agreement with OIG, in which OIG alleged that Pharmex Pharmacy employed a person who was barred from participating in a federal health program. Pharmex's suspension will remain in effect until Pharmex recovers from default on its payment obligations and OIG reinstates Pharmex's participation in government health programs. Senior Counsel Srishti Sheffner and Geoffrey Hymans represented OIG.
09.11.2020
dr Anthony Cruse has agreed to be banned for 10 years for receiving improper compensation
Effective November 9, 2020, Anthony L. Cruse, D.O., of Oklahoma City, Oklahoma consented, pursuant to 42 U.S.C. 1320a-7(b)(7) for 10 years. The investigation found and the OIG claimed that Dr. Cruse knowingly received improper compensation from Orthopedic & Multispecialty Surgery, LLC (OCOM) in exchange for referrals or had received or caused other physicians to receive or cause other physicians from Southwest Orthopedic Specialists, PLLC (SOS) in violation of the Anti-Kickback Statute in the form of: (1) free or below fair market value office space, employees and supplies; (2) compensation in excess of market value for the services provided by SOS and Cruse; (3) Repurchase Provisions and Payments for Dr. Cruse and other SOS doctors in their OCOM equity that exceeded fair market value; and (4) preferred investment opportunities related to the provision of anesthesia services at OCOM by Oklahoma, LLC anesthesia partners. OIG also claimed that Dr. Cruse engaged in conduct that failed to meet the requirements of an applicable exception to the Physician Self-referral Act because Dr. Cruse and SOS: (1) were compensated by OCOM in the form of below fair market value compensation for office space, staff and supplies; and (2) by OCOM above fair market value for SOS and Dr. Services rendered by Cruse. dr Cruse and SOS referred OCOM for specific healthcare services, which resulted in OCOM submitting requests to Medicare for payment for those specific healthcare services. Senior Counsel Karen Glassman represented OIG.
13.10.2020
William Rosellini and his companies agreed to pay $50,000 and be disfellowshipped for 5 years for allegedly violating the civil fines statute by improperly claiming funds from NIH small business research grants
On October 13, 2020, William Rosellini, Nexeon Medsystems, Inc., Pulsus Medical, LLC, and Nexeon Medsystems Puerto Rico Operating Company, Inc. (collectively, "Nexeon") entered into a settlement agreement with OIG, to which they agreed to pay $50,000 and from participating in all state health programs for five years under 42 U.S.C. to be excluded. 1320a-7a and 42 U.S.C. 1320a-7(b)(7). The Settlement Agreement eliminates allegations that Nexeon withdrew funds from the HHS payment management system from National Institutes of Health (NIH) Small Business Innovation Research (SBIR) awards that: (1) to a foreign subsidiary without NIH approval in violation of NIH SBIR requirements; (2) based on estimates and other potential costs that were never incurred; (3) commingled among various affiliates and used for improper expenses unrelated to the NIH SBIR awards; and (4) not supported by adequate documentation to ensure that funds for eligible expenses have been used in accordance with the terms of the awards. Senior Counsels Michael Torrisi and David Traskey, assisted by Chief Investigator Amber Mahmood, represented OIG.
Advanced pain management specialists agreed to pay $24,000 for the alleged civil fines statute violation by filing claims for uncovered services
On October 13, 2020, Advanced Pain Management Specialists, P.A., (Advanced Pain), Fort Myers, Florida entered into a $24,921.96 settlement agreement with OIG. The settlement agreement resolves allegations that Advanced Pain filed trial validity test (SVT) claims with Medicare in connection with urine drug test claims when SVT was an uncovered benefit. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker, worked together to achieve this resolution.
30.09.2020
dr Joseph Rizzo and the Center for Preventive and Regenerative Medicine have agreed to be disfellowshipped for 7 years for receiving improper compensation in the form of alleged research grants
On September 30, 2020, Joseph Rizzo, M.D. (Dr. Rizzo) and the Center for Preventative and Regenerative Medicine, P.A. (CPRM), of Lubbock, Texas, both agreed, pursuant to 42 U.S.C. 1320a-7(b)(7) for 7 years. The investigation found and the OIG claimed that Dr. Rizzo and CPRM received compensation in the form of purported research grants from a distribution company and two laboratories in exchange for Dr. Rizzo clinical laboratory services ordered by laboratories. Under this financial agreement, the labs performed the work performed by Drs. Rizzo commissioned clinical laboratory services and filed payment claims with the Medicare program in violation of the Anti-Kickback Statute. Senior Counsel Karen Glassman represented OIG.
11.09.2020
dr Hy Ngo agreed to pay $85,000 for allegedly violating the Civil Penalties Act by employing an expelled person
On September 11, 2020, Hy Ngo, MD (Dr. Ngo) of Los Angeles, California entered into a $85,318.98 settlement agreement with OIG. The settlement agreement eliminates allegations that Dr. Ngo employed a person who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a physician, provided items or services that were billed to government healthcare programs. Associate Counsel Jonathan Culpepper represented OIG.
04.08.2020
Northern Lighthouse agreed to pay $29,000 for allegedly violating the Civil Penalties Act by employing a disfellowshipped person
On August 4, 2020, Northern Lighthouse entered into a settlement agreement with multiple Maine locations for $29,971.36 with OIG. The settlement agreement eliminates allegations that Northern Lighthouse employed a person who was disqualified from participating in a federal health program. The OIG's investigation determined that the excluded individual, a direct support worker, provided items or services that were billed to government healthcare programs.
20.07.2020
Texas company and owner agree to voluntary disqualification
On July 20, 2020, Jason Bourque (Bourque) and Allen Research Corporation (Allen Research), Frisco, Texas, in connection with the resolution of their liability under the False Claims Act, consented pursuant to 42 U.S.C. 1320a-7(b)(7) for 10 years. The investigation found, and OIG claimed, that Bourque and Allen Research: Recruited physicians to be part of an alleged "research study" for transdermal pain cream; directed certain recruited doctors who participated in the alleged "research study" to mail prescriptions for pain creams to a pharmacy in Allen, Texas; had an agreement with the pharmacy under which the pharmacy agreed to pay Bourque and Allen Research a percentage of their insurance reimbursements, including amounts paid by TRICARE, for prescription pain reliever creams that Bourque and Allen Research had the pharmacy fill; and then paid certain doctors who wrote the prescriptions a percentage of the amount received from the pharmacy. OIG claimed that the agreement between Bourque, Allen Research, the pharmacy and the doctors violated the anti-kickback statute. Senior Counsel Karen Glassman represented OIG.
14.07.2020
New York Federally Qualified Health Center settles case involving false grant claims and misrepresentations
On July 14, 2020, Brooklyn Plaza Medical Center (BPMC), a federally qualified medical center in Brooklyn, New York, entered into a $100,000 settlement agreement and 5-year recipient compliance agreement with OIG. The Settlement Agreement eliminates allegations that BPMC made misspecified claims in the form of claims from the HHS payment management system for grant funds managing health resources and services that were not supported by adequate documentation, timesheets, and a financial management and control system to support them Guaranteed HHS grant funds were used only for authorized purposes under federal laws, regulations and the terms of BPMC's federal grants. The OIG further alleged that on several occasions during the same period, BPMC falsely disclosed the following in funding applications to HHS: (1) safeguards to prohibit employees from using their positions for personal gain; and (2) a financial management and control system that ensured that HHS grant funds were used only for authorized purposes under federal laws, regulations and the terms of BPMC's federal awards. The Office of Investigations and the Office of Counsel to the Inspector General, represented by Senior Counsels Michael Torrisi and David Traskey, worked together to reach this settlement.
07-10-2020
Texas Skilled Nursing Facility adjudicates case of disfellowshipped person
On July 10, 2020, RJ Meridian Care Alta Vista, LLC d/b/a Meridian Care Monte Vista (Meridian Care), San Antonio, Texas entered into a $143,630.83 settlement agreement with OIG. The settlement agreement eliminates allegations that Meridian Care employed an individual who was disqualified from participating in a federal healthcare program. The OIG's investigation determined that the disfellowshipped individual, an admissions officer, provided items or services that were billed to government healthcare programs.
29.06.2020
The Florida practice settles a case of false allegations
On June 29, 2020, the Florida Pain and Rehabilitation Center (FPRC), Lake City, Florida entered into a settlement agreement with OIG for $94,658.76. The settlement agreement resolves allegations that FPRC filed sample validity testing (SVT) claims with Medicare in connection with urine drug testing claims when SVT was an uncovered service. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker, worked together to achieve this resolution.
Florida Laboratory settles case with false claims
On June 29, 2020, River Crossing Labs, LLC (RCL) of Tampa, Florida entered into a $68,253.44 settlement agreement with OIG. The Settlement Agreement resolves allegations that RCL Medicare made trial validity testing (SVT) claims in connection with urine drug testing claims when SVT was an uncovered service. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker, worked together to achieve this resolution.
06-05-2020
Florida Laboratory settles case with false claims
On June 5, 2020, Complete Biosolutions, Inc. (CBI), of Hialeah, Fla., entered into a $126,793.56 settlement agreement with OIG. The settlement agreement resolves allegations that CBI filed sample validity testing (SVT) claims with Medicare in connection with urine drug testing claims when SVT was an uncovered service. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker, worked together to achieve this resolution.
01.06.2020
Mark Kaiser and Doc Solutions have agreed to be banned for 20 years for causing false neurostimulator claims to be filed
On June 1, 2020, in connection with the resolution of their liability under the False Claims Act, Mark Kaiser (Kaiser), Bradenton, Fla., and Doc Solutions LLC (Doc Solutions), Indiana, consented pursuant to 42 U.S.C. 1320a-7(b)(7) for twenty years. The Government alleged that Kaiser and Doc Solutions had misrepresented to healthcare providers that it was appropriate to submit Medicare reimbursement claims: (a) for the Stivax device by submitting Healthcare Common Procedure Coding System (HCPCS) codes, including L8679; and (b) for the services of the physician using the Stivax device by submitting a plurality of Current Procedural Terminology (CPT) codes. However, the HCPCS and CPT codes promoted by Kaiser and Doc Solutions were at all times intended to reimburse materials and services related to surgically implanted neurostimulators, which are implanted under the skin by a surgeon in a surgical setting. The Stivax device is not an implantable neurostimulator, but an electroacupuncture device that is placed on the patient's ears without anesthesia in a doctor's office. Medicare does not reimburse for electroacupuncture devices and related services. Senior Counsel Katie Fink represented OIG.
27.05.2020
The Florida practice settles a case of false allegations
On May 27, 2020, Stages of Life Medical Institute, Inc. (SLMI), of Longwood, Florida, entered into a $54,746.52 settlement agreement with OIG. The Settlement Agreement resolves allegations that SLMI filed trial validity testing (SVT) claims with Medicare in connection with urine drug testing claims when SVT was an uncovered service. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker, worked together to achieve this resolution.
21.05.2020
Texas Pharmaceutical Company settles drug price reporting case
On May 21, 2020, Method Pharmaceuticals, LLC (Method), Fort Worth, Texas, entered into a $45,000 settlement agreement with OIG. The Settlement Agreement resolves allegations that Method failed to provide the Centers for Medicare and Medicaid Services (CMS) with timely certified monthly and quarterly Average Manufacturer's Price (AMP) data for certain months and quarters in 2015, 2016, 2017 and 2018 to transmit. The Medicaid The Drug Rebate program requires manufacturers to enter into and enforce a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the manufacturer's covered outpatient medications. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Mary Riordan represented OIG with support from program analyst Mariel Filtz.
14.05.2020
South Carolina Ambulance Company settles case with false allegations
On May 14, 2020, Vital Care EMS, Inc. (Vital Care), an ambulance provider serving Sumter, Columbia and Greenville, South Carolina, entered into a $2,213,516.71 settlement agreement with OIG. The settlement agreement resolves allegations that Vital Care made Medicare Part B claims for medical transportation to and from qualified nursing facilities (SNFs) when such transportation was covered by the consolidated SNF Medicare Part A bill payment. OIG Office of Audit Services and Office of the Inspector General's Counsel, represented by Senior Counsels Srishti Sheffner and Geoffrey Hymans, worked with the support of Paralegal Jennifer Hilton to achieve this resolution.
05-08-2020
Illinois Diagnostic Service Provider and Owner settle case with false claims
On May 8, 2020, Hussain Ghalib and U.S. Diagnostics, Inc. (collectively “US Diagnostics”) of Chicago, Illinois, entered into a $147,302.35 settlement agreement with OIG. The Settlement Agreement eliminates allegations that US Diagnostics filed claims for Healthcare Common Procedure Coding System (HCPCS) code 93965 when those claims applied to a procedure already included as part of the duplex ultrasound procedures for which US Diagnostics claims under using HCPCS codes 93970 or 93971 for the same beneficiary on the same delivery days. The OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not be billed separately and was not medically necessary. Senior Counsel Geoffrey Hymans and Joan Matlack represented OIG, assisted by Program Analyst Mariel Filtz.
22.04.2020
The Texas doctor agrees to the voluntary exclusion
On April 22, 2020, in connection with the resolution of his liability under the False Claims Act, Maaz Abbasi, M.D., of Houston, Texas, consented pursuant to 42 U.S.C. 1320a-7(b)(7) for three years. The investigation found that in exchange for illegal remuneration: (1) Dr. Abbasi signed Medicare home health care certificates and plans certifying patients' eligibility for home healthcare services without knowledge of the patient's medical condition or homebound status; and (2) dr. Abbasi signed another physician's signature on Medicare Home Health Certificates and Care Plans of Care, certifying the patient's eligibility for home health services without the physician's authorization, permission, or knowledge and without knowledge of the patient's medical condition or homework status . Senior Counsel Ellen Slavin represented OIG.
20.04.2020
Georgia Hospital settles case involving allegations of patient dumping
On April 20, 2020, DeKalb Medical Center, Inc. (DeKalb), Decatur, Georgia, entered into a $260,000 settlement agreement with OIG. The settlement agreement eliminates allegations that DeKalb violated the Emergency Medical Treatment and Labor Act (EMTALA) based on OIG's investigation when it failed to provide adequate screening testing and stabilizing treatment for twenty-one individuals. Below are examples of such incidents.

Patient N.R.A., a 25-year-old female, presented to DeKalb's Emergency Department (ED) on January 18, 2015 with complaints of acute stomach pain, nausea, and vomiting. The medical record also listed a possible pregnancy as her main complaint. N.R.A. had a history of peptic ulcer disease and peptic ulcer disease. Medical records indicate that N.R.A. was seen by a registered nurse and triaged using an Emergency Severity Index at Level 4 (indicating a non-urgent patient). The triage nurse recorded vital signs from N.R.A. and marked "No" next to nine questions on a non-patient specific checklist. Within six minutes of the nurse beginning the triage process, N.R.A. was discharged from DeKalb's ER.

Patient B.B., a 29-year-old man, was rushed to DeKalb's emergency room by ambulance on February 2, 2015 after complaining of neck pain after suffering a car accident an hour before arriving. B.B. rated his pain as a 5 on a scale of 1 to 10 (with 10 being the worst). Medical records indicate that B.B. was evaluated by a registered nurse who triaged him using the Emergency Severity Index at Level 4 (indicating a non-urgent patient). The triage nurse recorded B.B.'s vital signs. and marked "No" next to nine questions on a non-patient specific checklist. B.B. was then discharged from DeKalb's emergency room.

In each of the incidents described above, DeKalb's ER was able to conduct appropriate medical screening to determine if patients had a medical emergency and provide stabilizing treatments if patients had such conditions, but OIG claims that DeKalb did not do this. Similar incidents occurred with the following 19 people who presented to DeKalb's ER: C.R.B. (01/24/2015); BNC (01/30/2015); DMA (02/02/2015); TR (03/02/2015); DM. (2/6/2015); direct current (02/10/2015); TD (02/11/2015); T.M.M. (02/24/2015); A.A.H. (03/01/2015); MCB (03/02/2015); R.S.M. (3/3/2015); W.P.H. (03/06/2015); F.D.R. (7.3.2015); K.D. (04/05/2015); T.M.C. (04/09/2015); TC (04/09/2015); R.L.M. (04/09/2015); TB (04/10/2015); and LDC (09/01/2015). In each of these cases, the OIG determined that DeKalb failed to provide these individuals with appropriate medical evaluation or stabilizing treatment within the capabilities of his ED. Senior Counsel Srishti Sheffner represented OIG.

04-06-2020
New Mexico doctor and practice settle case with false claims
On April 6, 2020, Gopal Reddy, M.D. and Gopal Reddy M.D., P.C. (collectively "Dr. Reddy"), of Albuquerque, New Mexico, entered into a $199,705.36 settlement agreement with OIG. The settlement agreement eliminates allegations that Dr. Reddy filed claims for Healthcare Common Procedure Coding System (HCPCS) code 93965 when those claims applied to a procedure that was already included as part of the duplex ultrasound procedures that Dr. Reddy filed claims with HCPCS codes 93970 or 93971 for the same beneficiary on the same benefit dates. The OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not be billed separately and was not medically necessary. Senior Counsel Geoffrey Hymans and Joan Matlack represented OIG, assisted by Program Analyst Mariel Filtz.
30.03.2020
North Carolina Ambulance Company settles case with false claims
On March 30, 2020, Bertie Ambulance Service, Inc. (Bertie), of Windsor, North Carolina, entered into a $342,208.22 settlement agreement with OIG. The settlement agreement resolves allegations that Bertie filed Medicare Part B claims for medical transportation to and from qualified nursing facilities (SNFs) when such transportation was covered by the consolidated SNF Medicare Part A bill payment. 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 support of Paralegal Jennifer Hilton, worked together to achieve this resolution.
23.03.2020
Massachusetts Ambulance Company settles case with false claims
On March 23, 2020, STAT Ambulance Service of New England, Inc. (STAT), New Bedford, Massachusetts entered into a $75,228.16 settlement agreement with OIG. The Settlement Agreement eliminates allegations that STAT asserted claims against Medicare Part B for medical transportation to and from qualified nursing facilities (SNFs) when such transportation was already covered by the consolidated SNF Medicare Part A billing payment. OIG's Office of Audit Services and Office of Legal Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans, with the support of Legal Assistant Jennifer Hilton, worked together to achieve this resolution.
03-12-2020
Arkansas assisted living facility barred for non-compliance
On March 12, 2020, OIG disbarred Whispering Knoll, of Pine Bluff, Arkansas, for failure to make payment under a settlement agreement with OIG in which OIG alleged that Whispering Knoll employed an individual who was disqualified from participating in a federal healthcare program. Whispering Knoll's suspension will remain in effect until the default in its payment obligations is resolved and OIG resumes Whispering Knoll's participation in government healthcare programs. Senior Counsel Nancy Brown represented OIG with support from Paralegal Specialist Jennifer Hilton.
03-12-2020
Colorado doctors and practice settle case with bribes
On March 12, 2020, Chad E. Boekes, M.D., Louis B. Kasunic, D.O., and Castle Rock Family Physicians, P.C. (collectively “Castle Rock”), Castle Rock, Colorado, entered into a $54,982 settlement agreement with OIG. The settlement agreement eliminated allegations that Castle Rock solicited and received compensation in the form of "litigation and settlement payments" related to the blood collection from laboratory companies Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex). OIG alleged that Castle Rock solicited and received compensation from HDL and Singlex in return for Castle Rock and Castle Rock employees who referred patients to HDL and Singlex for laboratory testing paid for by the Medicare program. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
03-06-2020
Illinois Independent Diagnostic Testing Facility settles case with false claims
On March 6, 2020, Dav-Kim Portable X-Ray Services Co. (Dav-Kim), of Skokie, Illinois, entered into a $126,628.76 settlement agreement with OIG. The Settlement Agreement eliminates allegations that Dav-Kim filed claims for Healthcare Common Procedure Coding System (HCPCS) code 93965 when those claims related to a procedure that was already included as part of the duplex ultrasound procedures for which Dav-Kim Kim's claims had HCPCS codes 93970 or 93971 for the same beneficiary on the same benefit dates. Senior Counsel Geoffrey Hymans and Joan Matlack represented OIG, assisted by Program Analyst Mariel Filtz.
18.02.2020
Texas doctor and practice settle case with 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, a $71,168.20 settlement agreement with OIG. The settlement agreement eliminates allegations that Dr. Robbins filed claims for Healthcare Common Procedure Coding System (HCPCS) code 93965 when those claims related to a procedure that was already included as part of the duplex ultrasound procedures for which Dr. Robbins' claims had HCPCS codes 93970 or 93971 for the same beneficiary on the same benefit dates. The OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not be billed separately and was not medically necessary. Senior Counsel Geoffrey Hymans and Joan Matlack represented OIG, assisted by Program Analyst Mariel Filtz.
02-10-2020
Maryland Hospital settles case involving allegations of patient dumping
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 eliminates allegations that UMMC violated the Emergency Medical Treatment and Labor Act (EMTALA) based on the OIG's investigation by failing to provide adequate medical screening and stabilizing care to a 22-year-old patient. Specifically, the patient presented to the UMMC Emergency Department (ED) by ambulance on January 9, 2018. The patient was diagnosed with a facial bruise and a lip abrasion and was discharged. The patient refused to sign the discharge forms, stated that she was homeless and refused to leave the premises. The patient was escorted from UMMC premises by security forces wearing only a hospital gown and socks. The following day, the patient returned to the UMMC emergency room by ambulance after a passerby called 911. The passer-by found the patient in 30 degrees at a bus stop in front of the hospital. A nurse told the patient that if she didn't have a place to stay, she would have to go to an animal shelter. The patient was then discharged without medical check-up or stabilization. Associate Counsel Candace Ashford represented OIG.
02-03-2020
Kentucky Medical Group settles case with 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 filed claims for sample validity testing (SVT), an uncovered service, with Medicare. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Geoffrey Hymans and David Traskey represented OIG, with support from Paralegal Specialist Jennifer Hilton.
22.01.2020
New York Ambulance Company settles case with false claims
On January 22, 2020, SeniorCare Emergency Medical Services, Inc. (SeniorCare), of Bronx, New York, entered into a $1,231,854.09 settlement agreement with OIG. The settlement agreement resolves allegations that SeniorCare asserted claims against Medicare Part B for medical transportation to and from qualified nursing facilities (SNFs) when such transportation was already covered by the consolidated SNF Medicare Part A billing payment. OIG's Office of Audit Services and Office of Legal Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans, with the support of Legal Assistant Jennifer Hilton, worked together to achieve this resolution.
Illinois doctor settles case with false claims
On January 22, 2020, Dominic Tolitano, M.D., of Wood Dale, Illinois, entered into a $130,253.98 settlement agreement with OIG. The settlement agreement eliminates allegations that Dr. Tolitano filed claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, even though those claims were for a procedure that was already included as part of the duplex ultrasound procedures that Dr. Tolitano had filed claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same benefit dates. The OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not be billed separately and was not medically necessary. Senior Counsel Geoffrey Hymans and Joan Matlack represented OIG, assisted by Program Analyst Mariel Filtz.

2019

31.12.2019
The Pennsylvania psychiatric facility and owners agree to voluntary evictions
On December 31, 2019, 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, under 42 U.S.C. 1320a-7(b)(7) Tree of Life agreed to be barred for 25 years Ada Vidal and Victor Vidal agreed to be barred for 20 years The Inquisition found that Tree of Life, Ada Vidal and Victor Vidal: (1) knowingly filed or caused the filing of thousands of fraudulent Medicaid claims for outpatient mental health services for services never provided or falsely overcharged, services based on false patient progress notes and Billing sheets and forged signatures of psychiatrists and therapists and services rendered by unqualified persons; and (2) knowingly submitted or prompted the filing of fraudulent Medicaid mental health outpatient claims resulting from the payment of compensation to a social worker for referrals of patients, including Medicaid patients. Senior Counsel Sarah Kessler represented OIG.
26.12.2019
Dental case in Maryland involving a disfellowshipped person
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 eliminates allegations that Dr. Brodell employed a person who was disqualified from participating in a federal health care program. The OIG's investigation determined that the disfellowshipped individual, a dentist, provided items or services billed to government healthcare programs. The Office of Investigations and the Office of Counsel to the Inspector General, represented by Senior Counsels Katie Fink and Jennifer Leonardis, worked together to reach this settlement.
Nevada hospital settles patient dumping case
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 eliminates allegations that, based on the OIG's investigation, St. Rose violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide appropriate medical screening, stabilizing treatment and transfer of a patient. On May 22, 2016, the patient presented to the St. Rose Emergency Department (ED) complaining of dizziness, black stools, yellow skin, and stiff muscles. Admitted with low blood pressure and no blood products, he went into cardiac arrest and died shortly after arriving at the receiving hospital. Senior Counsel Sandra Sands represented OIG.
The California hospital is settling the case involving allegations of patient dumping
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 eliminates allegations that San Mateo violated the Emergency Medical Treatment and Labor Act (EMTALA) based on the OIG's investigation when it failed to provide adequate medical screening, stabilizing treatment and transfer for a 23-year-old pregnant woman to provide . On August 24, 2016, the patient presented to the San Mateo Emergency Department (ED) complaining of abdominal pain with some vaginal discharge and bleeding for approximately four hours. She was about 25 weeks pregnant. San Mateo did not perform a vaginal examination and did not determine if the patient was in labor. San Mateo's emergency physician arranged for the patient to be transferred to another hospital for a higher level of care. The ED doctor was informed that it would take 45 minutes for the ambulance to arrive at the San Mateo emergency room and therefore recommended that the patient be transported in a private vehicle. The patient gave birth to her baby in her car on the way to the receiving hospital and the patient herself was diverted to another hospital, arriving 26 minutes later. The baby was not breathing on arrival at the hospital and the NICU was unable to resuscitate the baby. Senior Counsel Sandra Sands represented OIG.
16.12.2019
Florida hospital settles case involving allegations of patient dumping
On December 16, 2019, Florida Hospital Heartland Medical Center (FHHMC), Sebring, Florida entered into a $35,000 settlement agreement with OIG. The settlement agreement eliminates allegations that FHHMC violated the Emergency Medical Treatment and Labor Act (EMTALA) based on the OIG's investigation by failing to provide adequate medical screening and stabilizing treatment to a nearly 18-year-old man. On January 30, 2015, the patient presented to the FHHMC Emergency Department (ED) complaining of pain and swelling in the left testicle for the past three days and rating his pain as a 5 out of 10. His scrotum was swollen and tender. After an examination by an ED doctor, the patient was discharged with instructions to see a pediatric urologist. The patient was not seen or examined by the on-call urologist prior to discharge. The OIG claimed that the patient did not receive adequate medical check-up or stabilizing treatment for his medical emergency. Senior Counsel Sandra Sands represented OIG.
12.12.2019
Tennessee Laboratory settles case with 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 filed claims for sample validity testing (SVT), an uncovered service, with Medicare. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and David Traskey, worked together to achieve this resolution.
12.11.2019
New York doctor and practice settle case with false claims
On December 11, 2019, Enrico Fazzini, D.O. and Enrico Fazzini, D.O., Ph.D., P.C. (collectively "Dr. Fazzini") with multiple New York locations entered into a $191,209.96 settlement agreement with OIG. The settlement agreement clears up allegations that Dr. Fazzini has submitted allegations: (1) using CPT code 95937 (Neuromuscular Junction (NMJ) test) when he has not performed NMJ tests; and (2) for CPT code 95913 (for thirteen or more nerve conduction studies (NCS)) if he only performed twelve or fewer NCS. Senior Counsels Srishti Sheffner and Geoffrey Hymans represented OIG, with support from Program Analyst Mariel Filtz.
22.11.2019
Georgia Hospital settles case involving allegations of patient dumping
On November 22, 2019, Rockdale Medical Center (RMC), Conyers, Georgia entered into a $70,000 settlement agreement with OIG. The settlement agreement eliminates allegations that RMC violated the Emergency Medical Treatment and Labor Act (EMTALA) based on the OIG's investigation by failing to provide a 79-year-old woman with screening medical evaluation, stabilizing treatment or proper transfer. Specifically, the patient presented to RMC's Emergency Department (ED) by ambulance after being involved in a motor vehicle accident that left multiple people injured. EMS contacted RMC's emergency department for instructions on disposing of the injured, and RMC's emergency physician ordered that the patient be taken to a trauma center. When one of the ambulances arrived at RMC's ambulance bay with the patient, a hospital nurse approached the ambulance and told the driver to take the patient to the trauma center. The ambulance then transported the patient to the trauma center without the patient receiving a medical check-up. During transport, the patient's condition deteriorated and she eventually died in the receiving hospital. Senior Counsel Geeta Taylor represented OIG.
11-19-2019
The New York Drug Rehabilitation Center settles the case with Kickback and Stark allegations
On November 19, 2019, A.R.E.B.A. Casriel, Inc. (ACI), of Manhattan, New York, has entered into a $151,056.75 settlement agreement with OIG. The Settlement Agreement eliminates allegations that ACI received compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of complimentary point-of-care test cups provided in exchange for prohibited referrals. OIG further claimed that the referrals were prohibited because the compensation created a financial relationship and prompted ACI Millennium to make claims for designated healthcare services resulting from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
17.11.2019
California Health Clinic and Executive Agree on Voluntary Exclusions
On November 17, 2019, Norman Harr (Harr) and Horisons Unlimited Health Care (Horisons), with multiple locations in and around Merced, California, agreed to be disfellowshipped in connection with the resolution of their liability under the False Claims Act. Harr agreed, under 42 U.S.C. to be excluded. § 1320a-7(b)(7) for a period of 15 years. Horisons agreed, under 42 U.S.C. to be excluded. §§ 1320a-7(b)(7) and (8) for a period of 20 years. OIG alleged that Harr and Horisons billed federal healthcare programs for services they knew were non-reimbursable, including billing for the following: (1) services performed by unlicensed and/or unqualified physicians; (2) missed dental services; (3) reimbursable health services if acupuncture, a non-reimbursable service, was actually provided; (4) Visits to licensed physicians when patients have actually received Ziploc bags of Suboxone that were issued to them in McDonald's or Rite Aid parking lots; (5) non-refundable experimental treatments using incorrect general medical and dental codes; (6) unnecessary medical testing; (7) unnecessary orthodontics; (8) visits to a licensed social worker instead of a routine office visit to increase reimbursement; and (9) fungal toenail trimming when the patient actually received a toenail cut that would not have been covered. OIG also alleged that Harr and Horisons altered medical records, including making diagnoses to receive reimbursement they would not otherwise be entitled to, and received cash payments from a laboratory in return for referring federal health program patients for testing. Senior Counsel Andrea Treese Berlin represented OIG.
11-12-2019
Doctors and practice in Florida settle case with kickbacks
On November 12, 2019, Jose R. Gonzalez, M.D., Pedro Nam, M.D., and Wellington Medical Care Associates, LLC (collectively, “Wellington Medical”) of Loxahatchee, Fla. entered into a $107,260 settlement agreement with OIG. The settlement agreement resolves allegations that Wellington Medical solicited and received compensation from laboratory companies Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex) in the form of "handling and settlement payments" related to the blood collection. The OIG alleged that Wellington Medical solicited and received compensation from HDL and Singlex in exchange for Wellington Medical and Wellington Medical employees referring patients for laboratory testing of HDL and Singlex, which the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
08.11.2019
Diagnostic Imaging Company agrees to voluntary exclusion
On November 8, 2019, Lakeshore Diagnostic Ultrasound Co. (Lakeshore), Essexville, Michigan agreed to remain under 42 U.S.C. 1320a-7(b)(7). The OIG's investigation found that Lakeshore had filed claims for CPT code 96965 (Current Procedural Terminology) for the same service days that it had filed claims for CPT code 93970 or 93971, which was already included as part of the duplex ultrasonic procedures, for the Lakeshore filed claims using CPT codes 93970 or 93971 for the same beneficiary on the same benefit dates. Senior Counsel Geoffrey Hymans and Joan Matlack represented OIG, assisted by Program Analyst Mariel Filtz.
11-06-2019
Tennessee Ambulance Provider settles case with false allegations
On November 6, 2019, Healthcare Transport, LLC (HT), Bartlett, Tennessee, entered into a $93,725.22 settlement agreement with OIG. The settlement agreement resolves allegations that HT, through an outside billing agent, made claims for essential life support ambulances when the trips were to destinations for which ambulance services are not covered by Medicare, such as trips to diagnostic and therapeutic facilities (and the associated " return") "journey was to a residence). The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to achieve this resolution.
The Texas Ambulatory Surgery Center is adjudicating the case of an expelled person
On November 6, 2019, Amarillo Endoscopy Center (AEC), Amarillo, Texas, entered into a $121,550.12 settlement agreement with OIG. The settlement agreement resolves allegations that AEC employed a person who was disqualified from participating in a federal health program. The OIG's investigation found that the excluded individual, a nursing assistant, provided items or services to AEC patients that were billed to federal health care programs. Associate Counsel Dennis Pangindian represented OIG with support from Paralegal Specialist Jennifer Hilton.
04.11.2019
Georgia Hospital settles case involving allegations of patient dumping
On November 4, 2019, the Board of Hospitals of Valdosta and Lowndes County d/b/a South Georgia Medical Center (SGMC), Valdosta, Georgia entered into a $40,000 settlement agreement with OIG. The settlement agreement eliminates allegations that SGMC violated the Emergency Medical Treatment and Labor Act (EMTALA) based on the OIG's investigation by failing to have a 27-year-old man evaluated and treated by his on-call urologist. Specifically, the patient presented to the SGMC Emergency Department (ED) on June 18, 2014, complaining of pain due to a five-day episode of priapism. He was seen by an ED doctor who contacted SGMC's on-call urologist. However, the urologist did not come to the emergency room for further evaluation or treatment of the patient. Instead, the urologist requested that the patient be transferred to another hospital for treatment. The transfer took no longer than eight hours and was carried out to a hospital about 240 kilometers away. Priapism is a serious condition and delaying proper treatment can result in injury, necrosis, or loss of the penis. The patient's transfer was medically inappropriate and put the patient at further risk by delaying necessary medical attention. Senior Counsel Sandra Sands represented OIG.
01.11.2019
The Ohio Ambulance Company and the owner agree to the voluntary exclusion
On November 1, 2019, Eastern Area Specialty Transport, Inc. and David Haines, its owner (collectively, "EAST"), of Leesburg, Ohio, agreed for a period of five years pursuant to 42 U.S.C. 1320a-7(b)(7). OIG's investigation found that EAST presented Medicare Part B claims for medical transportation to and from qualified nursing facilities (SNFs) when such transportation was already covered by the consolidated SNF Medicare Part A bill payment. 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 support of Paralegal Jennifer Hilton, worked together to achieve this resolution.
17.10.2019
Virginia doctor settles case of false and fraudulent Medicare claims
On October 17, 2019, Julio C. Gonzalez, M.D., of Falls Church, Virginia, entered into a $29,378.26 settlement agreement with OIG. The settlement agreement clears up allegations that Dr. Gonzalez Medicare submitted claims for nerve conduction studies, which are considered screening tests and are not covered by Medicare. The OIG's Office of Audit Services and the Office of Counsel to the Inspector General, represented by Senior Counsel Geoffrey Hymans, worked together to achieve this resolution.
10.11.2019
The Texas Chiropractic Practice settles the case of a disfellowshipped person
On October 11, 2019, the West Texas Multicare Clinic, P.A. d/b/a Precision Chiropractic (Precision Chiropractic), of Amarillo, Texas, entered into a $10,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Precision Chiropractic employed an individual who was disqualified from participating in a federal healthcare program. The OIG's investigation determined that the disfellowshipped individual, a billing specialist, provided items or services to Precision Chiropractic patients who were billed to federal healthcare programs.
04.10.2019
Texas Laboratory settles case with false claims
On October 4, 2019, Ohio River Laboratories, LLC (ORL), Houston, Texas, entered into a $49,493.48 settlement agreement with OIG. The settlement agreement resolves allegations that ORL submitted claims to Medicare for Sample Validity Testing (SVT), an uncovered service. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels David Traskey and Geoffrey Hymans represented OIG, with support from Paralegal Specialist Jennifer Hilton.
02.10.2019
Florida medical practice settles the case with Kickback and Stark allegations
On October 2, 2019, Physicians Group Services, P.A. (PGS), with multiple locations in North Florida, has entered into a settlement agreement with OIG for $1,128,615.04. The Settlement Agreement eliminates allegations that PGS received compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of point-of-care test cups that resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the compensation created a financial relationship and prompted PGS Millennium to make claims for designated healthcare services arising from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
01.10.2019
Indiana Nursing Facility is adjudicating the case of a disfellowshipped person
On October 1, 2019, Miller's Health System, Inc. d/b/a Miller's Merry Manor (Miller's), Portage, Indiana entered into a $51,489.97 settlement agreement with OIG. The settlement agreement eliminates allegations that Miller employed a person who was disqualified from participating in a federal health care program. The OIG's investigation determined that the disfellowshipped individual, a director of in-service training, provided items or services to Miller's patients that were billed to federal health care programs.
30.09.2019
Louisiana Laboratory agrees to voluntary disqualification
On September 30, 2019, UTC Laboratories, Inc. a/k/a RenRx (UTC), New Orleans, Louisiana, in connection with the resolution of its liability under the False Claims Act, agreed to indemnify for 25 years under 42 U.S.C. 1320a-7(b)(7). The OIG alleged that UTC was held liable for: (1) allegedly offering and paying compensation, directly or indirectly, to physicians to induce the ordering of pharmacogenetic testing, allegedly in exchange for their participation in a clinical trial, under Violation of the Anti-Kickbacks Statute (AKS); (2) allegedly offering and paying, directly or indirectly, any compensation, including sales commissions, to organizations and individuals to induce referrals for pharmacogenetic testing, in violation of the AKS; and (3) providing pharmacogenetic testing that was not medically necessary. Senior Counsel Karen Glassman represented OIG.
27.09.2019
Arizona investigator settles subsidy fraud case
On September 27, 2019, Dr. Ravi Goyal signed a settlement agreement with OIG for $73,975. The settlement agreement eliminates allegations that Dr. Goyal is said to have submitted or submitted to his university, an NIH grantee, three invoices from a third party, while failing to disclose to the university that the funds paid to the third party ultimately went to a company owned by Dr Goyal. The university was reimbursed from NIH grant funds for the funds paid to the third party. Senior Counsel Michael Torrisi and Associate Counsel Dennis Pangindian represented OIG.
Georgia Hospital settles case involving allegations of patient dumping
On September 27, 2019, Doctors Hospital of Augusta (DHA), Augusta, Georgia entered into a $180,000 settlement agreement with OIG. The Settlement Agreement eliminates allegations that DHA violated the Emergency Medical Treatment and Labor Act (EMTALA) based on the OIG's investigation by failing to provide adequate medical screening and stabilizing treatment for a patient and adequate relocation of a second person not accepted Patient. The first patient was a 25-year-old woman who presented to the DHA Emergency Department (ED) complaining of ingestion of an unknown substance and loss of consciousness. The patient was reportedly weepy and anxious and complained of headache, neck pain, facial pain and left shoulder pain. A nurse triaged the patient and gave her an Emergency Severity Index score of three, which was "urgent" under the DHA triage policy. A doctor examined the patient medically; However, the screen did not include the necessary laboratory tests related to the patient's symptoms. The patient was enrolled in the DHA's medical screening process for normal patients and requested funding to continue the study. Since the patient could not pay, she was discharged. The patient immediately sought treatment at another hospital, where she was treated.

The second patient was an 84-year-old woman with pneumonia and severe hypernatremia and hyperglycemia. The patient required critical care at the intensive care unit (ICU) level and the transferring hospital did not have an intensive care unit. A DHA doctor refused to transfer the patient on the grounds that the referring facility could treat the patient. DHA had the power and ability to take care of the patient. Associate Counsel Candace Ashford represented OIG.

(Video) Examining whether police should enforce traffic stops

26.09.2019
The Texas medical office settles the case of a disfellowshipped person
On September 26, 2019, the Fredericksburg Family Practice PA d/b/a Cornerstone Clinic (Cornerstone Clinic), Fredericksburg, Texas entered into a $53,549.66 settlement agreement with OIG. The settlement agreement eliminates allegations that the Cornerstone Clinic employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a medical coder, provided items or services to patients at the Cornerstone Clinic that were billed to federal healthcare programs.
25.09.2019
Pennsylvania Pharmacy and Owners Agree to Voluntary Disqualification
On September 25, 2019, Dhanyabapa LLC d/b/a E-Z Pharmacy and Shardaben Patel, Philadelphia, Pennsylvania, agreed to be barred from participating in all federal healthcare programs for ten individuals in connection with the resolution of their liability under the False Claims Act become years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that E-Z Pharmacy and Shardaben Patel billed Medicare for prescription drugs that were not actually dispensed. Senior Counsel Katie Fink represented OIG.
24.09.2019
Pennsylvania Pharmacy and Owners Agree to Voluntary Disqualification
On September 24, 2019, G&A Somerton Pharmacy, LLC d/b/a Somerton Pharmacy and Polina Khodak, Philadelphia, Pennsylvania, in connection with the resolution of their liability under the False Claims Act, agreed to be barred from attending all are federal health programs for ten years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Somerton Pharmacy and Polina Khodak Medicare billed for prescription drugs that were not actually dispensed. Senior Counsel Katie Fink represented OIG.
16.09.2019
Owner of North Carolina DME business agrees to voluntary exclusion
On September 16, 2019, Margaret A. Gibson (Gibson), of Newport, North Carolina, in connection with the resolution of her liability under the False Claims Act, agreed to indemnify for 5 years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Gibson, through its company A Perfect Fit For You, Inc. Medicaid, incorrectly billed various durable medical devices including but not limited to the following items: Powered Air Flotation Beds, Bone Growth Stimulators, Power Wheelchair Accessories; custom knee/ankle/foot orthoses; and cough stimulating devices, all of which were non-medically necessary, were not purchased from A Perfect Fit For You, Inc. through a wholesaler or manufacturer, and were never shipped to recipients. Senior Counsel Christina McGarvey represented OIG.
22.08.2019
Florida Laboratory settles case with false claims
On August 22, 2019, American Clinical Solutions, LLC (ACS), of Boca Raton, Florida, entered into a $61,546.31 settlement agreement with OIG. The settlement agreement resolves allegations that ACS made claims on Medicare for Sample Validity Testing (SVT), an uncovered service. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Andrea Treese Berlin and Deputy Branch Chief Kirk Sripinyo represented OIG with support from Paralegal Specialist Jennifer Hilton.
20.08.2019
Georgia doctor settles case with false claims
On August 20, 2019, Gregory D. Martin, M.D., of Valdosta, Georgia, entered into a $181,874.30 settlement agreement with OIG. The settlement agreement eliminates allegations that Dr. Martin filed claims for Healthcare Common Procedure Coding System (HCPCS) code 96965 when those claims related to a procedure that was already included as part of the duplex ultrasound procedures for which Dr. Martin claims had HCPCS codes 93970 or 93971 for the same beneficiary on the same performance dates. The OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not be billed separately and was not medically necessary. Senior Counsel Geoffrey Hymans and Joan Matlack represented OIG, assisted by Program Analyst Mariel Filtz.
13.08.2019
New Jersey Diagnostic Testing Facility administers false and fraudulent claims
On August 13, 2019, MDR Diagnostics, LLC (MDR), of New Brunswick, New Jersey, entered into a $144,621.98 settlement agreement with OIG. The OIG's investigation found that MDR filed claims for nerve conduction studies, which are considered screening tests and are not covered by Medicare. The OIG's Office of Audit Services and the Office of Counsel to the Inspector General, represented by Senior Counsel Geoffrey Hymans, worked together to achieve this resolution.
08.07.2019
Kentucky Laboratory settles case with false claims
On August 7, 2019, PremierTox 2.0, Inc. (PremierTox), of Russell Springs, Kentucky, entered into a $99,157 settlement agreement with OIG. The settlement agreement resolves allegations that PremierTox filed claims for sample validity testing (SVT), an uncovered service, with Medicare. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Geoffrey Hymans and David Traskey represented OIG, with support from Paralegal Specialist Jennifer Hilton.
New Jersey Physicicers and Practice Settle Case Involving Kickbacks
On August 7, 2019, Joseph P. Clancy, Jr., M.D., Walter P. Miller, M.D., and Southern Ocean Primary Care Associates, LLC (collectively, “Southern Ocean”) entered into a $311,626 settlement agreement with multiple New Jersey locations with OIG. The Settlement Agreement eliminates allegations that Southern Ocean sought and received compensation from laboratory companies Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex) in the form of "litigation and settlement payments" related to the blood collection. The OIG alleged that Southern Ocean requested and received compensation from HDL and Singlex in exchange for Southern Ocean and a Southern Ocean employee referring patients for HDL and Singlex lab testing that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
Tennessee Laboratory settles case with false claims
On August 7, 2019, Discover Diagnostic Laboratory, LLC (DDL), of Oak Ridge, Tennessee, entered into a $95,882.36 settlement agreement with OIG. The settlement agreement resolves allegations that DDL filed claims for sample validity testing (SVT), an uncovered service, with Medicare. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Geoffrey Hymans and David Traskey represented OIG, with support from Paralegal Specialist Jennifer Hilton.
08-05-2019
The owner of the Kansas Infusion Company agrees to the voluntary disqualification
On August 5, 2019, Donald R. Peterson, of Overland Park, Kansas, in connection with the resolution of his liability under the False Claims Act, agreed to refrain from participating in all federal healthcare programs under 42 U.S.C. to be excluded. 1320a-7(b)(7). OIG alleged that Peterson submitted requests to Medicare through IVXpress, Inc. for infusions and/or injections that lacked the required direct supervision of the infusion and/or injection by a physician or nurse. Associate Counsel Dennis Pangindian represented OIG.
31.07.2019
Tennessee biotechnology company settles case of false testimony in HHS grant application
On July 31, 2019, Prizam Healthcare Technologies, LLC d/b/a Raiven Healthcare and James Stefansic (collectively, “Raiven”), of Nashville, Tennessee, entered into a $40,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Raiven submitted an NIH grant application that falsely represented that a community mental health center had agreed to recruit participants for Raiven's proposed study. Senior Counsel Michael Torrisi and David Traskey represented OIG.
19.07.2019
Georgia Pharmaceutical Company settles drug price reporting case
On July 19, 2019, the U.S. Pharmaceutical Corporation (USPC), Decatur, Georgia, entered into a $380,142.05 settlement agreement with OIG. The settlement agreement resolves allegations that USPC failed to provide the Centers for Medicare and Medicaid Services (CMS) with timely certified monthly and quarterly Average Manufacturer's Price (AMP) data for certain months and quarters in 2012, 2015, 2016 and 2017 to transfer. The Medicaid The Drug Rebate program requires manufacturers to enter into and enforce a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the manufacturer's covered outpatient medications. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Mary Riordan represented OIG with support from program analyst Mariel Filtz.
Texas doctor and hospital director settle case with kickbacks
On July 19, 2019, Corazon Ramirez, M.D., of Dallas, Texas, entered into a $171,480 settlement agreement with OIG. The settlement agreement clears up allegations that Dr. Ramirez, as the former CEO and COO of Pine Creek Medical Center, has paid allowances to various Pine Creek Medical Center physicians in the form of payments for print and billboard advertising for the physician owners of their physician offices. Senior Counsel Karen Glassman, Senior Counsel Michael Torrisi and Deputy Branch Chief Kirk Sripinyo represented OIG.
18.07.2019
Pennsylvania doctor agrees to voluntary exclusion
On July 18, 2019, Richard Mintz, D.O., a physician in Dresher, Pennsylvania, consented under 42 U.S.C. Be barred from participating in all government health programs for a period of 7 years. 1320a-7(b)(6)(B). The OIG claimed that Dr. Mintz wrote medically unnecessary prescriptions for opioids for cash that did not meet professionally accepted standards of care. Senior Counsel Lisa Veigel represented OIG.
07-12-2019
Michigan Physic Practice settles case with Kickback and Stark allegations
On July 12, 2019, Anesthesia Services, P.C. d/b/a University Pain Clinic (UPC), Detroit, Michigan has entered into a $44,900 settlement with OIG. The Settlement Agreement eliminates allegations that UPC received compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of point-of-care test cups that resulted in prohibited referrals. OIG further claimed that the referrals were prohibited because the compensation created a financial relationship and prompted UPC Millennium to make claims for designated healthcare services resulting from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
The podiatry practice in Illinois settles the case of a disfellowshipped person
On July 12, 2019, Smith Centers for Foot & Ankle Care (SCFAC), Chicago, Illinois entered into a $37,688.76 settlement agreement with OIG. The settlement agreement eliminates allegations that SCFAC employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a medical assistant, provided items or services to SCFAC patients that were billed to government healthcare programs.
07-08-2019
Pennsylvania Ambulance Companies, owners and related parties agree to voluntary disclaimers
On July 8, 2019, in connection with the resolution of their liability under the False Claims Act, Damon Wade, Amy Wade, Unicare Ambulance, LLC (Unicare) and PA Paramedics LLC d/b/a Eastern Care Ambulance (PA Paramedics), Bensalem , Pennsylvania, agreed to refrain from participating in all federal health programs under 42 U.S.C. to be excluded. 1320a-7(b)(7). Damon Wade agreed to be banned for a 10-year period. Amy Wade, Unicare and PA Paramedics agreed to be barred for a period of 5 years. OIG alleged that Damon Wade, Amy Wade, Unicare and PA Paramedics repeatedly provided false information to avoid overpayment debt to the Medicare program and to hide the fact that Damon Wade's state paramedic license had previously been suspended for admitting that the forging a doctor's signature. Senior Counsel Gregory Wellins represented OIG.
28.06.2019
Illinois Hospital settles case of disfellowshipped person
On June 28, 2019, Fayette County Hospital (FCH), Vandalia, Illinois entered into a $125,407.58 settlement agreement with OIG. The settlement agreement eliminates allegations that FCH employed an individual who was disqualified from participating in a federal health care program. OIG's investigation found that the disfellowshipped individual, a nurse, provided items or services to FCH patients that were billed to federal health care programs. Associate Counsel James Hansen represented OIG.
Kentucky Laboratory settles case with false claims
On June 28, 2019, Ethos Laboratory (Ethos), of Newport, Kentucky, entered into a $1,345,959.74 settlement agreement with OIG. The settlement agreement resolves allegations that Ethos filed claims for sample validity testing (SVT), an uncovered service, with Medicare. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Geoffrey Hymans and Andrea Treese Berlin represented OIG with support from Paralegal Specialist Jennifer Hilton.
Alabama Ambulance Provider settles case with false allegations
On June 28, 2019, Samaritan EMS, Inc. (Samaritan), of Union Grove, Alabama, entered into a $942,373.67 settlement agreement with OIG. The settlement agreement resolves allegations that Samaritan made claims for basic and advanced life support ambulances where the trips were to destinations for which ambulance services are not covered by Medicare, such as trips to diagnostic and therapeutic facilities (and the associated "return trip “ to a residence). Senior Counsel Geoffrey Hymans and Andrea Treese Berlin represented OIG.
26.06.2019
North Carolina Hospital settles case involving allegations of patient dumping
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 eliminates allegations that TRH violated the Emergency Medical Treatment and Labor Act (EMTALA) based on the OIG's investigation by failing to provide adequate medical screening and stabilizing treatment to a patient. The patient presented to TRH's Emergency Department (ED) complaining of abdominal pain and pain radiating bilaterally to his lower extremities. The patient also had elevated blood pressure and respiratory rate. Despite this notion, TRH discharged the patient without proper medical evaluation or stabilizing treatment. The patient returned to TRH's emergency department by ambulance later that day complaining of lower extremity paralysis, leg pain and leg swelling. TRH eventually transferred the patient to another hospital. Under EMTALA, the maximum penalty for hospitals with fewer than 100 beds at the time of this alleged violation was $25,000. Senior Counsel Geeta Taylor represented OIG.
17.06.2019
Florida doctor's office settles case with kickbacks
On June 17, 2019, Midland Medical, Inc. and its subsidiary Midland Medical-Broward, Inc. (collectively, “Midland”) of Oakland Park, Fla. entered into a $102,204 settlement agreement with OIG. The settlement agreement resolves allegations that Midland received compensation in the form of "litigation and settlement payments" related to the blood draw from laboratory companies Health Diagnostic Laboratory, Inc. (HDL) and Singlex, Inc. (Singulex). OIG alleged that Midland received HDL and Singlex compensation in exchange for Midland and Midland employees who referred patients for HDL and Singlex lab testing that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
14.06.2019
Massachusetts Physic Practice settles case with Kickback and Stark allegations
On June 14, 2019, HKD Treatment Options, P.C. (HKD), of Lowell, Massachusetts, has entered into a $87,650 settlement agreement with OIG. The Settlement Agreement eliminates allegations that HKD received compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of point-of-care test cups that resulted in prohibited referrals. OIG further claimed that the referrals were prohibited because the compensation created a financial relationship and prompted HKD Millennium to file claims for designated healthcare services resulting from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
06.06.2019
New Mexico Federal Qualified Health Center settles subsidy fraud case
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 submitted to the Department of Health and Human Services (HHS) a specific claim under an HHS grant that PVMC knew or should have known was false or fraudulent. In particular, the OIG alleged that PVMC made deductions from a health infrastructure investment grant from the Health Resources and Services Administration and used the funds for improper operating expenses unrelated to the grant. Senior Counsels David Traskey and Kirk Sripinyo represented OIG.
Florida Physician Group settles case with false claims
On June 6, 2019, Southeastern Integrated Medical, PL (SIM), a multi-location physician group practice in North Central Florida, entered into a $62,727.88 settlement agreement with OIG. The settlement agreement resolves allegations that SIM filed claims for sample validity testing (SVT), an uncovered service, with Medicare. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Andrea Treese Berlin and Kirk Sripinyo represented OIG with support from Paralegal Specialist Jennifer Hilton.
31.05.2019
Kentucky Laboratory settles case with false claims
On May 31, 2019, Commonwealth Pain Associates, PLLC (Commonwealth), Louisville, Kentucky entered into a $88,214.88 settlement agreement with OIG. The settlement agreement resolves allegations that Commonwealth Medicare filed claims for Sample Validity Testing (SVT), an uncovered service. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Geoffrey Hymans and David Traskey represented OIG, with support from Paralegal Specialist Jennifer Hilton.
28.05.2019
Missouri doctor agrees to voluntary disqualification
On May 28, 2019, William Blake Rodgers, M.D., of Jefferson City, Missouri, in connection with the resolution of his liability under the False Claims Act, agreed for a period of four years under 42 U.S.C. 1320a-7(b)(7). The OIG claimed that Dr. Rodgers, a spine surgeon, has filed and filed claims with federal health programs for failure to perform surgical procedures and improper performance of neurophysiological monitoring services. Senior Counsel David Fuchs represented OIG.
The Maryland Dentist settles the case involving a disfellowshipped person
On May 28, 2019, Ryan D. Pensyl, DMD (Dr. Pensyl), of Cumberland, Maryland, entered into a $10,941.60 Settlement Agreement with OIG. The settlement agreement eliminates allegations that Dr. Pensyl has employed a person who has been disqualified from participating in a federal health care program. The OIG's investigation determined that the disfellowshipped individual, a dentist, provided items or services billed to government healthcare programs. The Office of Investigations and the Office of Counsel to the Inspector General, represented by Senior Counsels Katie Fink and Jennifer Leonardis, worked together to reach this settlement.
22.05.2019
Diagnostic service provider settles case with false claims
On May 22, 2019, On-Site Imaging, LLC (On-Site), of Morganville, New Jersey, entered into a $82,065.08 settlement agreement with OIG. The Settlement Agreement eliminates allegations that On-Site filed claims for Healthcare Common Procedure Coding System (HCPCS) code 96965 when those claims applied to a procedure already included as a component of the On-Site's duplex ultrasound procedures Claims filed using HCPCS codes 93970 or 93971 for the same beneficiary on the same benefit dates. The OIG further contends that the claims submitted for HCPCS code 93965 were for a procedure that should not be billed separately and was not medically necessary. Senior Counsel Geoffrey Hymans and Joan Matlack represented OIG, assisted by Program Analyst Mariel Filtz.
21.05.2019
California doctor settles case of false and fraudulent claims
On May 21, 2019, Yousef Mehrabi, M.D. (Dr. Mehrabi), of Encino, Calif., entered into a $52,799.61 settlement agreement with OIG. The OIG's investigation found that Dr. Mehrabi has submitted claims for nerve conduction studies, which are considered screening tests and are not covered by Medicare. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, worked together to achieve this resolution.
20.05.2019
Tennessee Hospital settles case of disfellowshipped person
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 eliminates allegations that a subsidiary acquired by WTH, Tennova Regional Hospital (TRH), employed an individual who was barred from participating in a federal healthcare program. The OIG's investigation found that the disfellowshipped individual, a registered nurse, provided items or services to TRH patients that were billed to federal healthcare programs. Senior Counsel Kenneth Kraft represented OIG with support from 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 compensation from Health Diagnostic Laboratory, Inc. (HDL), a laboratory company, in the form of "litigation and settlement payments" related to the blood draw. OIG alleged that Midwest Health received HDL's compensation in return for Midwest Health and Midwest Health employees referring patients to HDL for laboratory tests paid for by the Medicare program. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
05.07.2019
Kansas doctor agrees to voluntary disqualification
On May 7, 2019, Joseph P. Galichia, M.D. (Dr. Galichia), Kansas, in connection with the resolution of his liability under the False Claims Act, to be banned from participating in all federal health care programs for a period of three years under 42 U.S.C. 1320a-7(b)(6)(B). The OIG claimed that Dr. Galichia filed claims with government health programs for surgical procedures he performed to implant coronary artery stents that were not medically necessary. Senior Counsel David Fuchs represented OIG.
05.06.2019
Florida hospital settles case involving allegations of patient dumping
On May 6, 2019, Park Royal Hospital (Park Royal), Fort Meyers, Florida entered into a $52,414 settlement agreement with OIG. The settlement agreement eliminates allegations that Park Royal violated the Emergency Medical Treatment and Labor Act (EMTALA), based on the OIG's investigation, when it refused to accept the transfer of a patient with an unstabilized medical emergency from another hospital's emergency department. The patient presented to the emergency department of this hospital following a suicide attempt and was diagnosed with lacerated wrists and a psychiatric emergency. Park Royal is a hospital with specialized psychiatric skills. OIG claimed that Park Royal refused to accept a transfer of the patient despite having the special skills to stabilize the patient and the capacity at the time of the transfer because the patient's insurance was out of network. Senior Counsel Geeta Taylor represented OIG.
25.04.2019
The Georgia urology practice adjudicates the case of a disfellowshipped person
On April 25, 2019, Morganstern Urology (Morganstern), Atlanta, Georgia, entered into a $18,810.40 settlement agreement with OIG. The settlement agreement eliminates allegations that Morganstern employed a person who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a physician, provided items or services to Morganstern patients that were billed to federal healthcare programs.
12.04.2019
The Texas State Agency and the Living Center settle a case involving a disfellowshipped person
On April 12, 2019, the Texas Health and Human Services Commission and the Lufkin State Supported Living Center (Lufkin SSLC) entered into a settlement agreement with OIG for $121,068.42. The settlement agreement resolves allegations that Lufkin SSLC employed an individual who was disqualified from participating in a federal healthcare program. The OIG's investigation found that the disfellowshipped individual, a registered nurse, provided items or services to Lufkin SSLC's patients that were paid for by government healthcare programs. Senior Counsel Katie Fink represented OIG with support from Program Analyst Mariel Filtz.
12.04.2019
California doctor and practice settles case of false and fraudulent claims
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 filed claims with Medicare for items or services that it knew or should have known were not supplied as claimed and were false or fraudulent. Specifically, the OIG alleged that CWC filed claims for: (1) diagnostic electromyography services using CPT code 51784 and diagnostic anorectal manometry (ARM) services using CPT code 91122 when therapeutic, non-diagnostic, services were provided ; (2) ARM Services using CPT code 91122 not performed in accordance with CMS policies; (3) electrical stimulation of the pelvic floor not preceded by a 4-week course with failed pelvic muscle training; and (4) 13 assessment and management services using CPT code 99214 that did not meet the criteria for billing under that code. The OIG Department of Data Analysis and the Office of the Advisor to the Inspector General, represented by Senior Counsels David Traskey and Michael Torrisi, with the support of Program Analyst Mariel Filtz, worked together to reach this agreement.
04.04.2019
Maine Mental Health Service Provider is adjudicating the case involving a disfellowshipped person
On April 4, 2019, Aroostook Mental Health Services, Inc. (AMHS), of Caribou, Maine, entered into a $17,750.12 settlement agreement with OIG. The settlement agreement resolves allegations that AMHS employed a person who was disqualified from participating in MaineCare, Maine's Medicaid program. OIG's investigation found that the disfellowshipped individual, a counselor, provided items or services to AMHS patients that were billed to MaineCare.
28.03.2019
Texas Skilled Nursing Facility adjudicates case of disfellowshipped person
On March 28, 2019, Sweeny Community Hospital d/b/a Lake Jackson Healthcare (LJH), Lake Jackson, Texas entered into a $113,802.80 settlement agreement with OIG. The settlement agreement eliminates allegations that LJH employed a person who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a professional nurse, provided items or services to LJH patients that were billed to federal health care programs.
26.03.2019
Wisconsin Mental Health Entity, Owner and Related Party agree to voluntary disclaimers
On March 26, 2019, in connection with the resolution of their liability under the False Claims Act, Acacia Mental Health Clinic, LLC (Acacia), Abraham Freund and Isaac Freund agreed to refrain from participating in all federal healthcare programs under 42 U.S.C. to be excluded. 1320a-7(b)(7). Acacia and Abraham Freund agreed to be barred for a 20-year period. Isaac Freund agreed to be banned for a period of 5 years. At the time of the allegations, Wisconsin was reimbursing Medicaid providers for urine drug screening conducted with point-of-care cups under Current Procedure Terminology (CPT) Code 80104 approximately $20 per test, regardless of the number of drug classes tested. OIG alleged that: (1) Acacia, at the direction of Abraham Freund, filed claims against Wisconsin Medicaid under CPT code 80101 with a separate unit for each drug class, even though CPT code 80101 was appropriate only for more sophisticated tests performed using laboratory equipment, which Acacia had not possess; (2) at the direction of Abraham Freund, Acacia also misrepresented to Wisconsin regulators that it possessed the laboratory equipment necessary to conduct testing under CPT Code 80101 in order to conceal its false accounting; (3) Acacia and Abraham Freund knew that by filing claims for urine drug testing performed at Acacia under CPT code 80101, they misrepresented the types of testing performed on Wisconsin Medicaid; and (4) by filing these allegedly false claims with Medicaid, Acacia and Abraham Freund unlawfully increased the reimbursement received from Wisconsin Medicaid by hundreds of dollars per test. OIG further alleged that Acacia and Abraham Freund provided or caused Wisconsin to provide Medicaid with false information about telemedicine services because it was illegal to submit requests for telemedicine services provided to patients by psychiatrists outside the United States, at Abraham Freund's direction and With the involvement of Isaac Freund, Acacia performed medically unnecessary and duplicate urine drug testing on its Medicaid patients. Senior Counsel Keshia Thompson represented OIG.
21.03.2019
Ohio Skilled Nursing Facility adjudicating disfellowshipped person case
On March 21, 2019, Berea Alzheimer's Care Center (BACC), Berea, Ohio, entered into a $75,998.54 settlement agreement with OIG. The settlement agreement eliminates allegations that BACC employed a person who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a medical records coordinator, provided items or services to BACC patients that were billed to federal health care programs.
13.03.2019
Kentucky Laboratory settles case with false claims
On March 13, 2019, VerraLab JA, LLC (VerraLab), Louisville, Kentucky, entered into a $125,983.16 settlement agreement with OIG. The settlement agreement resolves allegations that VerraLab filed claims for sample validity testing (SVT), an uncovered service, with Medicare. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Geoffrey Hymans and David Traskey represented OIG, with support from Paralegal Specialist Jennifer Hilton.
Kentucky Medical Group Practice settles case with false claims
On March 13, 2019, Medical Specialist of Kentuckiana, PLLC (MSK), of Louisville, Kentucky entered into a $69,776.24 settlement agreement with OIG. The settlement agreement resolves allegations that MSK Medicare filed claims for Sample Validity Testing (SVT), an uncovered service. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Geoffrey Hymans and David Traskey represented OIG, with support from Paralegal Specialist Jennifer Hilton.
08.03.2019
Oklahoma Skilled Nursing Facility adjudicates case of disfellowshipped person
On March 8, 2019, Sweet Town, LLC d/b/a Cleveland Manor Nursing and Rehabilitation (Cleveland Manor), Cleveland, Oklahoma entered into a $171,047 settlement agreement with OIG. The settlement agreement resolves allegations that Cleveland Manor employed a person who was disqualified from participating in a federal health program. OIG's investigation determined that the expelled individual, an office manager, provided items or services to Cleveland Manor patients that were billed to federal health care programs.
01.03.2019
Tennessee Specialty Nursing Facility adjudicating case of disfellowshipped person
On March 1, 2019, MHC, Inc. d/b/a Maplewood Health Care Center (Maplewood), Jackson, Tennessee, entered into a $81,419.42 settlement agreement with OIG. The settlement agreement eliminates allegations that Maplewood employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation determined that the disfellowshipped individual, a registered nurse, provided items or services to Maplewood patients that were billed to the state's healthcare programs. Senior Counsel Kenneth Kraft represented OIG with support from Paralegal Specialist Jennifer Hilton.
13.02.2019
Diagnostic service provider settles case with false claims
On February 13, 2019, Medical Diagnostics Services, Inc. (MDS), with locations in Michigan and Illinois, entered into an $878,180.08 settlement agreement with OIG. The settlement agreement eliminates allegations that MDS filed claims for Healthcare Common Procedure Coding System (HCPCS) code 96965 when those claims applied to a procedure already included as part of the duplex ultrasound procedures for which MDS claims using the HCPCS codes 93970 or submitted 93971 for the same beneficiary on the same benefit dates. The OIG further contends that the claims submitted for HCPCS code 93965 were for a procedure that should not be billed separately and was not medically necessary. Senior Counsel Geoffrey Hymans and Joan Matlack represented OIG, assisted by Program Analyst Mariel Filtz.
02.07.2019
Tennessee Prosthetics Company compares case to bribery allegations
On February 7, 2019, Amputee Associates, LLC (AA), of Nashville, Tennessee, entered into a $681,774 settlement agreement with OIG. The settlement agreement resolves allegations that AA offered and paid illegal compensation in the form of fee reductions and payments to two surgical practices and an orthotist. Specifically, OIG alleged that AA reduced its monthly fee to a Texas surgical practice by an amount equal to the monthly salary the practice paid its prosthetist in order to induce the practice to refer prosthetics businesses to AA. OIG also alleged that AA made payments to an orthotist employed by a Georgia surgical practice to induce the orthotist to refer prosthetics business to AA. In addition, OIG alleged that AA made payments to a surgical practice in Tennessee to induce the practice to recommend the purchase of AA's goods and services. Senior Counsel Michael Torrisi represented OIG.
02.06.2019
Ohio practice and owner settle case with false allegations
On February 6, 2019, Mohammad Mouhib Kalo, M.D., and Wheelersburg Internal Medicine Group, Inc. (collectively, “WIMG”), Wheelersburg, Ohio, entered into a $111,706 settlement agreement with OIG. The settlement agreement resolves allegations that WIMG filed claims for sample validity testing (SVT), an uncovered service, with Medicare. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Geoffrey Hymans and David Traskey represented OIG, with support from Paralegal Specialist Jennifer Hilton.
24.01.2019
Kentucky Pain Management Practice settles case with false allegations
On January 24, 2019, the Northern Kentucky Center for Pain Relief, LLC (NKCPR), Florence, Kentucky entered into a $126,799.90 settlement agreement with OIG. The settlement agreement resolves allegations that NKCPR filed claims for sample validity testing (SVT), an uncovered service, with Medicare. SVT is a quality control procedure in which a urine drug screening sample is evaluated to determine if it matches normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsel Geoffrey Hymans and David Traskey represented OIG, with support from Paralegal Specialist Jennifer Hilton.
01.04.2019
The Oklahoma Assisted Living Facility adjudicates the case of a disfellowshipped person
On January 4, 2019, Baptist Village of Owasso (BVO), Owasso, Oklahoma entered into a $96,020.92 settlement agreement with OIG. The settlement agreement eliminates allegations that BVO employed a person who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, an admissions specialist, provided items or services to BVO patients that were billed to federal health programs.

2018

21.12.2018
Oklahoma Pain Management Practice and doctors settle case with Kickback and Stark allegations
On December 21, 2018, Tulsa Pain Consultants, Inc., Martin Martucci, M.D., and Andreas Revelis, M.D. (collectively “TPC”), Tulsa, Oklahoma, entered into a $98,942.50 settlement agreement with OIG. The Settlement Agreement eliminates allegations that TPC received compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of point-of-care test cups that resulted in prohibited referrals. OIG further claimed that the referrals were prohibited because the compensation created a financial relationship and prompted TPC Millennium to make claims for designated healthcare services resulting from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
Alabama Hospital settles case involving allegations of dumping by patients
On December 21, 2018, Mobile Infirmary Medical Center (MIMC), Mobile, Alabama, entered into an $80,000 settlement agreement with OIG. The settlement eliminates allegations that MIMC violated the Emergency Medical Treatment and Labor Act (EMTALA) based on the OIG's investigation when it failed to provide adequate medical screening and stabilizing treatment for two people. The first patient, a 24-year-old male, presented to the Emergency Department (ED) at MIMC complaining of weakness and exhibiting an altered mental status. He was reportedly aggressive and disobeyed staff orders. As he left the emergency room, he apparently collapsed. A security guard, a hospital worker, placed him in a wheelchair and wheeled the patient off the hospital grounds - where he was left on the ground. Approximately four hours later the patient was found cold with reduced responsiveness. He was taken to another hospital by ambulance. He died two weeks later. The second patient, a 35-year-old man, presented to the MIMC emergency department accompanied by his girlfriend. The patient complained of shortness of breath and chest pain. The patient requested a doctor's visit and became aggressive when a nurse asked him why. This resulted in the patient being escorted out of the emergency room by security guards. A few minutes later, the patient returned to the emergency room. This time the patient's friend drove to the ambulance and reported that the patient had suffered a seizure and was in her van. She was informed by the staff that they would not help get the patient out of the truck. Also, the security guard told her she had to go. The patient's girlfriend then took him to another hospital, where he was pronounced dead within 20 minutes of his arrival. Senior Counsel Sandra Sands represented OIG.
20.12.2018
California doctor and practice settles case with false claims
On December 20, 2018, Michael Jadali, D.O., and the Center for Pain & Rehabilitation Medicine (collectively, "Dr. Jadali"), of San Jose, California entered into a $60,406.30 Settlement Agreement with OIG. The settlement agreement eliminates allegations that Dr. Jadali has submitted claims to Medicare for Healthcare Common Procedure Coding System Codes 80500 (Clinical Pathology Consultation; limited, without review of medical history and medical records) and 80502 (Clinical Pathology Consultation, comprehensive, for a complex diagnosis) issue, with review of medical history and medical records) where no consultation request was made, no written report was prepared by a consultant pathologist, and no exercise of medical judgment by a consultant pathologist was required. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
12.12.2018
Connecticut Hospital is adjudicating case involving allegations of patient dumping
On December 12, 2018, Hartford Hospital (Hartford), Hartford, Connecticut entered into a $50,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Hartford violated the Emergency Medical Treatment and Labor Act by giving a woman who died at 23.5. weeks pregnant when she presented to the Hartford emergency room with symptoms of preeclampsia, an emergency medical condition, failed to provide adequate medical evaluation. Senior Counsels Joan Matlack and Srishti Sheffner represented OIG.
01.12.2018
Georgia Healthcare Providers and Owners Agree to Voluntary Exclusion
On December 1, 2018, in connection with the resolution of their liability under the False Claims Act, Families United Services, Inc. (FUS) and Pamela McKenzie, Georgia, agreed to be barred from participating in all state healthcare programs for periods of five years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that FUS and Pamela McKenzie filed claims with Georgia Medicaid for failure to provide behavioral health services. Senior Counsel Katie Fink represented OIG.
30.11.2018
Doctor and entrepreneur agrees to voluntary exclusion
On November 30, 2018, Zahid Aslam, M.D., a physician with ownership interests in several medical practices in Delaware and Maryland, in connection with the resolution of his liability under the False Claims Act, agreed to be banned from participating in all state healthcare programs for a period of time of eight years under 42 U.S.C. 1320a-7(b)(7). The OIG claimed that Dr. Aslam improperly filed claims for: (1) laboratory services that were not medically necessary, not eligible for payment and/or were not performed; (2) medical and/or consulting services that listed the wrong provider and/or did not qualify for payment because they were not provided by an authorized provider; and (3) medical services that listed the incorrect current procedure terminology (CPT) code and/or lacked documentation to support the listed CPT code. Senior Counsel Lisa Veigel represented OIG.
27.11.2018
Louisiana Clinic and Physician settle case of false and fraudulent Medicare claims
On November 27, 2018, Michael L. Drerup, M.D., and Alexandria Neurosurgical Clinic (collectively, “Drerup”), Alexandria, Louisiana, entered into an $80,941.82 Settlement Agreement with OIG. The settlement agreement resolves allegations that Drerup submitted claims to Medicare for nerve conduction studies, which are considered screening tests and are not covered by Medicare. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, worked together to reach this agreement.
Maine mental health provider settles case of disfellowshipped person
On November 27, 2018, Spurwink Services (Spurwink), of Portland, Maine, entered into a $61,461.00 settlement agreement with OIG. The settlement agreement resolves allegations that Spurwink employed a person who was disqualified from participating in MaineCare, Maine's Medicaid program. OIG's investigation determined that the excluded individual, an inpatient physician, provided items or services to Spurwink's patients that were billed to MaineCare.
19.11.2018
Connecticut Diagnostic Services Provider settles case with false allegations
On November 19, 2018, Southern Connecticut Vascular Center, LLC (SCVC), Stratford, Connecticut entered into a $792,076.76 settlement agreement with OIG. The settlement agreement eliminates allegations that SCVC filed claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, even though those claims applied to a procedure that was already included as part of the duplex ultrasound procedures for which SCVS claims using the HCPCS codes 93970 or 93971 for the same beneficiary on the same benefit dates. The OIG further contends that the submission of applications for HCPCS code 93965 was for a procedure that should not be billed separately and was not medically necessary. Senior Counsel Geoffrey Hymans and Joan Matlack represented OIG, assisted by Program Analyst Mariel Filtz.
13.11.2018
Texas Laboratory suspended for default
On November 13, 2018, OIG disqualified Medicus Laboratories, LLC (Medicus), a laboratory located in Dallas, Texas, for failure to pay under a settlement agreement with OIG in which OIG alleged that Medicus made false or fraudulent claims to Medicare. Medicus' suspension will remain in effect until the default is resolved and OIG reinstates Medicus' participation in government healthcare programs. Senior Counsel Geoffrey Hymans represented OIG.
07.11.2018
Illinois Hospital settles case of disfellowshipped person
On November 7, 2018, the University of Chicago Medical Center (UCMC), Chicago, Illinois entered into a $253,671.20 settlement agreement with OIG. The settlement agreement resolves allegations that UCMC hired through a staffing agency a person who was barred from participating in a federal health program. The OIG's investigation found that the disfellowshipped individual, a registered nurse, provided items or services to UCMC patients that were billed to government healthcare programs.
01.11.2018
Ohio Nursing Home is adjudicating the case of a disfellowshipped person
On November 1, 2018, Wayside Farm, Inc. (Wayside), Peninsula, Ohio, entered into a $293,842.58 settlement agreement with OIG. The settlement agreement eliminates allegations that Wayside employed a person who was disqualified from participating in a federal health care program. OIG's investigation found that the disfellowshipped individual, a registered nursing assistant, provided items or services to Wayside patients that were billed to federal healthcare programs.
30.10.2018
Texas doctor and practice settle case with false claims
On October 30, 2018, Angela Smith, M.D., and Willow Wellness Center, P.A. (collectively “Dr. Smith”), Tyler, Texas, entered into a $629,264.14 settlement agreement with OIG. The settlement agreement eliminates allegations that Dr. Smith had submitted claims to Medicare for Healthcare Common Procedure Coding System Code 80502 (Clinical pathology consultation, comprehensive, for a complex diagnostic problem, with review of medical history and medical records) where no consultation request had been made, no written report was made of a consulting pathologist and no exercise of medical judgment by a consulting pathologist was required. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
30.10.2018
Illinois Diagnostic Services Provider settles case with false allegations
On October 30, 2018, Cal-Devon Urgent Care, Inc. (CDUC), Chicago, Illinois entered into a $224,151.48 settlement agreement with OIG. The settlement agreement eliminates allegations that CDUC filed claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, even though those claims applied to a procedure that was already included as part of the duplex ultrasound procedures for which CDUC claims using the HCPCS codes 93970 or 93971 for the same beneficiary on the same benefit dates. The OIG further contends that the submission of applications for HCPCS code 93965 was for a procedure that should not be billed separately and was not medically necessary. Senior Counsel Geoffrey Hymans and Joan Matlack represented OIG, assisted by Program Analyst Mariel Filtz.
30.10.2018
Kansas Financial Management Services Provider will adjudicate a Disfellowshipped Person's case
On October 30, 2018, the Resource Center for Independent Living, Inc. (RCIL), of Osage City, Kansas, entered into a $232,610 settlement agreement with OIG. The settlement agreement eliminates allegations that RCIL employed an individual who was disqualified from participating in a federal health care program. OIG's investigation found that the disfellowshipped individual, a direct service worker, provided items and services to RCIL patients that were billed to Kansas Medicaid. Senior Counsel Nancy Brown represented OIG with support from Paralegal Specialist Jennifer Hilton.
24.10.2018
Physicians and medical practices in Florida settle the case of false and fraudulent claims
Jaime L. Sepulveda, MD, LLC (d/b/a Miami Urogynecology Center), Jaime L. Sepulveda, MD, and Sujata Yavagal, MD. (collectively, “Miami Urogynecology Center”), of South Miami, Florida, have entered into a $173,768.08 settlement agreement with OIG. The Settlement Agreement eliminates allegations that the Miami Urogynecology Center filed claims with Medicare for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, the OIG alleged that the Miami Urogynecology Center filed claims for: (1) diagnostic electromyography services using CPT code 51784 when therapeutic, non-diagnostic services were provided; (2) pelvic floor physical therapy services using CPT codes 97032 and 97110 when such services were provided by an unqualified person; and (3) assessment and management (E&M) services, using CPT codes 99213 and 99214, billed in connection with pelvic floor therapy procedures when separate and identifiable E&M services were not provided. The Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Srishti Sheffner and Michael Torrisi, worked with the support of Program Analyst Mariel Filtz to reach this agreement.
16.10.2018
Pennsylvania Community Mental Health Clinics and Owners Agree to Voluntary Exclusions
On October 16, 2018, Melchor Martinez (Martinez), Melissa Chlebowski (Chlebowski), Lehigh Valley Community Health Centers, Inc. (Lehigh Valley), Northeast Community Mental Health Centers, Inc (Northeast), and Carolina Community Mental Health Centers, Inc. (Carolina), together ("MM"), agreed to waive participation in all federal health programs under 42 U.S.C. 1320a-7(b)(7). Martinez is currently ruled out and has agreed to be ruled out for an additional 10 years. Chlebowski, Lehigh Valley, Northeast and Carolina agreed to be barred for 5 years. OIG alleged that MM submitted or caused to be submitted false allegations to Medicare and Medicaid arising out of the following: (1) Martinez's undisclosed administration of Northeast, Lehigh Valley and Carolina in violation of his exclusion from state health programs; (2) the use of unqualified and/or unsupervised psychotherapists at Northeast, Lehigh Valley and Carolina; and (3) the submission and payment of Medicaid claims for medication management visits, which have been upcoded to reflect longer visits. Senior Counsel Nancy Brown represented OIG.
10.11.2018
Illinois Therapy Service Providers and Owners agree to voluntary exclusion
On October 11, 2018, Quality Therapy & Consultation, Inc. (QTC) and Francis Parise (Parise), of Orland Park, Illinois, in connection with the resolution of their liability under the False Claims Act, agreed to be banned from attending all federal health events to become nursing programs under 42 U.S.C. 1320a-7(b)(7). QTC agreed to a permanent ban and Parise to a five-year ban. Parise is an occupational therapist and the owner and president of QTC. OIG alleged that, at Parise's direction, QTC provided qualified nursing and qualified nursing rehabilitation therapy services that were not medically required, was involved in modifying medical records, and increased its Medicare reimbursements by "upcoding" the Resource Utilization Group's scores patients had inappropriately increased. Senior Counsel David Fuchs represented OIG.
Nevada Medical Biller agrees to 25-year ban
On October 11, 2018, Tymekka Greenough (Greenough), the internal medical biller of First Initiative, LLC (First Initiative), a Nevada behavioral health services provider, consented to reside under 42 U.S.C. 1320a-7(b)(7). The OIG's investigation found that Greenough knowingly filed or filed allegations with the Nevada Medicaid Program on behalf of First Initiative that were false, fraudulent, or not performed as alleged, including: (1) individual psychotherapy services using CPT Codes 90832 , 90834, and 90837; (2) individual psychotherapy services using biofeedback training using CPT code 90876; (3) case management services using CPT code T1016; and (4) qualification and development services using CPT code H2014. Senior Counsel Srishti Sheffner and Michael Torrisi represented OIG.
05.10.2018
The Arkansas Assisted Living Facility adjudicates the case of a disfellowshipped person
On October 5, 2018, Whispering Knoll, of Pine Bluff, Arkansas, entered into a $35,195.95 settlement agreement with OIG. The settlement agreement eliminates allegations that Whispering Knoll employed an individual who was disqualified from participating in a federal health care program. OIG's investigation determined that the disfellowshipped individual, a licensed general practitioner, provided items or services to Whispering Knoll's patients that were billed to federal health care programs. Senior Counsel Nancy Brown represented OIG with support from Paralegal Specialist Jennifer Hilton.
05.10.2018
New York Pharmacy settles case of disfellowshipped person
On October 5, 2018, Healthways Worldwide Inc. d/b/a Healthways Pharmacy and Surgical (Healthways), Brooklyn, New York, entered into a $204,426.64 settlement agreement with OIG. The settlement agreement eliminates allegations that Healthways employed an individual who was disqualified from participating in federal healthcare programs. The OIG's investigation found that the disfellowshipped pharmacist provided Healthways patients with products or services that were billed to federal healthcare programs. Senior Counsel Jennifer Leonardis represented OIG.
03.10.2018
Arizona doctor settles case involving Kickback and Stark allegations
On October 3, 2018, Ronald Burns, M.D. (Dr. Burns), of Phoenix, Arizona, entered into a $75,409.15 settlement agreement with OIG. The settlement agreement eliminates allegations that Dr. Burns, in his capacity as then owner of a pain practice, entered into contracts on behalf of the pain practice and received compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point-of-care test cups that led to banned referrals. OIG further claimed that the referrals were prohibited because a financial relationship was created through the remuneration and that Dr. Burns Millennium to file claims for designated healthcare services resulting from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
28.09.2018
Virginia Doctor and Practice settle case of false and fraudulent claims
On September 28, 2018, Atlantic Obstetrics & Gynecology, P.C. d/b/a Atlantic OB-GYN and Timothy J. Hardy, M.D. (collectively “Atlantic OB-GYN”), with locations in Chesapeake and Virginia Beach, Virginia, entered into a settlement agreement with OIG for $81,959.60. The Settlement Agreement eliminates allegations that Atlantic OB-GYN made claims against Medicare for items or services that it knew or should have known were not supplied as claimed or were false or fraudulent. Specifically, the OIG alleged that Atlantic OB-GYN filed claims for: (1) diagnostic electromyography services using CPT code 51784 and diagnostic anorectal manometry services using CPT code 91122 when therapeutic services, not diagnostic services, were provided , and (2) pelvic floor electrical stimulation not preceded by 4 weeks of failed pelvic muscle training. OIG's Consolidated Data Analysis Center 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, worked together to reach this agreement.
27.09.2018
The New Jersey Health Center is adjudicating a disfellowshipped person's case
On September 27, 2018, Newark Community Health Centers, Inc. (NCHC), New Jersey entered into a $98,750.36 settlement agreement with OIG. The settlement agreement eliminates allegations that NCHC employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the excluded individual, a physician involved in quality assurance and risk management, provided items and services to the NCHC that were billed to state health programs. Associate Counsel Srishti Sheffner represented OIG.
19.09.2018
South Carolina doctors and practice settle case with kickbacks
On September 19, 2018, Sarah S. Cottingham, M.D., Russell E. Ditzler, M.D., and Lexington County Health Services District, Inc. d/b/a Lexington Medical Center (collectively, “Lexington”), Columbia, South Carolina Settlement Agreement Completed with OIG for $97,784. The settlement agreement resolves allegations that Lexington sought and received compensation in the form of "handling and settlement payments" related to the blood collection from two laboratory companies, Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex). OIG alleged that Lexington solicited and received compensation from HDL and Singlex in return for Lexington and Lexington employees who referred patients for HDL and Singlex lab testing that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
14.09.2018
Illinois psychologist agrees to 20-year ban
On September 14, 2018, Anthony D. Vertino, Psy.D. (Vertino), Illinois, agreed for a period of twenty years pursuant to 42 U.S.C. being barred from participating in all government health programs. 1320a-7(b)(7). The OIG's investigation found that Vertino made claims for psychological services that were not provided as claimed or were false or fraudulent because the claims related to treatment dates when patients were hospitalized or when Vertino traveled abroad. Senior Counsel Joan Matlack represented OIG.
Tennessee nurse agrees to 10-year ban
On September 14, 2018, Cindy Scott, R.N., A.P.R.N. (Scott), Tennessee, agreed to reside for a period of ten years under 42 U.S.C. being barred from participating in all federal health programs. 1320a-7(b)(6)(B) and 1320a-7(b)(7). OIG alleged that Scott made or caused the filing of false claims about controlled substance prescriptions that were medically unnecessary, materially exceeded the needs of their patients, and fell below professionally accepted standards of care. In particular, OIG alleged that Scott prescribed individual patients monthly prescriptions in excess of five hundred (500) milligram equivalents (MME) daily dose of morphine containing inappropriate combinations of long-acting and short-acting opioids, often combined with high levels of a benzodiazepine and/or or carisoprodols. OIG also alleged that Scott prescribed controlled substances and combinations of controlled substances and other medications without adequately documenting: (1) a clear objective finding of a chronic source of pain to justify the continued and escalating prescription; (2) attempts to identify the etiology of the reported pain; (3) a thorough medical history or appropriate investigation of a history of possible drug abuse; or (4) a written treatment plan regarding use of the prescriptions. Senior Counsels Andrea Treese Berlin, Katie Fink and Joan Matlack represented OIG.
06.09.2018
Florida Pediatric Practice and Physicians Settle Case with Kickback and Stark Allegations
On September 6, 2018, Milind V. Tilak, M.D., Suwarna Tilak, M.D., Doctor's Inlet Pediatrics and Primary Care, P.A., and Avenues Pediatrics and Internal Medicine (collectively "Doctor's Inlet"), Middleburg and Jacksonville, Florida, signed a settlement agreement over $58,370 with OIG. The Settlement Agreement eliminates allegations that Doctor's Inlet received improper compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of point-of-care test cups that led to prohibited referrals. OIG further claimed that the referrals were prohibited because the remuneration created a financial relationship and that Doctor's Inlet prompted Millennium to make claims for designated healthcare services that resulted from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
05.09.2018
California biotech company settles case with false grant claims
On September 5, 2018, Sonata Biosciences, Inc. (Sonata), of Auburn, California, entered into a $37,716.30 settlement agreement with OIG. The Settlement Agreement resolves allegations that Sonata knowingly submitted to the Department of Health (HHS) two specific claims under an HHS grant that Sonata knew or should have known were false or fraudulent. Specifically, OIG alleged that Sonata deducted $37,384.74 from a National Institutes of Health Small Business Innovation Research Grant for costs unrelated to the grant. Senior Counsel Michael Torrisi and David Traskey, assisted by Chief Investigator Jennifer Trussell, represented OIG.
24.08.2018
Maine's health care system administers the case of a disfellowshipped person
On August 24, 2018, St. Mary's Health System (St. Mary's), Lewiston, Maine, entered into a $68,497.32 settlement agreement with OIG. The settlement agreement eliminates allegations that St. Mary's employed an individual who was disqualified from participating in a federal health care program. OIG's investigation found that the disfellowshipped individual, a call center patient scheduler, provided items and services to St. Mary's patients that were billed to state health care programs.
21.08.2018
Supplier suspended by Oklahoma Prosthetics for late payment
On August 21, 2018, OIG barred La Fuente Ocular Prosthetics, LLC (La Fuente), an Oklahoma City, Oklahoma prosthesis supplier, for failure to meet payment obligations under a settlement agreement with OIG in which OIG alleged that La Fuente had false or fraudulent claims asserted against Medicare and created false records for a false claim. La Fuente's suspension will remain in effect until the arrears on its payment obligations are resolved and OIG reinstates La Fuente's participation in government health programs. Senior Counsel Geoffrey Hymans represented OIG.
20.08.2018
Nevada Behavioral Health Services Provider and Owners Agree to 50-Year Exclusion
On August 20, 2018, First Initiative, LLC, a provider of behavioral health services in Las Vegas, Nevada, and Shameika Amin, its owner (collectively, "First Initiative"), agreed for a period of fifty years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation found that First Initiative knowingly filed or filed claims with the Nevada Medicaid program for: (1) individual therapy services using CPT codes 90834 and 90837 when group therapy services were provided; (2) individual psychotherapy services using biofeedback training using CPT code 90876 where biofeedback training has not been provided; and (3) behavioral health services billed under the names and national provider identifiers of providers who did not provide the services. Senior Counsel Michael Torrisi and Associate Counsel Srishti Sheffner represented OIG.
17.08.2018
ALJ confirms OIG disclaimer
On August 17, 2018, an Administrative Justice Judge (ALJ) of the Departmental Appeals Board upheld the 15-year disqualification of Karim Maghareh, Ph.D. (Maghareh) and BestCare Laboratory Services, LLC (BestCare), Webster, Texas from participation in all federal health programs under 42 U.S.C. § 1320a-7(b)(7). The ALJ found that Maghareh and BestCare had filed false claims with Medicare for reimbursement of travel expenses related to the collection of samples that BestCare performed laboratory testing on. Specifically, BestCare Medicare incorrectly billed trained personnel for travel, but instead used commercial airline flights to ship samples unaccompanied by trained personnel. Senior Counsels Lauren Marziani, Tamara Forys and David Fuchs represented OIG.press release
08.08.2018
California Independent Diagnostic Testing Facility and Owner Agree to Voluntary Disclaimer
On August 8, 2018, CHJ Diagnostic, Inc., an independent diagnostic testing facility located in Orange, California, and Andranik Tovmasyan, its owner (collectively, "CHJ"), agreed for a period of five years pursuant to 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that CHJ filed claims for nerve conduction studies, which are considered screening tests and are not covered by Medicare. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, worked together to achieve this resolution.
08-06-2018
The operator of the hyperbaric oxygen therapy agrees to the voluntary exclusion
On August 6, 2018, Scott Warantz (Warantz), of New York, in connection with the resolution of his liability under the False Claims Act, agreed for a period of five years under 42U.S.C. be barred from participating in all federal health programs. § 1320a-7(b)(7). OIG alleged that Warantz improperly filed or submitted applications for hyperbaric oxygen therapy allegedly being monitored by a physician, even though the physician did not perform monitoring at that facility and instead provided services at an independent facility in New Jersey. Associate Counsel Srishti Sheffner represented OIG.
02.08.2018
Texas physician and practice settle case with kickbacks
On August 2, 2018, Elizabeth Seymour, M.D., and ERS Medical Associates of Denton (collectively, “ERS”), Denton, Texas entered into a $54,860 settlement agreement with OIG. The Settlement Agreement resolves allegations that ERS sought and received compensation from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "litigation and settlement payments" related to the blood collection. The OIG alleged that ERS solicited and received compensation from HDL and Singlex in exchange for ERS and an ERS employee referring patients to HDL and Singlex for laboratory testing that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
02.08.2018
South Carolina doctor and practice settle case with kickbacks
On August 2, 2018, Horace E. Walpole, M.D., and Powdersville Internal Medicine (collectively, "Powdersville IM"), Piedmont, South Carolina, entered into a $68,500 Settlement Agreement with OIG. The Settlement Agreement eliminates allegations that Powdersville IM solicited and received compensation from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "litigation and settlement payments" related to the blood collection. OIG alleged that Powdersville IM solicited and received compensation from HDL and Singlex in exchange for Powdersville IM referring patients to HDL and Singlex for laboratory testing services that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
02.08.2018
Ohio Skilled Nursing Facility adjudicating disfellowshipped person case
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 eliminates allegations that SHCC employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a licensed general practitioner, provided items or services to SHCC patients that were billed to state health care programs. Senior Counsel Nancy Brown, assisted by paralegal Eula Taylor, represented OIG.
02.08.2018
Maine Chiropractic Practice adjudicates case of disfellowshipped person
On August 2, 2018, the Gerrish Chiropractic Center (GCC), Bar Harbor, Maine, entered into a $7,019.10 settlement agreement with OIG. The settlement agreement eliminates allegations that GCC employed a person who was disqualified from participating in a federal health care program. OIG's investigation found that the disfellowshipped individual, an office manager and a chiropractic assistant, provided items or services to GCC patients that were billed to federal health care programs.
02.07.2018
Vermont doctor and practice adjudicating disfellowshipped person's case
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 eliminates allegations that Dr. Newman employed a person who was disqualified from participating in a federal health care program. The OIG's investigation found that the excluded individual, a registered nurse, sold items or services to Dr. Newmans provided patients billed to government health 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, worked together to reach this agreement.
02.07.2018
New Jersey pediatrician settles case with false claims
On July 2, 2018, Rashmi Sandeep, MD (Dr. Sandeep), of Brick, New Jersey, entered into a $336,298.52 settlement agreement with OIG. The settlement agreement resolves allegations made by Dr. Sandeep Medicaid knowingly submitted, through certain New Jersey Medicaid Managed Care Organizations (MCOs), claims for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. In particular, OIG claimed that Dr. Sandeep: (1) Filed or has filed claims for items or services provided to Medicaid beneficiaries enrolled in certain MCOs in which Dr. Sandeep failed to personally perform the billed services or to directly supervise her NPI number because she was either not in the United States or otherwise not in the state of New Jersey; (2) caused the resubmission of previously denied claims for items or services provided to Medicaid beneficiaries registered with a particular MCO by identifying itself as the rendering provider when in fact it was not was; and (3) claims filed or filed for items or services provided to Medicaid beneficiaries registered with a particular MCO under their NPI number for services by non-certified providers other than Dr. Sandeep are enrolled. Associate Counsel Srishti Sheffner represented OIG with support from Paralegal Specialist Mariel Filtz.
29.06.2018
Florida company settles case relating to select agent regulations
On June 29, 2018, a Florida company agreed to pay $100,000 to settle its liability for violating select agent regulations. The OIG alleged that the lab violated select drug regulations when it transferred a select toxin to a facility not registered to possess, use or transfer that toxin, and the company failed to obtain prior approval from the Centers for Disease Control and Prevention had obtained this referral. OIG alleges this conduct subjects the company to civil 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 with false allegations
On June 11, 2018, the 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 filed claims with Medicare for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. Additionally, during the course of the OIG investigation, Comanche discovered and disclosed that it had made Medicare requests for emergency medical transport that was not medically appropriate or necessary. Comanche also disclosed that it had submitted requests to Medicare for transport where the documentation for the transport did not match the patient's condition, and therefore did not support the documented medical necessity of the transport. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
California doctor and practice settles case of false and fraudulent claims
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 settlement agreement with OIG for $419,578. The settlement agreement clears up allegations that Dr. Dunn Medicare made a claim for items or services that it knew or should have known were not supplied as claimed or were false or fraudulent. In particular, the OIG claimed 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 were provided; (2) electrical stimulation of the pelvic floor not preceded by a 4-week course with failed pelvic muscle training; and (3) pelvic floor physical therapy services performed by an unqualified person. The 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 support of Paralegal Specialist Mariel Filtz, worked together to reach this settlement.
30.05.2018
Virginia Non-Profit and Federally Qualified Health Center is adjudicating the subsidy fraud case
On May 30, 2018, St. Charles Health Council, Inc. (St. Charles), of Pennington Gap, Virginia, entered into a $115,000 settlement agreement with OIG. The Settlement Agreement resolves allegations that St. Charles knowingly submitted to the Department of Health and Human Services (HHS) a certain claim under an HHS grant that St. Charles knew or should have known was false or fraudulent, and knowingly and unlawfully evaded any obligation to transmit monies related to such benefit to HHS. Specifically, OIG alleged that St. Charles withdrew $500,000 from a Health Resources and Services Administration capital development grant and used the funds for improper operating expenses unrelated to the grant. OIG further alleged that St. Charles improperly failed to repay those monies for over three months. Senior Counsel Michael Torrisi and David Traskey, assisted by Chief Investigator Jennifer Trussell, represented OIG.
24.05.2018
The Michigan Drug and Alcohol Rehab Center settles the case with 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 eliminates allegations that Recovery Pathways received improper compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of point-of-care test cups that resulted in prohibited referrals. OIG further claimed that the referrals were prohibited because the compensation created a financial relationship and that Recovery Pathways prompted Millennium to make claims for designated healthcare services that resulted from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
21.05.2018
Missouri Ambulance District settles case with 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 filed claims with Medicare for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
17.05.2018
Pennsylvania Home Health Company settles case of disfellowshipped person
On May 17, 2018, Immediate Home Care (IHC) of Bensalem, Pennsylvania entered into a $189,445.68 settlement agreement with OIG. The settlement agreement eliminates allegations that IHC employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a home caregiver, provided items or services to IHC patients that were billed to federal health care programs. Senior Counsel Nancy Brown represented OIG.
05.07.2018
Georgia Medical Assistant agrees to voluntary disqualification
On May 7, 2018, Robert Gennaro (Gennaro) of Woodstock, Georgia, in connection with the resolution of his liability under the False Claims Act, consented again to refrain from participating in all federal healthcare programs for a period of ten years under 42 U.S.C. to be excluded. § 1320a-7(b)(7). The OIG's investigation found that Gennaro worked at pain management clinics in Georgia and Kentucky that Dr. Robert Windsor (Dr. Windsor) owned and operated under the umbrella of National Pain Care, Inc. Real-time intraoperative monitoring (IOM) of surgeries. IOM is a medical procedure in which a doctor monitors nerve and spinal cord activity during surgical procedures to minimize possible adverse effects on a patient's nervous system during surgery. The company presented on behalf of Dr. Windsor Federal Health Programs for the professional component of IOM services when Gennaro billed IOM on behalf of Dr. Windsor performed. Senior Counsel Lisa Veigel represented OIG.
05.04.2018
Tennessee Hospital settles case involving allegations of patient dumping
On May 4, 2018, Houston County Community Hospital (HCCH) in Erin, Tennessee entered into a $25,000 settlement agreement with OIG. The settlement agreement eliminates allegations that HCCH violated the Emergency Medical Treatment and Labor Act by failing to provide appropriate medical screening or treatment to stabilize a medical emergency condition for a 58-year-old patient. In particular, after the patient presented to HCCH's Emergency Department (ED) for evaluation and treatment for blurred vision and dizziness, HCCH failed to perform adequate medical screening within the hospital's ED capabilities, including those routinely for the emergency room emergency services available to determine if the patient had a medical emergency. Instead, an emergency nurse referred the patient to a local ophthalmologist and delayed the provision of an appropriate medical screening exam, which was eventually performed by another hospital the same day. In addition, HCCH failed to provide medical treatment to stabilize the patient's medical emergency condition, cerebral infarction. Senior Counsel Ellen Slavin represented OIG.
05.04.2018
The California health care system handles the case of a disfellowshipped person
On May 4, 2018, Alameda Health System (AHS), California entered into a $257,874 settlement agreement with OIG. The settlement agreement eliminates allegations that AHS employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, an eligibility officer, provided items or services to AHS patients that were paid for by state health programs.
30.04.2018
The Iowa hospital is settling the case involving allegations of patient dumping
On April 30, 2018, Covenant Medical Center (“Covenant”) in Waterloo, Iowa entered into a $90,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Covenant violated the Emergency Medical Treatment and Labor Act when it failed to provide adequate medical screening and stabilizing treatment for a patient and then improperly transferred him to another hospital. The patient, a 54-year-old male, arrived at the Covenant Emergency Department (ED) by ambulance complaining of shortness of breath, chest pain and diaphoresis. The ED doctor examined the patient and consulted the on-call cardiologist. The patient's condition deteriorated and he was intubated. On the advice of the cardiologist on duty, the ED doctor began transcutaneous stimulation. The ER physician did not request the on-call cardiologist to be present in the ER, nor did the on-call cardiologist come to the ER to evaluate and treat the patient. The ED doctor requested transfer to a nearby hospital for placement of a transvenous pacemaker. The patient was transferred to the receiving hospital almost three hours after being presented to the Covenant ER. The receiving hospital fitted the patient with a transvenous pacemaker, but it expired shortly thereafter. OIG claimed that Covenant's on-call cardiologist was able to provide a transvenous pacemaker. Associate Counsel Madeline Bainer represented OIG.
23.04.2018
Alaska Disability Service Provider settles cases of false and fraudulent claims
On April 23, 2018, 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 that the Arc (1) billed for services not rendered; (2) simultaneous billing of individual and group services from the same service provider; and (3) billed for overlapping services with the same service provider. OIG and Alaska MFCU also alleged that the Arc knowingly withheld an overpayment owed to the Alaska Medicaid program that was found in audits conducted by or at the direction of the Arc. Senior Counsel Katherine Matos represented OIG.
11.04.2018
New York Group homeowner agrees to voluntary disqualification
On April 11, 2018, in connection with the resolution of his liability under the False Claims Act, Benard Rorie (Rorie), of Brooklyn, New York, consented for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation found 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 sell residents of group homes managed by Rorie's company Joining Hands to Narco Freedom for outpatient programs and enforcement of residents' participation in these programs regardless of the need for outpatient treatment. Senior Counsels David Fuchs and Geeta Taylor represented OIG.
04.09.2018
Colorado doctors and practice settle case with kickbacks
On April 9, 2018, C. David Bird, M.D., Kurt W. Lesh, M.D., and Colorado Springs Family Practice (collectively, “CS Family Practice”), Colorado Springs, Colorado, entered into a $152,554 Settlement Agreement with OIG. The Settlement Agreement resolves allegations that CS Family Practice received compensation from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "litigation and settlement payments" related to the collection of solicited and received blood. The OIG alleged that CS Family Practice solicited and received compensation from HDL and Singlex in return for CS Family Practice and CS Family Practice employees who referred patients for HDL and Singlex lab testing that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
04.09.2018
North Carolina Hospital settles case involving allegations of patient dumping
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 eliminates allegations that WCH violated the Emergency Medical Treatment and Labor Act by failing to provide adequate screening medical evaluation and stabilizing treatment to a patient. An ambulance was called to provide medical assistance to the patient, a 54-year-old woman who was suffering from worsening shortness of breath that she had had for two weeks. Emergency medical technicians (EMTs) arrived at the patient and found that she was suffering from uncontrolled high blood pressure and increasing shortness of breath with dyspnoea on exertion. Paramedics drove the patient to the WCH Emergency Department (ED), which was two minutes from the patient's home. Along the way, the EMTs called WCH to report on the patient's condition and to notify WCH that the EMTs would take the patient to WCH's emergency room. When the ambulance with the patient was on the premises of the WCH, the emergency services were asked to call the WCH. The WCH ER staff then informed the EMTs that the WCH was on redirection and could not see the patient. However, WCH was not prepared for distraction, and although WCH knew the ambulance was already on his property, WCH directed emergency responders to take the patient to another hospital 22 miles away. Associate Counsel Srishti Sheffner represented OIG.
04.05.2018
Doctor and practice in Alabama settle case with bribes
On April 5, 2018, Rex A. Butler, M.D., and South Central Medical Center, P.C. (collectively “SCMC”), Andalusia, Alabama, entered into a $505,030 settlement agreement with OIG. The Settlement Agreement eliminates allegations that SCMC solicited and received compensation from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "handling and settlement payments" related to the blood collection. The OIG alleged that SCMC solicited and received compensation from HDL and Singlex in return for SCMC referring patients to HDL and Singlex for laboratory testing services that the Medicare program paid for. OIG also alleged that another lab company provided SCMC with an in-office phlebotomist to collect blood samples from SCMC patients at no cost to SCMC, and SCMC used the blood samples collected by the phlebotomist to order tests in HDL, singlex and the other lab. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
04.05.2018
Alabama doctor and practice settle case with Kickback and Stark allegations
On April 5, 2018, AMC – Affordable Medical Care f/k/a Andalusia Medical Center and Dr. Kevin Diel (collectively “AMC”), of Opp, Alabama, entered into a $40,500.50 settlement agreement with OIG. As a result of its investigation, the OIG alleged that AMC received improper compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of point-of-care test cups that resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because a financial relationship was created through the compensation and that AMC caused Millennium to make claims for designated healthcare services resulting from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
02.04.2018
North Carolina Hospital settles case alleging patient dumping
On April 2, 2018, Southeastern Regional Medical Center (SRMC), Lumberton, North Carolina entered into a $200,000 settlement agreement with OIG. The settlement eliminates allegations that, based on the OIG's investigation, SRMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide adequate medical screening, stabilizing treatment and/or adequate relocation for four people .

In the following two cases in particular, SRMC has not carried out appropriate medical check-up and/or stabilizing treatment. The first patient, a 71-year-old male who had been living independently, presented to the SRMC Emergency Department (ED) on January 21, 2016, complaining of leg pain, weakness, inability to walk, and a drastic change in behavior and function. His daughter reported that he was occasionally disoriented, but that he was visiting her and was in good health. The ED doctor 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 emergency room with similar symptoms and complaints. This time, another ED doctor diagnosed the patient with a traumatic subdural hemorrhage and referred the patient for brain surgery. At the receiving hospital, the patient remained in critical condition for two weeks with a diagnosis of acute respiratory failure, possible stroke and seizures. The patient died the following week. The second patient, a 49-year-old male, presented to the SRMC Emergency Department on August 27, 2015 with lethargy and a multiple drug overdose. The patient said he was depressed and had had suicidal thoughts. The ED doctor ordered blood and urine tests, an EKG and a head CT and determined that the patient had a history of depression and chronic back pain. The patient was placed under suicide prevention but no psychiatric evaluation was ordered. The patient was discharged approximately 4.5 hours later with diagnoses of polypharmacy and asthenia with discharge orders for near syncope and weakness. Four days later, the patient died from a self-inflicted gunshot wound to the head.

In two other cases, SRMC failed to meet its EMTALA obligations when it failed to reassess the patient at the time of transfer to determine whether: (1) the benefits to each patient continued to outweigh the risks, (2) the prior agreements for adequate staffing and transportation were appropriate given the patient's deterioration; and (3) additional medical treatment was required to minimize the risks to the health of the individual and, in the case of a woman in childbirth, the health of the unborn child. The third patient, a 44-year-old female, presented to the SRMC Emergency Department at 3:38 p.m. on February 28, 2014. to evaluate an altered mental state when she was found unresponsive with an empty bottle of Butalbital at her side. A CT scan showed extensive acute subarachnoid hemorrhage with possible arterial aneurysm hemorrhage. At 9:30 p.m., the ED doctor certified that the medical benefits of neurosurgery at a hospital over 122 miles away outweighed the risks of a transfer. However, the patient was only transferred the following day at 2:16 a.m. when her condition had deteriorated significantly. The fourth patient, a 26-year-old patient, 28 weeks pregnant, presented to the emergency room on March 13, 2014 with a complaint of ruptured membranes and lower back discomfort. The ED doctor examined the patient at 11:15 a.m. and determined that her unborn child required tertiary services that were not available at the SRMC and certified that the medical benefits of delivering at a hospital over 80 miles away outweighed the risks of a transfer prevailed. However, the patient was not transferred until 1:00 p.m. Between the time of the ED doctor'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.

27.03.2018
Ohio Home Health Company settles case of disfellowshipped person
On March 27, 2018, ASAP Home Nurses, Inc. (ASAP), based in Wadsworth, Ohio, entered into a $11,406.26 settlement agreement with OIG. The settlement agreement eliminates allegations that ASAP employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a registered nursing assistant, provided items or services to ASAP patients that were billed to state healthcare programs. Senior Counsel Keshia Thompson represented OIG with support from Paralegal Specialist Eula Taylor.
26.03.2018
Pennsylvania doctor agrees to voluntary exclusion
On March 26, 2018, Stephen Latman (Latman), a physician in Reading, Pennsylvania, consented under 42 U.S.C. Be barred from participating in all government health programs for a period of 10 years. § 1320a-7(b)(6)(B). The OIG alleged that Latman prescribed patients opioids that significantly exceeded those patients' needs and failed to meet professionally accepted standards of care. Senior Counsel Lisa Veigel represented OIG.
26.03.2018
Wisconsin Independent Living Support Provider adjudicates case of disfellowshipped person
On March 26, 2018, Brookfield, Wisconsin-based Community Care, Inc. (CCI) entered into a $208,585.20 settlement agreement with OIG. The settlement agreement resolves allegations that CCI, a care management organization, contracted with a person who was disqualified from participating in federal health care programs. The OIG's investigation determined that the disfellowshipped individual provided residential items or services to CCI patients that were billed to federal health care programs. Associate Counsel Jonathan Culpepper represented OIG.
23.03.2018
Florida hospital settles case involving allegations of patient dumping
On March 23, 2018, Peace River Regional Medical Center (Peace River), Port Charlotte, Florida, entered into a $42,500 settlement agreement with OIG. The settlement agreement eliminates allegations that based on OIG's investigation, Peace River violated the Emergency Medical Treatment and Labor Act when it failed to accept an appropriate transfer of a patient. Specifically, the patient, a 17-year-old woman, presented to the Emergency Department (ED) of another hospital at 6 weeks gestation complaining of abdominal pain that lasted about a week. An ultrasound confirmed the intrauterine fetus with a heartbeat and a left ectopic rupture. The patient required obstetric care that was not available at this hospital. Accordingly, the ED contacted the Hospital Corporation of America Transport Center (TC) requesting a transfer due to a possible ruptured ectopic pregnancy. When TC notified Peace River's ED that it was attempting to facilitate an ED to ED transfer, the Peace River representative replied that it did not accept ED to ED transfers and hung up. TC called Peace River back and the call was transferred to ED where it was repeated that Peace River does not accept ED to ED transfers. The ED worker also mentioned that they gave the transferring hospital the contact information for Peace River's OB/GYN on-call service. The transferring hospital called Peace River's on-call obstetrician-gynecologist, who requested that all of the patient's medical reports be faxed to him before he would consider admitting the patient. During this conversation, the doctor learned that the patient was "out of county" and he would not accept the transfer. Senior Counsel Sandra Sands represented OIG.
21.03.2018
New Jersey Pharmacy and Owner Settle Disfellowshipped Person's Case
On March 21, 2018, Pharmex Pharmacy, LLC and Israel Weber (collectively, "Pharmex") of Lakewood, New Jersey entered into a $314,205.76 settlement agreement with OIG. The settlement agreement eliminates allegations that Pharmex employed a person who was disqualified from participating in federal health programs. The OIG's investigation found that the disfellowshipped pharmacist provided items or services to Pharmex patients that were billed to federal healthcare programs. Associate Counsel Srishti Sheffner represented OIG.
19.03.2018
Pennsylvania cardiologist agrees to voluntary disqualification
On March 19, 2018, Vidya Banka, MD (Dr. Banka), Pennsylvania, in connection with the resolution of his liability under the False Claims Act, agreed to be barred from participating in all state healthcare programs for a period of five years under the age of 42 become USC § 1320a-7(b)(7). OIG claimed Dr. Banka caused claims to be filed with Medicare for medically unnecessary cardiac stenting procedures. Senior Counsel Geeta Taylor represented OIG.
03.05.2018
Texas physician and practice settle case with kickbacks
On March 5, 2018, Ankur Doshi, M.D., and PrimeCare Medical Group (collectively, "PrimeCare"), with offices in Houston and Katy, Texas, entered into a $53,260 settlement agreement with OIG. The settlement agreement resolves allegations that PrimeCare sought and received compensation in the form of "trial and settlement" payments related to the blood collection from Health Diagnostic Laboratory, Inc. (HDL), a laboratory company. OIG alleged that PrimeCare solicited and received payment from HDL in exchange for PrimeCare referring patients to HDL for laboratory testing that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
08.03.2018
Ohio Hospital settles case involving allegations of patient dumping
On March 8, 2018, Paulding County Hospital (PCH), Paulding, Ohio, entered into a $50,000 settlement agreement with OIG. The Settlement Agreement eliminates allegations that PCH violated the Emergency Medical Treatment and Labor Act by failing to conduct an appropriate medical evaluation and effectuate the appropriate transfer of a patient. The patient, a 33-week pregnant woman, presented to the PCH Emergency Department (ED) complaining of fluid leakage, pelvic pain, and vomiting. A PCH emergency room nurse took the patient to an exam room. The nurse told the patient that the hospital did not have an on-site obstetrician and that the patient could either begin treatment at the PCH and be transferred later, or her male companion could drive her immediately to another hospital where her obstetrician practiced. After being told this, the patient left PCH in a private vehicle to another hospital, a thirty-minute drive away. PCH never gave the patient or her unborn child a medical check-up. At the receiving hospital, the patient underwent an emergency caesarean section and gave birth to a male child without a heartbeat. Efforts by the receiving hospital to resuscitate the infant were unsuccessful. Associate Counsel James Hansen represented OIG.
28.02.2018
Florida drug and alcohol rehabilitation center and owners settle case with bribery and Stark allegations
On February 28, 2018, The Pain Institute, Inc. d/b/a Space Coast Pain Institute, Stanley Golovac, M.D. and Richard Gayles, M.D. (collectively “Space Coast”), Merritt Island, Fla., entered into a $95,302.50 settlement agreement with OIG. As a result of its investigation, the OIG alleged that Space Coast received improper compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of point-of-care test cups that resulted in prohibited referrals . OIG further claimed that the referrals were prohibited because the compensation created a financial relationship and that Space Coast prompted Millennium to make claims for designated healthcare services that resulted from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
16.02.2018
Arkansas Skilled Nursing Facility is adjudicating the case of a disfellowshipped person
On February 16, 2018, the Arkansas Convalescent Center (ACC), Pine Bluff, Arkansas entered into a $189,805.55 settlement agreement with OIG. The settlement agreement eliminates allegations that ACC employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a licensed practicing nurse, provided items and services to ACC patients that were billed to state healthcare programs. Senior Counsel Nancy Brown represented OIG with support from Paralegal Specialist Jennifer Hilton.
13.02.2018
Arizona physicians and practices settle cases of false and fraudulent claims
On February 13, 2018, Modocurogyn, PLLC d/b/a AZ Urogynecology and Pelvic Health Center, a urogynecology practice with locations in Mesa, Scottsdale, and Glendale, Arizona, and its medical partners Dr. Mohamed Akl and Dr. Ahmed Akl (collectively "AZ Urogynaecology"), entered into a settlement agreement with OIG for $877,474. The Settlement Agreement resolves allegations that AZ Urogynecology made claims against Medicare for items or services that it knew or should have known were not supplied as claimed or were false or fraudulent. Specifically, the OIG alleged that AZ Urogynecology filed claims for: (1) diagnostic electromyography (EMG) services using CPT code 51784 and diagnostic anorectal manometry (ARM) services using CPT code 91122 when therapeutic services , non-diagnostic services, had been provided; (2) evaluation and management (E&M) services billed in connection with pelvic floor therapy procedures when separate and identifiable E&M services have not been performed; (3) unfocused biofeedback techniques; and (4) EMG and ARM-assisted biofeedback therapy not preceded by a four-week course with failed pelvic muscle training. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Michael Torrisi and Associate Counsel Srishti Sheffner, worked together to achieve this settlement.
13.02.2018
The Management Company will settle the case of an Excluded Person
On February 13, 2018, Southwest Trinity Management, LLC (STM) entered into a settlement agreement with OIG for $141,986.36. The settlement agreement eliminates allegations that STM, through a qualified nursing facility it owns and operates in Oklahoma City, Oklahoma, employed an individual who was disqualified from participating in a federal health care program. OIG's investigation determined that the disfellowshipped individual, a licensed practical nurse, provided items or services that were billed to government healthcare programs.
23.01.2018
Chiropractor and his practice management company agree on voluntary exclusion
On January 23, 2018, Matthew Anderson and PMC Management Company, LLC (PMC), Tennessee, agreed for a period of 5 years pursuant to 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Anderson and PMC prompted pharmacies to send payment requests to Part D plan sponsors and TennCare for medications, including controlled substances, that were not dispensed for a legitimate medical purpose and/or were dispensed without valid prescriptions under the law were surrendered by Tennessee. OIG also alleged that Anderson and PMC filed or caused to be filed claims to Medicare that: (1) were encoded with CPT code 99214 and the modifier -25, even though those claims were not, as such, payable; and (2) provided by a nurse not working with a physician as required by Tennessee law. Senior Counsel Andrea Treese Berlin represented OIG.
12.01.2018
Virginia Hospital settles the case of false and fraudulent Medicare claims
On January 12, 2018, Carilion Medical Center, Inc. d/b/a Carilion Roanoke Memorial Hospital, Carilion Services, Inc. and Carilion Clinic (collectively “Carilion”), Virginia entered into a $403,960.75 settlement agreement with OIG. The Settlement Agreement eliminates allegations that Carilion filed claims for the assessment and management of outpatient clinic visits of "new patients" using Healthcare Common Procedure Coding System (HCPCS) codes 99201-99205, when in fact the patients in question were "established patients" and Carilion should therefore have filed these claims using the generally lower paying HCPCS codes 99211-99215. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
11.01.2018
Georgia Hospital settles case involving allegations of patient dumping
On January 11, 2018, Piedmont Newton Hospital (Piedmont), Covington, Georgia entered into a $52,414 settlement agreement with OIG. The settlement agreement eliminates allegations that Piedmont violated the Emergency Medical Treatment and Labor Act when it failed to provide adequate medical screening and stabilizing treatment for a patient and then improperly transferred the patient to another hospital. The patient, a 58-year-old female, presented to the Piedmont Emergency Department (ED) in a private vehicle complaining of left-sided pleuritic chest pain and abdominal pain. An ED doctor examined the patient and found that her abdomen was diffusely taut and had hypoactive bowel sounds. The patient's blood samples showed that her lactic acid, bleeding and clotting time were increased. The patient's chest X-ray showed a large volume of intraperitoneal air under the right diaphragm, suggesting bowel perforation. The ED doctor discussed the patient's condition with the on-call surgeon, who recommended transferring the patient to the other hospital where she had undergone a dilatation and curettage procedure two days earlier. The other hospital agreed to the transfer and requested that the patient be airlifted to their facility. Three hours and forty-seven minutes after arriving at the Piedmont Emergency Department, the patient was transferred to the other hospital in critical condition. On arrival at the other hospital, the patient was in septic shock and on the verge of respiratory collapse. Even after emergency surgery to repair the intestinal perforation, the patient's condition continued to deteriorate and she died the same day. Associate Counsel Srishti Sheffner represented OIG.
10.01.2018
Tennessee Hospital settles case involving allegations of patient dumping
On January 10, 2018, Clarksville Health System, f/k/a Gateway Medical Center (CHS), entered into a $40,000 settlement agreement with OIG. The settlement agreement eliminates allegations that CHS violated the Emergency Medical Treatment and Labor Act by not accepting an appropriate transfer. A 13-year-old boy presented to the emergency department (ED) at a hospital complaining of testicular pain. An ultrasound showed no blood flow in the right testicle and a large amount of fluid around the testicle. In order to access the required specialized services of a urologist, which this hospital did not have, the ED requested CHS to accept the patient for transfer. However, the CHS urologist on duty refused to accept the patient's transfer and instead recommended that the patient be transferred to another facility. The OIG alleged that CHS refused to accept the appropriate transfer when it had both the capability and ability to stabilize the patient's emergency medical condition. Senior Counsel Sandra Sands represented OIG.

2017

29.12.2017
The Texas Mental Health and Drug Treatment Facility is adjudicating a disfellowshipped person's case
On December 29, 2017, Turtle Creek Recovery Center (Turtle Creek), Dallas, Texas entered into a $24,428.58 settlement agreement with OIG. The settlement agreement resolves allegations that Turtle Creek employed an individual who was disqualified from participating in a federal health care program. OIG's investigation found that the disfellowshipped individual, a counselor, provided Turtle Creek patients with items or services billed to state healthcare programs. Deputy Branch Manager Nicole Caucci represented OIG with the support of Paralegal Eula Taylor.
29.12.2017
Virginia Doctor and Practice settle case of false and fraudulent claims
On December 29, 2017, the Female Pelvic Medicine Institute of Virginia, P.C. and Nathan Guerette, M.D. (collectively Dr. Guerette), a urogynecology practice and physician with locations in Richmond and North Chesterfield, Virginia, entered into a $1,401,344 settlement agreement and three-year integrity agreement with OIG. The settlement agreement resolves allegations that Dr. Guerette made claims to government health programs for items or services that he knew or should have known were not supplied as claimed or were false or fraudulent. In particular, the OIG claimed that Dr. Guerette submitted claims for: (1) pelvic floor therapy services performed by unqualified individuals; (2) diagnostic electromyography services under CPT Code 51784 not performed in accordance with the requirements of the specified code; (3) unbundled biofeedback and physical therapy techniques; and (4) "incident on" services lacking the required level of medical supervision. The OIG also claimed that Dr. Guerette submitted requests for electromyography services under CPT code 51784 and anorectal manometry services under CPT codes 91120 and 91122, which are not supported by adequate medical record documentation. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Michael Torrisi and David Traskey, with support from Paralegal Specialist Mariel Filtz, worked together to achieve this settlement.
26.12.2017
Georgia Hospital settles case involving allegations of patient dumping
On December 26, 2017, Phoebe Putney Memorial Hospital (Phoebe Putney), Albany, Georgia entered into a $50,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Phoebe Putney violated the Emergency Medical Treatment and Labor Act by not accepting an appropriate transfer. A 54-year-old man presented to the emergency department (ED) of another hospital with a subdural hematoma. A CT scan showed that this subdural hematoma was on top of a previous hematoma. The patient had to be examined by a neurosurgeon who was not available at this hospital. Accordingly, the transferring hospital's ED physician attempted to transfer the patient to Phoebe Putney for neurosurgical treatment. Phoebe Putney treated the patient about a week earlier for the previous hematoma. Phoebe Putney refused to accept the transfer when she had both the skills and the capacity to treat the patient. The patient was then transferred to another hospital and immediately admitted to their neuro-intensive care unit, where he remained for several days before being discharged. Senior Counsel Sandra Sands represented OIG.
12.12.2017
Massachusetts Hospital settles case involving allegations of patient dumping
On December 12, 2017, Cambridge Health Alliance (Cambridge), Cambridge, Massachusetts entered into a $90,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Cambridge, based on the OIG's investigation, breached the Emergency Medical Treatment and Labor Act by failing to provide adequate medical screening to a patient who presented at the Somerville Hospital campus in Cambridge, Somerville. investigation provided. The patient was having an acute asthma attack, a life-threatening condition that requires immediate medical attention. OIG alleges the patient tried unsuccessfully to gain access to the Somerville ER at the entrance to the ambulance bay, but the door was locked and unattended. The patient then called 911 and informed the dispatcher that she was having an asthma attack and could not enter the hospital emergency room. The dispatcher then called the Somerville ER and told the nurse who answered that the patient was having an asthma attack outside the ER doors. Three minutes after that notification, the OIG further claims, the RN opened the ambulance bay door and looked around for the patient, but did not let go of the door, searched the area outside the entrance, or dispatched another employee to continue the search. Police and fire crews later found the patient lying collapsed on a bench near the door of the ambulance bay in complete cardiac arrest with no sign of breathing. Firefighters began life-saving measures before the patient was taken to the emergency room. The patient died six days later from hypoxic brain injury. The OIG alleged that Cambridge failed to conduct an adequate search for the patient and therefore failed to provide her with an adequate medical check-up after she presented to Cambridge's Emergency Department in Somerville. Senior Counsel Kenneth Kraft and Sandra Sands represented OIG.
12-06-2017
Tennessee Hospital settles case involving allegations of patient dumping
On December 6, 2017, Dyersburg Hospital Company, LLC d/b/a Dyersburg Regional Medical Center (DRMC), Dyersburg, Tenn. entered into a $45,000 settlement agreement with OIG. The settlement agreement eliminates allegations that based on the OIG's investigation, DRMC violated the Emergency Medical Treatment and Labor Act when it failed to provide a patient presenting to the DRMC's Emergency Department (ED) with an adequate screening medical evaluation and stabilizing treatment provided. The patient, a 58-year-old woman and resident of a long-term care facility, fell in the shower and was taken to the DRMC Emergency Department for evaluation and treatment. The ED doctor initiated a medical screening exam and documented the patient's symptoms of headache, altered mental status and her reported symptom of near fainting. Laboratory tests revealed abnormal glucose levels and abnormal hematocrit levels. The ED doctor planned to release the patient back to the nursing home. Before discharge, it was noted that the patient's right arm was swollen compared to when she arrived. Her discharge was canceled and X-rays were ordered, which revealed no evidence of a fracture. Six hours after the triage, a nurse reported that the patient needed suction. Nine hours after the triage, the patient was examined neurologically and the nurse documented that she was independent of time, place, person and situation. The doctor then ordered Narcan and a CT scan. Because the DRMC's CT scan could not support the patient's weight, the DRMC's emergency room contacted other hospitals to transfer the patient. About 2.5 hours later, the patient was rushed to another hospital where she received a CT scan. The CT scan showed a hematoma in her brain as well as Coumadin poisoning. The hospital then ordered an EEG, which showed no brain activity, and the patient died that same day. Senior Counsel Sandra Sands represented OIG.
05.12.2017
Ohio addiction treatment providers settle case with Kickback and Stark allegations
On December 5, 2017, Addiction Medical Care of Norwalk, Practice Management Associates Norwalk, LLC, Addiction Medical Care of Columbus and Practice Management Associates, LLC (collectively “AMC”) with locations in Norwalk and Columbus, Ohio entered into a Settlement Agreement for 79,880 $.50 with OIG. As a result of its investigation, the OIG alleged that AMC received improper compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of point-of-care test cups that resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because a financial relationship was created through the compensation and that AMC caused Millennium to make claims for designated healthcare services resulting from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG
04.12.2017
Missouri Physician and Practice Settle Case Involving Kickbacks
On December 4, 2017, Rodney Malisos, M.D., and Liberty Medical Center (collectively, "Liberty Medical"), Liberty, Missouri, entered into a $60,839 settlement agreement with OIG. The Settlement Agreement eliminates allegations that Liberty Medical solicited and received compensation from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "litigation and settlement payments" related to the blood collection. The OIG alleged that Liberty Medical solicited and received compensation from HDL and Singlex in return for Liberty Medical referring patients for laboratory testing of HDL and Singlex that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
04.12.2017
Alabama Hospital settles case involving allegations of patient dumping
On December 4, 2017 Greenville Hospital Corporation d/b/a L.V. Stabler Memorial Hospital (L.V. Stabler), Greenville, Alabama entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that L.V. Stabler violated the Emergency Medical Treatment and Labor Act when it failed to provide a 16-year-old patient with adequate medical evaluation and stabilizing treatment. The patient was 27 weeks pregnant and was taken to L.V. by ambulance. Stablers emergency room (ED) and complained of vaginal bleeding and severe pain in the lower abdomen. A nurse recorded the patient's vital signs and measured the fetal heart rate. An ED doctor examined the patient and called the patient's obstetrician to discuss the patient's condition. Without conducting an adequate medical check-up, the ED doctor decided to send the patient to another hospital where the patient's obstetrician was located for monitoring. The ED doctor discharged the patient and directed her to go to the other hospital 55 miles from L.V. was removed. more stable. On the way to the other hospital, the patient's relatives called the emergency services (EMS). When emergency services arrived, the patient was lying on the ground next to her car with severe abdominal pain, vaginal pain, and light bleeding. EMS drove the patient to another hospital, where she gave birth to a stillborn child within minutes of her arrival. Associate Counsel Srishti Sheffner represented OIG.
04.12.2017
North Carolina doctor and practice settle case with false claims, bribes and strong allegations
On December 4, 2017, Dr. Josette Maria (Dr. Maria) and Maria Medical Center (collectively "MMC"), with offices in Dunn and Spring Lake, North Carolina, entered into a $60,000 settlement agreement with OIG. The Settlement Agreement resolves allegations that MMC: (1) billed for services provided to Dr. were made available to Maria "on an ad hoc basis" despite her absence from the office suite; (2) routinely billed for services performed by unlicensed persons; and (3) received compensation from laboratory companies in the form of "litigation and settlement payments" in exchange for patient referrals for laboratory testing services paid for by Medicare. Deputy Branch Manager Tamara Forys and Senior Counsel Jennifer Leonardis represented OIG.
04.12.2017
Missouri neurologist agrees to voluntary disqualification
On December 4, 2017, Dr. Sherry Ma (Dr. Ma), a neurologist in Saint Louis, Missouri, to, under 42 U.S.C. Be barred from participating in all government health programs for a period of three years. § 1320a-7(b)(7) for alleged violation of the Fines Act. The OIG claimed that Dr. Ma received free vials of Botox§ and Myobloc§ (medication) to be used for certain patients with private insurance. Instead of throwing away what was left of the medications contained in the vials labeled as single-dose vials, Dr. Ma the rest for more than 24 hours. Subsequently, Dr. Ma provided the remaining portion of the medication for Medicare patients, but filed payment claims with Medicare as if she had bought new vials. Senior Counsel David Fuchs represented OIG.
29.11.2017
New York physical therapist and physical therapy practice settles case with false claims
On November 29, 2017, Lino Chuang and Excellent Choice Physical Therapy, P.C. (collectively Excellent Choice), a physical therapy practice with locations in Queens and Long Island, New York, has entered into a $500,000 settlement agreement and 3-year integrity agreement with OIG. The Settlement Agreement eliminates allegations that Excellent Choice filed claims for physical therapy services that: (1) were performed by individuals without the required license and qualifications; (2) not properly supervised on site by a physical therapist; and (3) provided in a group therapy setting when individual contact was required. Senior Counsel Michael Torrisi and David Blank represented OIG.
06.11.2017
The Ohio Home Health Agency is adjudicating a disfellowshipped person's case
On November 6, 2017, Diamonds & Pearls Health Services, LLC (DPHS) of Cleveland, Ohio entered into a $75,471.92 settlement agreement with OIG. The settlement agreement eliminates allegations that DPHS employed an individual who was disqualified from participating in federal health programs. The OIG's investigation determined that the disfellowshipped individual, a scheduling/human resources coordinator, provided items or services to DPHS patients that were billed to government healthcare programs.
06.11.2017
Indiana practice governs the case of a disfellowshipped person
On November 6, 2017, the Center for Ear, Nose Throat & Allergy, P.C. (CENTA), of Carmel, Indiana, has entered into a settlement agreement with OIG for $51,564.14. The settlement agreement resolves allegations that CENTA employed a person who was disqualified from participating in a federal health care program. The OIG's investigation determined that the excluded individual, a medical records clerk, provided items or services to CENTA patients that were billed to federal health care programs. Associate Counsel Srishti Sheffner represented OIG with support from Paralegal Specialist Jennifer Hilton.
01.11.2017
Texas Physicicers and Practice Settle Case Involving Kickbacks
On November 1, 2017, Ladan Bakhtari, M.D., David E. Garza, M.D., and internal medicine physicians (collectively, "IM's Physicians"), of Plano, Texas, entered into a $53,820 settlement agreement with OIG. The Settlement Agreement resolves allegations that Doctors of IM sought and received compensation in the form of "process and settlement" payments related to the blood collection from Health Diagnostic Laboratory, Inc. (HDL), a laboratory company. The OIG alleged that IM physicians received HDL's compensation in return for IM physicians and IM physicians who referred patients to HDL for laboratory tests paid for by the Medicare program. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
24.10.2017
California Independent Diagnostic Testing Facility and Owner Agree to Voluntary Disclaimer
On October 24, 2017, Prohealth Neurodiagnostic, Inc., an independent diagnostic testing facility in Van Nuys, California, and Arsen Oganesyan, its owner (collectively, "Prohealth") agreed to reside under 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that Prohealth filed claims for nerve conduction studies that are considered screening studies and are not covered by Medicare, in violation of a local coverage rule that governs the medical necessity of such studies. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, worked together to achieve this resolution.
19.10.2017
Florida Laboratory agrees to voluntary disqualification
On October 19, 2017, Total Lab Care, LLC (Total Lab Care), Jacksonville, Florida, in connection with the resolution of its liability under the False Claims Act, agreed to be permanently banned from participating in all federal healthcare programs under 42 U.S.C. to be excluded. § 1320a-7(b)(7). The OIG's investigation found that Total Lab Care knowingly billed federal health programs for non-reimbursable urine toxicology samples. In particular, the OIG alleged that Total Lab Care sought reimbursement for urine toxicology samples referred by a physician to whom Total Lab Care had paid improper financial compensation. Senior Counsel Felicia Heimer represented OIG.
17.10.2017
New Jersey Physicicers and Practice Settle Case Involving Kickbacks
On October 17, 2017, Scott R. Eisenberg, D.O., Robert G. Kayser, Jr., M.D., and Change of Heart Cardiology, LLC (collectively, "COH Cardiology"), of Sea Girt, New Jersey, entered into a $208,450 settlement agreement with OIG. The Settlement Agreement eliminates allegations that COH Cardiology sought and received compensation from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), laboratory companies, in the form of "litigation and settlement payments" related to the blood collection. OIG alleged that COH Cardiology solicited and received compensation from HDL and Singlex in exchange for COH Cardiology and a COH Cardiology employee referring patients for laboratory testing of HDL and Singlex that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
17.10.2017
Texas Marking Company CEO agrees to voluntary disqualification
On October 17, 2017, Mitch Edland (Edland), Addison, Texas, in connection with the resolution of his liability under the False Claims Act, agreed for a period of 5 years under 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that Edland's company, DNA Stat, LLC (DNA Stat), entered into an agreement with a laboratory to commercialize a pharmacogenomics clinical trial of which the laboratory was a sponsor. OIG's investigation found that Edland, in his capacity as CEO of DNA Stat, caused the filing of allegations with Medicare that were false and fraudulent due to the following conduct in violation of the Anti-Kickback Statute: (1) Payment by physicians for participation in a clinical trial that the OIG determined was not a legitimate clinical trial, to induce such physicians to order pharmacogenetic testing from the laboratory; (2) paying physicians based on the volume of referrals to his company to induce those physicians to order pharmacogenetic testing from the laboratory; (3) providing physicians with in-office medical technicians to persuade such physicians to order pharmacogenetic testing from the laboratory; (4) entering into a marketing agreement with the laboratory, taking into account the volume or value of the referrals, with a view to initiating referrals of tests to the laboratory; and (5) entering into marketing agreements with individual marketers, taking into account the volume or value of referrals, with the intention of initiating referrals of tests to the laboratory. Senior Counsel Karen Glassman represented OIG.
17.10.2017
Alabama Ambulance Companies settles case with false allegations
On October 17, 2017, Lifeguard Ambulance Service, LLC, Lifeguard Ambulance Service of Florida, LLC and Lifeguard Ambulance Service of Texas, LLC (collectively, "Lifeguard"), headquartered in Birmingham, Alabama, entered into a $110,813.69 settlement agreement with OIG. The settlement agreement resolves allegations that Lifeguard filed claims with Medicare for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
17.10.2017
Texas Mental Health Provider settles case involving disfellowshipped person
On October 17, 2017, MHMR of Tarrant County (MHMR), Fort Worth, Texas entered into a $97,869.78 settlement agreement with OIG. The settlement agreement eliminates allegations that MHMR employed an individual who was disqualified from participating in federal health programs. OIG's investigation determined that the disfellowshipped individual, a program director, provided items or services to MHMR clients who received services funded through a Medicaid waiver program. Senior Counsel Keshia Thompson represented OIG with support from Paralegal Specialist Eula Taylor.
17.10.2017
Missouri Hospital settles case alleging patient dumping
On October 17, 2017, Southeast Missouri Hospital (SEM), Cape Girardeau, Missouri entered into a $100,000 settlement agreement with OIG. The settlement agreement eliminates allegations that SEM violated the Emergency Medical Treatment and Labor Act by failing to provide adequate medical screening and stabilizing treatment for two patients who presented to SEM's Emergency Department (ED) in 2011. OIG claimed that this was not properly evaluated and treated, the patients with unstable medical emergencies were released into police custody under a hospital policy: if a patient had a blood alcohol level (BAL) above 100, the patient was turned over to local law enforcement and jailed brought . The first patient was 25 years old when she called a crisis hotline and an ambulance was dispatched to her home. She was taken to the emergency room at SEM for investigation into a possible attempted suicide by overdose. The patient's BAL was 422 and the ED doctor released her into the custody of local law enforcement, where she was held in prison awaiting to see a counselor. The second patient was 41 years old when he presented to SEM after attempting suicide by overdose. The patient was depressed, had a history of psychiatric problems, and had recently been admitted to electroconvulsive therapy. The patient's BAL was 288 and he was released into the custody of local law enforcement and sent to prison. The next day the patient was seen by a counselor in prison and then released from custody. The patient returned to SEM that evening after attempting suicide again by overdose. The patient was slurred, lethargic and had a shallow affect and was admitted to the intensive care unit in a guarded state. Senior Counsel Sandra Sands represented OIG.
10.11.2017
Illinois Case Management Provider administers the case involving a disfellowshipped person
On October 11, 2017, Shawnee Health Services (Shawnee), of Carterville, Illinois, entered into a $107,761.08 settlement agreement with OIG. The settlement agreement eliminates allegations that Shawnee employed a person who was disqualified from participating in federal health programs. OIG's investigation determined that the excluded individual, a case manager, provided items or services to Shawnee clients who were receiving services under a Medicaid waiver program.
10.10.2017
The Arkansas Department of Health is adjudicating the case of an expelled person
On October 10, 2017, the Arkansas Department of Health (ADH) entered into a $39,343.61 settlement agreement with OIG. The settlement agreement eliminates allegations that ADH employed a person who was barred from participating in federal health care programs. OIG's investigation found that the disfellowshipped individual, a hospice social worker, provided items or services to patients at a community-based hospice operated by ADH that were billed to federal health care programs. Senior Counsel Keshia Thompson represented OIG with support from Paralegal Specialist Eula Taylor.
27.09.2017
New Jersey doctor agrees to voluntary disqualification
On September 27, 2017, Dr. Dinesh Patel (Dr. Patel), of Edison, New Jersey, in connection with the resolution of his liability under the False Claims Act, agrees to be barred again from participating in all state healthcare programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that Dr. Patel, despite being previously barred from participating in New Jersey Medicaid on March 17, 2012 and from participating in all state health care programs on February 20, 2014, continued to provide administration and management services to Edison Adult Medical Daycare (EAMD) in violation against the terms of his exclusion. dr Patel had a previous interest in EAMD, which he transferred to his wife around the time of his disqualification from New Jersey Medicaid. Senior Counsel David Fuchs represented OIG.
27.09.2017
The Arizona Pain Management Practice settles the case with Kickback and Stark allegations
On September 27, 2017, Advanced Pain Management (APM), a multi-location pain management practice in Arizona, entered into a $186,210.20 settlement agreement with OIG. As a result of its investigation, the OIG alleged that APM received improper compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of point-of-care test cups that resulted in prohibited referrals . OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and that APM caused Millennium to make claims for designated healthcare services that resulted from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG
22.09.2017
Georgia doctor and practice settle case with kickbacks
On September 22, 2017, Alan D. Justice M.D. and Ocmulgee Physicians, LLC, formerly Poplar Physicians, LLC, (collectively “Ocmulgee”), Macon, Georgia, entered into a $277,202 settlement agreement with OIG. The settlement agreement eliminates allegations that Ocmulgee sought and received compensation in the form of "litigation and settlement payments" related to the blood collection from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), two laboratory companies. OIG alleged that Ocmulgee requested and received compensation from HDL and Singlex in exchange for Ocmulgee referring patients for lab testing for HDL and Singlex that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
22.09.2017
Podiatrist agrees to voluntary exclusion
On September 22, 2017, Patricia Anne Chapman (Chapman), of Liberty Lake, Washington, consented to reside for a period of 10 years under 42 U.S.C. being barred from participating in all federal health programs. § 1320a-7(b)(7). OIG's investigation found that Chapman, in her Clinton, Iowa, Medicare podiatry practice, made false or fraudulent claims using Current Procedural Terminology Code 97032: (1) for electrical stimulation (E-Stim) services that were not medically appropriate or necessary , (2) for e-stim services not performed with “continuous presence” and “manual application” as required by the Code, (3) for twice the number of e-stim units as indicated in the patient records of the beneficiaries are documented, and (4) for the use of false records and statements to support the false e-stim claims. Senior Counsel Keshia Thompson represented OIG.
18.09.2017
New York Pharmacy settles case of disfellowshipped person
On September 18, 2017, Century Pharmacy (Century), of Brooklyn, New York, entered into a $10,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Century employed a person who was disqualified from participating in federal healthcare programs. The OIG's investigation found that the disfellowshipped individual, who assisted in filling out prescriptions among other clerical duties, provided items or services to Century patients that were billed to government healthcare programs. Senior Counsel Kenneth Kraft represented OIG with support from Paralegal Specialist Eula Taylor.
18.09.2017
The New York Addiction Treatment Center settles the case with kickback allegations
On September 18, 2017, Parallax Center, Inc. (Parallax), of New York, New York, entered into a $64,203.30 settlement agreement with OIG. As a result of its investigation, the OIG alleged that Parallax received improper compensation from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium) in the form of point-of-care test cups that resulted in prohibited referrals. OIG further claimed that the referrals were prohibited because the compensation created a financial relationship and that Parallax prompted Millennium to make claims for designated healthcare services that resulted from the prohibited referrals. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
18.09.2017
North Shore Medical Center is adjudicating the case involving the allegation of patient dumping
On September 18, 2017, North Shore Medical Center (NSMC), Lynn, Massachusetts entered into a $60,000 settlement agreement with OIG. The settlement agreement eliminates allegations that NSMC violated the Emergency Medical Treatment and Labor Act by failing to provide adequate medical screening for a 14-year-old patient and inappropriately transferring her to another hospital. The patient arrived in an ambulance, secured to a stretcher and under a police escort, for a psychiatric evaluation at the NSMC's Union Hospital Emergency Department after being abusive at home and banging her head against a wall. Upon arrival at NSMC Union Hospital, the patient was placed in a room still attached to the stretcher. The NSMC Union Hospital paramedic walked into the room and told paramedics to transport the patient to the NSMC's Salem Hospital Emergency Department for a pediatric psychiatric evaluation. Prior to the transfer recommendation, NSMC failed to provide the patient with a medical check-up. On the way to NSMC Salem Hospital, police directed the ambulance to take the patient to another hospital, where her mother was waiting. Senior Counsel Kristen Schwendinger represented OIG.
15.09.2017
Texas psychiatric facility settles case of disfellowshipped person
On September 15, 2017, Sundance Behavioral Healthcare System (Sundance), Texas entered into a $49,183.48 settlement agreement with OIG. The settlement agreement eliminates allegations that Sundance employed an individual who was disqualified from participating in federal healthcare programs. The OIG's investigation determined that the disfellowshipped individual, a licensed professional nurse, provided items or services to Sundance patients that were billed to state health care programs. Deputy Branch Manager Nicole Caucci represented OIG with the support of Legal Assistant Jennifer Hilton.
11.09.2017
West Virginia doctor agrees to voluntary disqualification
On September 11, 2017, Dr. Cheryl Wingate (Dr. Wingate), of Fairmont, West Virginia, in connection with the resolution of her liability under the False Claims Act, agrees to be barred from participating in all federal health care programs for a period of 5 years under 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that Dr. Wingate caused compound pharmacies to submit false claims about compound creams and medications to TRICARE and the Medicare program by issuing or authorizing prescriptions that were not legitimate because Dr. Wingate did not examine or evaluate the patients in question, and did not have an established doctor-patient relationship with them. The OIG's investigation also found that Dr. Wingate issued and approved the drug prescriptions in exchange for compensation paid to it by the pharmacies, telemedicine facilities, or other intermediaries acting on the pharmacies' behalf.
08.09.2017
California Independent Diagnostic Testing Facility and Owner Agree to Voluntary Disclaimer
On September 8, 2017, Olive Sleep & EEG, Inc., an independent diagnostic testing facility, and Mariam Unjughulyan, its owner, (collectively, “Olive Sleep”) agreed to reside under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation found that Olive Sleep filed claims for nerve conduction studies that are considered screening studies and are not covered by Medicare, in violation of a local coverage rule that governs the medical necessity of such studies. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, worked together to achieve this resolution.
09-05-2017
Montana doctor agrees to voluntary disqualification
On September 5, 2017, Dr. Cory Lee Pickens, of Billings, Montana, in connection with the resolution of liability under the False Claims Act, for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that Dr. Pickens, although previously barred from participating in all state health care programs on September 20, 2011, provided services to Medicaid program beneficiaries during his barring. Senior Counsel David Traskey represented OIG.
31.08.2017
Florida Pharmaceutical Company settles drug price reporting case
On August 31, 2017, Stratus Pharmaceuticals Inc. (Stratus), Florida, entered into a $40,000 settlement agreement with OIG. The Settlement Agreement resolves allegations that Stratus failed to submit certified monthly and quarterly Average Manufacturer Price (AMP) data for certain months and quarters in 2014 and 2015 to the Centers for Medicare and Medicaid Services (CMS). The Medicaid Drug Rebate Program requires drug companies to enter into and enforce a national rebate agreement with the Department of Health and Human Services in order for Medicaid payments to be available for the drug company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Mary Riordan represented OIG.
23.08.2017
Tennessee Transportation Service Providers and Owners agree to voluntary exclusion
On August 23, 2017, in connection with the resolution of liability under the False Claims Act, Employment & Assessment Solutions, Inc., a transportation service provider, and Chris Manus, its owner (collectively, "EASI"), agreed to be disclaimed for: a Nine-year period under 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that EASI caused claims to be filed with state healthcare programs for services billed by EASI to patients but not actually provided, including transportation services not provided to patients at the time of their alleged transportation detained or hospitalized. Associate Counsel Srishti Sheffner represented OIG.
15.08.2017
Utah Laboratory is adjudicating the case involving selected agent regulations
On August 15, 2017, a Utah lab agreed to pay $250,000 to settle its liability for violating select agent regulations. The OIG alleged that the lab violated select agent regulations by allowing access to select agents or toxins stored in registered laboratory facilities to a person who did not have a safety risk assessment permit and who was later identified as a restricted person were kept. OIG alleges this conduct subjects the laboratory to civil penalties under the Bioterrorism Preparedness Act, 42 U.S.C. 262a(i) and 42 C.F.R. 1003.102(b)(16).
14.08.2017
Michigan Laboratory is adjudicating the case involving selected agent regulations
On August 14, 2017, a Michigan lab agreed to pay $55,000 to settle its liability for violating select agent regulations. The OIG alleged that the lab violated select agent regulations by allowing access to select agents or toxins stored in registered laboratory facilities to a person who did not have a safety risk assessment permit and who was later identified as a restricted person were kept. OIG alleges this conduct subjects the laboratory to civil penalties under the Bioterrorism Preparedness Act, 42 U.S.C. 262a(i) and 42 C.F.R. 1003.102(b)(16).
08.11.2017
The Texas Home Health Company is adjudicating a disfellowshipped person's case
On August 11, 2017, ASAP Professional Home Health (ASAP), Houston, Texas, entered into a $21,797.76 settlement agreement with OIG. The settlement agreement eliminates allegations that ASAP employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshiped person, a companion, provided items or services to ASAP patients that were billed to federal health care programs. Senior Counsel Nancy Brown represented OIG with support from Paralegal Specialist Eula Taylor.
21.07.2017
Utah Pain Doctor and Medical Practice settle case of false and fraudulent Medicare claims
On July 21, 2017, Jahan Imani, M.D. (Imani), and Intermountain Medical Management, P.C. (IMM), a Utah-based pain management specialist, and his practice entered into a $399,895.92 settlement agreement with OIG. The settlement agreement resolves allegations that IMM made false or fraudulent payment claims through Imani by inappropriately using modifier 59 for multiple units of HCPCS code G0431 when only one unit can be billed per patient contact. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, worked together to reach this agreement.
07.06.2017
Texas Physicicers and Practice Settle Case Involving Kickbacks
On July 6, 2017, Jonathan B. Shaffer, M.D., Dina B. White, M.D., and Sweetwater Medical Associates (collectively, "Sweetwater"), of Sugar Land, Texas, entered into a $62,400 settlement agreement with OIG. The settlement agreement resolves allegations that Sweetwater sought and received compensation from Health Diagnostic Laboratory, Inc. (HDL), a laboratory company, in the form of "litigation and settlement payments" related to the blood draw. OIG alleged that Sweetwater solicited and received payment from HDL in exchange for Sweetwater referring patients to HDL for laboratory testing services that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
07.06.2017
Pennsylvania Hospice CEO agrees to voluntary exclusion
On July 6, 2017, Malvina Yakobashvili, the President, CEO and owner of a hospice facility in Pennsylvania, agreed to reside under 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that Yakobashvili's company, Home Care Hospice, Inc.: (1) asserted claims with Medicare for hospice services provided to beneficiaries who did not qualify under Medicare guidelines for (a) routine hospice care because patients have not been properly certified as being terminally ill or (b) continuing care; and (2) engaged in a cover-up scheme that involved the forgery of documents to conceal the fraud.
23.06.2017
South Carolina Hospital settles case alleging patient dumping
On June 23, 2017, AnMed Health (AnMed) of Anderson, South Carolina entered into a $1,295,000 settlement agreement with OIG. The settlement agreement eliminates allegations that AnMed violated the Emergency Medical Treatment and Labor Act (EMTALA) in 36 incidents investigated by OIG. In these incidents, individuals with unstable emergency psychiatric disorders presented to AnMed's Emergency Department (ED). Rather than being evaluated and treated by an on-call psychiatrist, and despite empty psychiatric beds to which patients could have been admitted for stabilizing treatment, patients were involuntarily admitted and held in AnMed's emergency department for between 6 and 38 days at a time. The following is an example of such an incident. One patient was presented to AnMed's emergency department via law enforcement with psychosis and thoughts of homicide and was admitted involuntarily. The patient did not receive psychiatric evaluation or treatment from available AnMed psychiatrists and was not admitted to the psychiatric unit for stabilizing treatment. Instead, the patient was kept in the emergency room for 38 days and eventually evaluated by a psychiatrist from another facility who was familiar with her condition. The psychiatrist prescribed various medications for anxiety. The patient was eventually discharged home. Senior Counsel Sandra Sands represented OIG.
21.06.2017
Dentist in Louisiana settles case with medically unnecessary claims
On June 21, 2017, Robert J. Edwards, DDS (Dr. Edwards), of Baton Rouge, Louisiana, entered into an $80,070.10 settlement agreement with OIG. The settlement agreement clears up allegations that Dr. Edwards has made claims for medically unnecessary permanent root canals, extractions, restorations and stainless steel crowns for a number of pediatric Medicaid dental patients. The OIG's Office of Evaluations and Inspections and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Geeta Tyalor, worked together to reach this agreement.
20.06.2017
Florida Pharmacy is adjudicating a disfellowshipped person's case
On June 20, 2017, Linton Square Pharmacy & Medical Supplies, Inc. (Linton Square), Delray Beach, Florida entered into a $339,956.05 settlement agreement with OIG. The settlement agreement eliminates allegations that Linton Square employed a person who was disqualified from participating in federal health programs. The OIG's investigation found that the disfellowshipped individual, a pharmacist, provided items or services to patients in Linton Square that were billed to federal health care programs. Senior Counsel Keshia Thompson represented OIG with support from Paralegal Specialist Jennifer Hilton.
16.06.2017
UMass Medical Center settles case of false and fraudulent Medicare claims
On June 16, 2017, UMass Memorial Medical Center, Inc. (UMass) entered into a settlement agreement with OIG for $441,047.36. The Settlement Agreement dispels allegations that UMass filed claims to assess and manage outpatient clinic visits for "new patients" using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205, when in fact the patients in question were "established patients" were and UMass should therefore have filed these claims using the lower paying HCPCS codes 99213-99215. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, worked together to reach this agreement.
16.06.2017
Boston Medical Center adjudicates false and fraudulent Medicare claims
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 eliminates allegations that BMC filed claims for the assessment and management of outpatient clinic visits for "new patients" using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205, when in fact the patients in question were "established patients." and BMC should therefore have filed these claims using the lower paying HCPCS codes 99213-99215. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, worked together to reach this agreement.
30.05.2017
Mental health company agrees to permanent ban
On May 30, 2017, Complementary Support Services, CCS South, LLC, CCS Central, LLC, CCS North, LLC, CCS Metro, LLC, and Clinical Support Services, LLC (collectively, “CSS”), Minnesota agreed to be permanently affiliated with the Participation in all federal health programs under 42 U.S.C. to be excluded. § 1320a-7(b)(7). OIG's investigation found that CSS misrepresented mental health services to the Minnesota Medicaid program. The OIG alleged that CSS charged for documentation time even though state law and regulations only allowed reimbursement for in-person services. Senior Counsel Geeta Taylor and Associate Counsel David Fuchs represented OIG.
Illinois nursing facilities settle the case of a disfellowshipped person
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 eliminates allegations that Heritage employed an individual who was disqualified from participating in a federal healthcare program. The OIG's investigation determined that the disfellowshipped individual, a licensed practicing nurse, provided items or services to heritage patients that were billed to federal health care programs. Senior Counsel Nancy Brown represented OIG.
17.05.2017
New York doctor agrees to another voluntary disqualification
On May 17, 2017, Dr. Michael Esposito (Dr. Esposito), of Albany, New York, in connection with the resolution of his liability under the False Claims Act, agrees to be barred again from participating in all federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that although he was previously banned from participating in all state health programs for a five-year period on December 9, 2016, he forged another doctor's signature on prescriptions, including opioids, to order medication for to get himself and others person. In the present matter, Dr. Esposito claimed payment from Medicare for services he provided, ordered, and prescribed to Medicare beneficiaries while he was disqualified. Senior Counsel David Traskey represented OIG.
16.05.2017
Missouri Physician and Practice Settle Case Involving Kickbacks
On May 16, 2017, Timothy W. McPherson, D.O., and McPherson Medical and Diagnostic, LLC (collectively, “McPherson”), of Steele, Missouri, entered into a $61,392 settlement agreement with OIG. The settlement agreement resolves allegations that McPherson received compensation in the form of "handling and settlement payments" related to the blood collection from Health Diagnostic Laboratory, Inc. (HDL) and Singulex, Inc. (Singulex), two laboratory companies. OIG alleged that McPherson received compensation from HDL and Singlex in exchange for McPherson referring patients for lab testing for HDL and Singlex that the Medicare program paid for. Senior Counsels Katie Fink and Jennifer Leonardis represented OIG, with support from Program Analyst Mariel Filtz.
15.05.2017
California dentist settles case with medically unnecessary claims
On May 15, 2017, Ana M. Gama, DDS and Ana M. Gama, DDS, Inc. (collectively Dr. Gama), Ontario, California entered into a $31,817.88 settlement agreement and three-year integrity agreement with OIG. The settlement agreement clears up allegations that Dr. Gama has made claims for medically unnecessary pulpotomies, extractions, restorations and stainless steel crowns for a number of pediatric Medicaid dental patients. The OIG's Office of Evaluations and Inspections and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Geeta Tyalor, worked together to reach this agreement.
15.05.2017
New York doctor agrees to voluntary exclusion
On May 15, 2017, Dr. Haroutyoun Margossian (Dr. Margossian), a New York physician specializing in female urinary incontinence, for a period of seven years under 42 U.S.C. being barred from participating in all government health programs. § 1320a-7(b)(7). The OIG's investigation found that Dr. Margossian knowingly made or had made to Medicare and Medicaid claims about the treatment of patients with urinary incontinence that he should have known were not as alleged or false or fraudulent. In particular, the OIG claimed that Dr. Margossian failed to: (1) hire licensed individuals to perform 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 allegations of patient dumping
On May 12, 2017, Monroe County Hospital (MCH) in Forsyth, Georgia entered into a $25,000 settlement agreement with OIG. The settlement agreement removes allegations that MCH breached the Emergency Medical Treatment and Labor Act when a woman who presented to MCH's Emergency Department (ED) complained that she was broken in the 36. The patient informed a nurse that she wanted to see her doctor in Macon, Georgia. Without conducting a medical screening exam, the emergency room staff decided that the patient could go to her doctor in Macon. The patient was then escorted to her car and told to call 911. Paramedics arrived and found the patient in her car. She was taken to another hospital, where she gave birth 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.
20.04.2017
Health care administrator agrees to voluntary disqualification
On April 20, 2017, Yogesh K. Pancholi (Pancholi), Michigan, in connection with the resolution of his liability under the False Claims Act, consented to a five-year indemnity pursuant to 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that Pancholi caused false claims to be filed with Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care that were remitted in exchange for illegal compensation or kickbacks paid by Pancholi. Senior Counsel David Traskey represented OIG.
18.04.2017
Connecticut Hospital settles case of false and fraudulent Medicare claims
On April 18, 2017, Hartford Hospital (Hartford), Connecticut entered into a $2,469,374 settlement agreement with OIG. The settlement agreement eliminates allegations that Hartford made claims where patients received home healthcare services within three days of the patients being discharged from Hartford that were incorrectly coded as a discharge and not a transfer to acute care. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Nancy Brown, worked together to reach this agreement.
Connecticut Hospital settles case of false and fraudulent Medicare claims
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 made claims where patients received home healthcare services within three days of the patients being discharged from Midstate that were incorrectly coded as a discharge rather than a transfer to acute care. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Nancy Brown, worked together to reach this agreement.
Texas Independent Diagnostic Testing Facility settles case of false and fraudulent Medicare claims
On April 18, 2017, Frontera Strategies, LP (Frontera), Texas entered into a $510,938.74 settlement agreement with OIG. The settlement agreement eliminates allegations that Frontera submitted claims to Medicare for nerve conduction studies (NCS), which are considered screening tests and are not covered by Medicare. Medicare Administrative Contractor Local coverage regulations stipulate that electromyography and NCS must be performed for diagnostic purposes. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, worked together to reach this agreement.
14.04.2017
The owner of the mental health company agrees to the voluntary disqualification
On April 14, 2017, Teri Dimond (Dimond), Minnesota, in connection with the resolution of her False Claims Act liability, agreed for a period of eight years under 42 U.S.C. being barred from participating in all government health programs. § 1320a-7(b)(7). OIG's investigation found that false claims about mental health services for the Minnesota Medicaid program were submitted to Dimond through her company. OIG alleged that the claims were false for one or more of the following reasons: (1) the services were provided by unlicensed physicians without proper clinical supervision; and (2) claims for reimbursement were made for time spent maintaining patient records and/or preparing reports in violation of state Medicaid regulations. Senior Counsel Geeta Taylor and Associate Counsel David Fuchs represented OIG.
31.03.2017
Texas Ambulance Company settles case with false allegations
On March 31, 2017, Freedom Ambulance, LLC (Freedom Ambulance), an ambulance company in Beeville, Texas, entered into a settlement agreement with OIG for $846,563.92. The Settlement Agreement resolves allegations that Freedom Ambulance Medicare and Texas Medicaid knowingly submitted false or fraudulent claims for repeat non-emergency ambulance services between beneficiaries' homes or qualified care facilities and out-of-hospital dialysis facilities. Senior Counsels Ellen Slavin and Katie Fink represented OIG, with support from Paralegal Specialist Mariel Filtz.
Massachusetts Ambulance Company settles case with false claims
On March 31, 2017, EasCare, LLC (EasCare), an ambulance company in Dorchester, Massachusetts, entered into a $255,768.14 settlement agreement with OIG. The settlement agreement resolves allegations that EasCare filed claims with Medicare for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
16.03.2017
Florida neurologist disqualified for default
On March 16, 2017, OIG Dr. Sean Orr (Dr. Orr), a Florida neurologist, for failing to meet his payment obligations under a settlement agreement (Agreement) with the Department of Justice (DOJ) and OIG. dr Orr previously entered into the agreement for knowingly misdiagnosing certain patients with various neurological disorders, such as: B. multiple sclerosis, which resulted in claims being filed with federal health care programs for medically unnecessary items and services. The terms of the agreement provided that Dr. Orr would make an initial upfront payment plus additional payments over a five year period. On January 23, 2017, the DOJ hired Dr. Orr a notice of default. Senior Counsel Karen Glassman represented OIG.
13.03.2017
Iowa chiropractor agrees to three-year ban
On March 13, 2017, Elizabeth Kressin, D.C. (Kressin), an Iowa chiropractor, to, under 42 U.S.C. Be barred from participating in government health programs for a period of three years. § 1320a-7(b)(7) for alleged violation of the Fines Act. OIG alleged that Kressin initiated the filing of claims with Iowa Medicaid for child chiropractic services not performed as claimed and for the treatment of medical conditions for which payment is not permitted under applicable regulations. Associate Counsel Jennifer Leonardis represented OIG.
08.03.2017
Michigan doctor agrees to three-year ban
On March 8, 2017, Dr. Vinod Sharma, (Dr. Sharma), a Michigan physician and pain management specialist, for a three-year period under 42 U.S.C. being disqualified from participating in Medicare and government health programs. § 1320c-5 following a referral to OIG by Kepro, the quality improvement organization for beneficiaries and family-centered care (QIO). The OIG's investigation found that Dr. Sharma has materially violated the obligation to provide services (1) of a quality consistent with professionally recognized standards of healthcare and (2) supported by evidence of medical necessity and quality in this form and manner for so much time as reasonably required by the QIO for the performance of its duties and responsibilities. In particular, the OIG claimed that Dr. Sharma failed to adequately document his response to urine drug screening results and any discussions he had with patients about urine drug screening results when those patients (1) tested positive for illicit drugs; (2) Tested positive for controlled substances that Dr. Sharma did not prescribe; (3) tested positive for uncontrolled substances that Dr. Sharma did not prescribe; or (4) tested negative for controlled substances that Dr. Sharma has prescribed. Senior Counsel Kristen Schwendinger, Senior Counsel Geoffrey Hymans and Associate Counsel Srishti Sheffner represented OIG.
17.01.2017
Iowa hospital settles case in which patient faced dumping allegations
On January 17, 2017, Covenant Medical Center (“Covenant”) in Waterloo, Iowa entered into a $100,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Covenant violated the Emergency Medical Treatment and Labor Act when it failed to provide appropriate psychiatric screening or stabilizing treatment to three patients presenting to the emergency room when an on-call psychiatrist was available. A woman presented to the emergency department complaining of depression and suicidal thoughts, but was later discharged with a referral to see her family doctor for follow-up. One child presented to the emergency department after an outbreak of violence, but was later discharged with instructions to contact his GP. A man who was presented to the emergency room and said his mind was "disturbed" later fled the emergency room in degree weather, wearing a paper coat while his discharge was processed. His body was found about 300 feet from Covenant, the cause of death being attributed to hypothermia. Senior Counsel Henry Green and Associate Counsel Madeline Bainer represented OIG.
13.01.2017
Michigan doctor agrees to voluntary disqualification
On January 13, 2017, Dr. Sotero Ureta, of Lake City, Michigan, in connection with the resolution of its liability under the False Claims Act, for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation found that Dr. Ureta caused false claims to be submitted to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health services that he remitted in exchange for illegal remuneration or kickbacks. Senior Counsel David Traskey represented OIG.
11.01.2017
New Jersey dentist agrees to pay $1.1 million and 50-year ban to settle civil fine case
Roben Brookhim, a non-licensed dentist in New Jersey, agreed to pay $1,134,000 for the alleged civil fines statute violation and agreed to a period of fifty years under 42 U.S.C. being barred from participating in federal health programs. § 1320a-7a and 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Brookhim owned, controlled and operated Associated Dental NP, LLC (ADNP), a multi-location dental practice in New Jersey, in violation of his exclusion from participation in the federal health care program in August 2000. Brookhim's fraud scheme took the identity of a licensed dentist from New Jersey (Dentist A) to provide services to ADNP patients. Brookhim assumed the identity of Dentist A because Brookhim's dental license was suspended in 1999 and revoked in 2004. OIG alleges that Brookhim filed claims for services with various New Jersey Medicaid Managed Care Organizations in which Dentist A was identified as providing services; In fact, Dentist A has never provided services to ADNP patients. Brookhim continued to pose as Dentist A and file claims on his behalf — even after Dentist A died. Senior Counsels David Blank and Michael Torrisi represented OIG with the support of Paralegal Specialist Mariel Filtz.press release
10.01.2017
North Carolina Hospital settles case involving allegations of patient dumping
On January 10, 2017, Cape Fear Medical Center (Cape Fear) in Fayetteville, North Carolina entered into a $40,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Cape Fear violated the Emergency Medical Treatment and Labor Act when it failed to provide adequate medical evaluation and stabilizing treatment for a woman who presented to Cape Fear's emergency department with her third child. The patient was discharged just over an hour after her presentation at Cape Fear. OIG alleged that Cape Fear failed to properly assess the patient (including checking the progress of her labor) prior to her discharge. The patient drove home and immediately gave birth to her child at home. Senior Counsel Sandra Sands represented OIG.
01.06.2017
Oklahoma Behavioral Health Counseling Center manager agrees to voluntary exclusion
On January 6, 2017, Heather Doss consented, under 42 U.S.C. Be barred from participating in all federal health programs for a period of two years. § 1320a-7(b)(7). OIG alleged that Doss knowingly filed or submitted to Medicaid false or fraudulent claims for services not rendered or rendered by unqualified persons, as well as claims with falsified dates or times. Senior Counsel Kenneth Kraft represented OIG.
01.06.2017
Utah Nursing Home and owner agree to 30-year ban
On January 6, 2017, Deseret Health Group and Jon Robertson (Robertson), Bountiful, Utah, agreed for a thirty year period pursuant to 42 U.S.C. Sections 1320a-7(b)(7) and 1320a-7(b)(6)(B). The OIG alleged that Deseret Health Group and Robertson: (a) failed to provide adequate care planning and assessment of residents; (b) failed to provide medication, treatment, laboratory tests, physical therapy and other services as ordered and/or prescribed by residents' physicians; (c) has failed to properly use and/or administer psychotropic drugs; (d) failed to follow appropriate pressure ulcer and infection control protocols for some residents; (e) failed to follow appropriate fall protocols for some Residents; (f) failing to properly administer medication to some residents to avoid medication errors; (g) failed to provide residents with a safe living environment; and (h) failed to promptly answer the call lights of some residents. Senior Counsel Felicia Heimer represented OIG.

2016

29.12.2016
Georgia Hospital settles case involving allegations of patient dumping
On December 29, 2016, Phoebe Putney Memorial Hospital (Phoebe Putney) in Albany, Georgia entered into a $40,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Phoebe Putney violated the Emergency Medical Treatment and Labor Act by not accepting an appropriate transfer. A 73-year-old man was transported by ambulance to another hospital and presented with hematuria, bleeding from the site of his Foley catheter, and abdominal pain. The patient required urological services that were not available at this hospital. The hospital asked Phoebe Putney to accept the transfer of this patient. OIG alleged that Phoebe Putney's on-call urologist declined the transfer when Phoebe Putney had both the ability and ability to treat the patient. Senior Counsel Sandra Sands represented OIG.
22.12.2016
South Carolina Hospital settles case involving allegations of patient dumping
On December 22, 2016, McLeod Medical Center (MMC), a small hospital in Dillon, South Carolina, entered into a $20,000 settlement agreement with OIG. The settlement agreement eliminates allegations that MMC violated the Emergency Medical Treatment and Labor Act by failing to provide adequate medical screening and stabilizing treatment to a patient who presented to MMC after being assaulted and hit on the head had been. The patient resisted his mother's efforts to place him in a wheelchair to enter the emergency room (ED). Security forces observed the patient's behavior and told the patient's mother that if the guard took her son to the emergency room, he would have him locked up. OIG alleges the mother explained to the security guard that her son had been hit in the head and is bleeding and that a security guard allegedly responded by reiterating that if her son entered the emergency room, he would call the police. At this point, the mother left with her son, and later took him to another hospital for examination and treatment. Senior Counsel Sandra Sands represented OIG.
22.12.2016
Missouri Hospital settles case alleging patient dumping
On December 22, 2016, OIG entered into a settlement agreement with HCA Midwest Division d/b/a Belton Regional Medical Center (BRMC), Belton, Missouri. BRMC agreed to pay $40,000.00 to release its liability for civil fines under the Patient Dumping Act. In particular, the OIG alleged that the BRMC violated the Emergency Medical Treatment and Labor Act by failing to provide appropriate medical evaluation and stabilizing treatment to two patients who presented to the BRMC's emergency department with psychiatric emergencies. Senior Counsel Henry E. Green represented OIG.
21.12.2016
Texas doctors settle case with bribery allegations
On December 21, 2016, Mark Sands, D.P.M., and Jeffrey Baxter, D.P.M., of Houston, Texas, entered into an $85,000 settlement agreement with OIG. The OIG's investigation found that Dr. sands and dr Baxter each received compensation from OneStep Diagnostic, Inc. (OneStep) in the form of compensation under medical director contracts. OIG alleges that the medical director contracts have reduced the value and volume of Dr. sands and dr Baxter's podiatry practice at OneStep. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
16.12.2016
New York chiropractors and practices agree to 40-year ban
On December 16, 2016, Alexander Khavash, a chiropractor, and the two chiropractic practices he owned, Alexander Khavash, DC, P.C., and AK Chiropractic, P.C., agreed to refrain from participating in all government healthcare programs for a period of forty years to be disqualified years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation found that Khavash and his practices filed claims with Medicare for chiropractic services that were not medically necessary and were not provided as claimed. Senior Counsel Michael Torrisi, Joan Matlack and Andrea Treese Berlin represented OIG.
09.12.2016
New York doctor agrees to 5-year ban
On December 9, 2016, Dr. Michael Esposito, under 42 U.S.C. being barred from participating in all federal health programs. § 1320a-7(b)(7). OIG's investigation found that Dr. Esposito forged another doctor's signature on prescriptions for medications for himself and another person paid for by the Medicare program. Senior Counsel David Blank and Associate Counsel Jennifer Leonardis represented OIG.
30.11.2016
New York specialty nursing facility settles case involving disfellowshipped person
On November 30, 2016, Ditmas Park Rehab/Care Center (Ditmas Park), Brooklyn, New York entered into a $205,089.22 settlement agreement with OIG. The settlement agreement eliminates allegations that Ditmas Park employed a person who was disqualified from participating in a federal health program. OIG's investigation found that the disfellowshipped individual, a licensed practicing nurse, provided items or services to patients of Ditmas Park that were billed to the state health care programs. Senior Counsel Katie Fink represented OIG with support from Paralegal Specialist Eula Taylor.
Florida hospital settles case alleging patient dumping
On November 30, 2016, Okaloosa Hospital, Inc. d/b/a Twin Cities Hospital (Twin Cities), a small hospital in Niceville, Florida, entered into a $20,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Twin Cities violated the Emergency Medical Treatment and Labor Act by failing to provide adequate medical screening and stabilizing treatment to a 56-year-old male patient who was having respiratory problems and was unstable. Twin Cities ER workers met the emergency medical transport in the ambulance bay and redirected the transport to another hospital where the patient was previously treated. Twin Cities failed to provide the patient with a medical screening evaluation or stabilizing treatment before emergency medical transport was diverted. The patient died shortly after arriving at the other hospital. Twin Cities self-reported the incident shortly thereafter. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Senior Counsel Geeta Taylor represented OIG.
New Jersey doctor enters into settlement agreement with OIG over kickback allegations
On November 30, 2016, Dr. Robert Collin, an internist from Newark, New Jersey, entered into a $111,415 settlement with OIG. The settlement eliminates allegations that Dr. Collin received compensation from Orange Community MRI, LLC, an imaging facility in Orange, New Jersey, in exchange for patient referrals. Senior Counsels David M. Blank and Lauren E. Marziani represented OIG.
28.11.2016
Missouri Hospital settles case alleging patient dumping
On November 28, 2016, Research Medical Center (RMC) in Kansas City, Missouri entered into a $360,000 settlement agreement with OIG. The settlement agreement eliminates allegations that RMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide adequate medical screening and improperly transferred a patient. The patient presented to the RMC Emergency Department (ED) with a psychiatric emergency. Without providing stabilizing treatment, RMC took the patient to a nearby facility in a private vehicle; On the way, the patient exited the vehicle and was hit by another vehicle. RMC itself disclosed the incident with this patient. Based on its investigation, the OIG concluded that RMC established a transfer policy that applies to patients presenting to RMC's ER with emergency psychiatric illnesses that also resulted in multiple EMTALA violations. Specifically, the OIG found seventeen instances where RMC failed to conduct adequate medical screening and patients presenting to RMC's emergency department with psychiatric emergencies were improperly transferred or discharged without providing stabilizing care. At the time of each patient's presentation, RMC was able to treat, stabilize, or admit each patient. Senior Counsel Geeta Taylor represented OIG.
Illinois Ambulance Company settles case with false allegations
On November 28, 2016, Mitchell-Jerdan Funeral Home, Ltd. (MJFH), an ambulance company in Mattoon, Illinois, entered into a $126,425.02 settlement agreement with OIG. The settlement agreement resolves allegations that MJFH made Medicare claims for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
15.11.2016
New York specialty nursing facility settles case involving disfellowshipped persons
On November 15, 2016, Fort Tryon Rehabilitation and Healthcare Facility, LLC (Fort Tryon), New York, New York entered into a $110,223.36 settlement agreement with OIG. The settlement agreement resolves allegations that Fort Tryon employed two people who were barred from participating in state health programs. OIG's investigation found that one disfellowshipped person was a registered nurse and the other was a registered practical nurse. Although disfellowshipped, both individuals provided items or services to Fort Tryon patients that were billed to state health programs. Senior Counsel Keshia Thompson represented OIG with support from Paralegal Specialist Eula Taylor.
New Jersey doctor and practice resolve case involving false and fraudulent Medicare claims
On November 15, 2016, Lawrence C. Antonucci, M.D., Clifford Sebastian, M.D., and Lawrence C. Antonucci, MD LLC entered into a $60,884.90 settlement agreement with OIG. The Settlement Agreement resolves allegations that they filed claims for Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was filed; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
11-07-2016
Tennessee Hospital settles case where patient had allegation of dumping
On November 7, 2016, Metro Knoxville HMA, LLC (Metro Knoxville) of Knoxville, Tennessee entered into a $45,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Metro Knoxville violated the Emergency Medical Treatment and Labor Act when it discharged a patient without providing adequate medical evaluation or treatment sufficient to stabilize the patient. The OIG's investigation found that the blood test results indicated the existence of a medical emergency; However, Metro Knoxville discharged the patient without confirming that these blood levels had stabilized. Senior Counsel Katherine Matos represented OIG.
04.11.2016
The doctor agrees to a 20-year grace period to resolve the civil fine case
Labib Riachi, M.D., a New Jersey-based obstetrician-gynecologist specializing in urogynecology, consented to reside under 42 U.S.C. being barred from participating in government health programs. § 1320a-7(b)(7) for alleged violation of the Fines Act. OIG claimed Dr. Riachi knowingly submitted claims to Medicare and Medicaid for pelvic floor therapy services that he knew or should have known were not performing as claimed or were false or fraudulent. These claims were not made as claimed or were false or fraudulent for one or more of the following reasons: (1) Dr. Riachi failed to personally perform or directly supervise Services while traveling outside of the United States or the State of New Jersey; (2) dr Riachi failed to personally oversee the performance of a diagnostic procedure performed by his medical assistants; (3) services were not actually rendered; (4) physical therapy services were provided by unlicensed and unqualified persons; (5) services were not documented; and (6) diagnostic services were not appropriate and necessary. David Blank, Tamara Forys and Jennifer Leonardis represented OIG with support from Paralegal Specialist Mariel Filtz.press release
02.11.2016
Arizona doctor and practice settle case of false and fraudulent Medicare claims
On November 2, 2016, A. Clark Ruttinger, DO, and A. Clark Ruttinger DO, PLLC (Ruttinger) entered into a $52,961.20 Settlement Agreement with OIG. The Settlement Agreement resolves allegations that Ruttinger is asserting Healthcare Common Procedure Coding System code G0452 where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
31.10.2016
The Colorado Health System settles a case of false allegations
On October 31, 2016, UCH-MHS d/b/a Memorial Health System (Memorial) entered into a $58,512.00 Settlement Agreement with OIG. The Settlement Agreement resolves allegations that Memorial made claims against Medicare for healthcare items and services provided to individuals held in law enforcement custody who were not eligible for payment under Medicare Part A or B. Senior Counsel Geeta Taylor represented OIG.
27.10.2016
Missouri Ambulance Company settles case with false claims
On October 27, 2016, American Paramedical Services, Inc. (APS) entered into a $187,480.12 settlement agreement with OIG. The settlement agreement resolves allegations that APS filed claims with Medicare for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
The Virginia Health System settles a case of false allegations
On October 27, 2016, Centra Health, Inc. (Centra) entered into a settlement agreement with OIG for $137,864.68. The settlement agreement resolves allegations that Centra filed claims with Medicare for emergency medical transportation to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
26.10.2016
California hospital settles case regarding a patient's allegations of dumping
On October 26, 2016, Sonoma Valley Hospital (Sonoma), a small hospital in Sonoma, California, entered into a $25,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Sonoma violated the Emergency Medical Treatment and Labor Act (EMTALA) when a 59-year-old woman failed to provide the necessary stabilizing treatment and adequate transfer. OIG's investigation determined that the patient arrived at Sonoma's Emergency Department (ED) in an ambulance. The patient had a fever, no palpable pulse or blood pressure, a slow respiratory rate, and severe pain. Ten days previously, she had undergone a diversion ileostomy (surgical opening of the bowel to the abdominal wall through which feces pass). The patient was diagnosed with sepsis and required immediate surgery. Although Sonoma was able to perform this surgery, Sonoma doctors wanted to send the patient back to the surgeon who performed her original surgery. Approximately 7.5 hours after the patient arrived at the Sonoma ER, she was mistakenly transferred to another hospital. In this hospital she was operated on immediately and died soon after. Senior Counsel Sandra Sands represented OIG.
Illinois doctor agrees to voluntary disqualification
On October 26, 2016, Duttala Obul Reddy, M.D. in connection with the resolution of liability under the False Claims Act, for a period of ten years under 42 U.S.C. being barred from participating in all federal health programs. § 1320a-7(b)(7). OIG claimed Dr. Reddy filed claims with Medicaid and Medicare seeking payment for assessment and administration services billed under current procedural terminology code 93310 and allegedly performed in long-term care facilities that either failed to perform or did not perform to the required extent. Senior Counsel Geeta Taylor represented OIG.
19.10.2016
North Carolina Hospital settles case alleging patient dumping
On October 19, 2016, Park Ridge Health (Park Ridge), a small hospital in Hendersonville, North Carolina, entered into a $20,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Park Ridge violated the Emergency Medical Treatment and Labor Act when it improperly transferred a pregnant patient in labor to an alternative hospital without adequately stabilizing her emergency medical condition. Senior Counsel Gregory Wellins represented OIG.
17.10.2016
The owner of the DME company agrees to a 10-year ban
On October 17, 2016, Phillip A. Minga, the owner of a durable medical device (DME) company, consented under 42 U.S.C. Be barred from participating in all government health programs for a period of ten years. § 1320a-7(b)(7) and 42 U.S.C. § 1320a-7(b)(16). The OIG's investigation found that Minga knowingly caused claims to be filed to Medicare for undelivered diabetes items that were the result of unsolicited contact with Medicare beneficiaries that violated and failed through the DME telemarketing provisions of the Social Security Act applicable exceptions were covered or as a result of a kickback. OIG's investigation also found that Minga knowingly withheld or caused an overpayment owed to the Center for Medicare and Medicaid Services as a result of a post-payment Medicare benefits integrity review conducted by AdvanceMed, the zone program integrity contractor became. OIG's investigation also found that Minga knowingly made an omission or misrepresented a material fact in applications by a DME company and its affiliates to participate or register as a supplier under Medicare, including organizations under Part C and D or : (a) Minga was omitted as an officer; and (b) Minga, as an officer, has not been convicted of a criminal offense within the 10 years prior to registration or renewal of registration. Senior Counsel Kristen Schwendinger and Associate Counsel David Fuchs represented OIG.
28.09.2016
The University of California Medical Center settles a case of false and fraudulent Medicare claims
On September 28, 2016, University of California San Francisco Health d/b/a UCSF Medical Center (UCSF) entered into a $1,443,016 settlement agreement with OIG. The settlement agreement eliminates allegations that UCSF filed claims for the assessment and management of outpatient clinic visits of "new patients" using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205, when in fact the patients in question were "established patients." and UCSF should therefore have filed these claims using the lower paying HCPCS codes 99213-99215. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, worked together to reach this agreement.
27.09.2016
Former South Carolina Hospital CEO Agrees to Voluntary Expulsion
On September 27, 2016, in connection with the resolution of the False Claims Act and Stark Law liability, Ralph J. Cox, III consented to a four-year period under 42 U.S.C. being barred from participating in federal health programs. § 1320a-7(b)(7). The OIG's investigation found that during his tenure as CEO and board member of the Board of Trustees of Tuomey Healthcare System, Inc. (Tuomey) in Sumter, South Carolina, Cox caused Tuomey to make payment claims to the Medicare and Medicaid programs that they were wrong because they broke Stark's law. A jury had previously found that Tuomey had violated the False Claims Act by knowingly providing Medicare with false claims for certain healthcare benefits that had been referred to Tuomey in violation of the Stark Act. Deputy Branch Manager Kevin Barry represented OIG.
22.09.2016
Massachusetts social worker agrees to voluntary disqualification
On September 22, 2016, David Margolis, a social worker, in connection with the resolution of liability under the False Claims Act, agreed to refrain from participating in all federal health care programs for a period of five years under 42 U.S.C. to be excluded. § 1320a-7(b)(7). OIG alleged that Margolis made false claims to Medicare for: (1) more therapy sessions than it actually offered to beneficiaries; (2) therapy sessions that didn't happen because Margolis was actually on vacation; (3) therapy sessions not held due to late cancellations by beneficiaries; (4) therapy sessions that did not occur because the beneficiaries did not show up for appointments; and (5) therapy sessions for relatives of the beneficiaries. Senior Counsel John O'Brien represented OIG.
21.09.2016
New Jersey Physicians and Practice Settle Case of False and Fraudulent Medicare Claims
On September 21, 2016, John G. Ciciarelli, II, MD, Jason Arash Nehmad, MD, and Northern Ocean County Medical Associates, PC entered into a $36,850.38 settlement agreement with OIG. The Settlement Agreement resolves allegations that they filed claims for Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was filed; (2) no written report was prepared by an independent physician other than the report of laboratory results; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
Kentucky Hospital settles case where patient had allegation of dumping
On September 21, 2016, T.J. Samson Community Hospital (T.J. Samson) in Glasgow, Kentucky entered into a $35,000 settlement agreement with OIG. The settlement agreement clears up allegations that T.J. Samson violated the Emergency Medical Treatment and Labor Act (EMTALA) when failing to appropriately transfer a 29-year-old woman who required specialized skills found at T.J. were available, did not agree. Samson. The OIG's investigation revealed that the patient presented to the emergency room of a small hospital with complaints of abdominal pain and right back pain. She was diagnosed with appendicitis and required emergency surgery, which the hospital couldn't do. This hospital contacted T.J. Samson to arrange for the patient's transfer. The surgeon on duty at T.J. Samson asked about the patient's insurance. When the surgeon on duty was told the patient was uninsured, he refused to accept the transfer. Senior Counsel Sandra Sands represented OIG.
19.09.2016
New Jersey Medical Biller settles case of false and fraudulent claims and agrees to 5-year ban
On September 19, 2016, Susan Toy entered into a $100,000 settlement agreement with OIG and agreed to be barred from participating in government healthcare programs for a minimum of five years. On July 1, 2016, OIG sent a letter to Toy proposing that she be subject to a civil fine and program ban under the Civil Fines Act. The settlement agreement settles OIG's allegations that Toy prepared and filed claims for services that were never provided. Toy prepared and filed claims for an ob/gyn medical practice in New Jersey through her healthcare billing company. Toy was responsible for preparing and filing claims based in part on superbills detailing the services allegedly provided during a patient encounter. OIG alleged that Toy prepared and filed claims for current procedure terminology code 91122 (anorectal manometry) for patient encounters where the procedure was neither performed nor identified as having been performed on the Superbill. Senior Counsels David Blank and Tamara Forys represented OIG with the support of Paralegal Specialist Mariel Filtz.
16.09.2016
Arkansas Ambulance Company settles case with false allegations
On September 16, 2016, Arkansas Excellent Transport, Inc. (AET) entered into a settlement agreement with OIG for $35,208.35. The settlement agreement resolves allegations that AET filed claims with Medicare for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which 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 Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, worked together to reach this agreement.
13.09.2016
Tennessee Hospital settles case where patient had allegation of dumping
On September 13, 2016, HMA Fentress County General Hospital, LLC f/d/b/a Jamestown Regional Medical Center (Jamestown), a small hospital in Jamestown, Tennessee, entered into a $10,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Jamestown violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide adequate medical evaluation, treatment or transfer for a 69-year-old woman. The OIG's investigation revealed that the patient presented to the Jamestown Emergency Department (ED) with the chief complaint of gastrointestinal bleeding accompanied by blood clots, abdominal and back pain. The patient's pain level was 7 out of 10. A lab test revealed an elevated white blood cell count and a CT scan of her abdomen and pelvis showed nothing abnormal. The patient received antibiotics and painkillers and was discharged with a diagnosis of sinusitis. On leaving the emergency room, the patient went to the bathroom and had a blood clot. She asked for a nurse's help, but the ED doctor said she could return to the ER for more tests or go to another hospital without arranging an adequate transfer. Senior Counsel Sandra Sands represented OIG.
12.09.2016
The Jackson Health System in Florida is adjudicating the case where a patient was accused of dumping
On September 12, 2016, the Miami-Dade County, Florida Public Health Trust, d/b/a Jackson Health System (Jackson), of Miami, Florida entered into a $50,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Jackson violated the Emergency Medical Treatment and Labor Act (EMTALA) by not accepting the appropriate transfer of a patient who needed the specialized skills available at Jackson. OIG's investigation found that a US Virgin Islands hospital (requesting hospital) contacted Jackson requesting that he transfer a patient who had a life-threatening Type A aortic dissection with thrombus that required immediate cardiothoracic surgery. The OIG's investigation found that Jackson refused to accept the patient's transfer unless it received a guarantee of payment. The requesting hospital received the guarantee of payment, but Jackson still refused to accept the referral because the request had to be approved by a supervisor who would not be present until the next business day. A few hours later, the patient died at the requesting hospital. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Felicia Heimer represented OIG.
07.09.2016
New Jersey DME Company agrees to permanent disqualification
On September 7, 2016, in connection with the resolution of liability under the False Claims Act, Oxford Diabetic Supply, Inc. (Oxford) agreed to be permanently banned from participating in federal healthcare programs under 42 U.S.C. to be excluded. § 1320a-7(b)(7). OIG alleged that Oxford created and controlled a company that, in violation of the Social Security Act's DME telemarketing provisions, made unsolicited phone calls to presumed Medicare beneficiaries to sell durable medical equipment (DME) to those beneficiaries. OIG claimed Oxford billed Medicare DME, which was sold as a result of those unsolicited calls. Associate Counsel David Fuchs represented OIG.
06.09.2016
Puerto Rico doctor agrees to voluntary disqualification
On September 6, 2016, Narciso Reyes Carrillo, MD, in connection with the resolution of liability under the False Claims Act, agreed for a period of five years under 42 U.S.C. being barred from participating in all federal health programs. § 1320a-7(b)(7). The OIG claimed that Dr. Reyes filed or filed false claims under Medicare while providing healthcare to Medicare beneficiaries in a hospital emergency room while barred from participating in government healthcare programs. OIG had Dr. Reyes was previously barred from serving a five-year felony conviction in October 2009 in the United States District Court for the District of Puerto Rico. Senior Counsel Sarah Kessler represented OIG.
01.09.2016
West Virginia psychiatrist agrees to 10-year ban
On September 1, 2016, Delano H. Webb, MD, a West Virginia psychiatrist, in connection with the resolution of liability under the False Claims Act, agreed to refrain from participating in federal health care programs under 42 U.S.C. to be excluded. § 1320a-7(b)(7). OIG claimed Dr. Webb signed and delivered blank prescriptions and incomplete certificates of medical necessity (CMNs) to durable medical device (DME) suppliers to fill out and in support of false claims to Medicare and West Virginia Medicaid for DME regardless of diagnosis or condition use medical necessity. The OIG claimed that the fraudulent prescriptions and CMNs signed by Dr. Webb allegedly showed that Dr. Webb had prescribed and confirmed the medical necessity and appropriateness of the DME, when in fact this was not the case. After initiating an investigation into the matter, Dr. Webb participated in a plan to obstruct the investigation by re-signing some of the fraudulent prescriptions and CMNs previously created by the DME supplier and certifying those prescriptions and CMNs without regard to medical necessity or ownership. These newly signed applications have been added to patient records to avoid Medicare and West Virginia Medicaid having to return payments previously made as a result of the incorrect applications submitted. Associate Counsel David Fuchs represented OIG.
31.08.2016
Texas Pharmacy and Pharmacy Manager settle case of disfellowshipped person
On August 31, 2016, Lifechek 336 Pharmacy, LLC, Lifechek Staff Services, Inc. and Bruce Gingrich (collectively, “Lifechek”), Texas entered into a $30,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Lifechek employed a person who was disqualified from participating in a federal healthcare program. OIG's investigation found that the disfellowshipped individual, a store manager and a pharmacy technician, provided items or services that were billed to government healthcare programs. Senior Counsel Nicole Caucci represented OIG.
29.08.2016
ALJ confirms OIG civil fines and disqualification provision
On August 29, 2016, an Administrative Justice Judge (ALJ) of the Departmental Appeals Board entered an order ordering penalties, trial and disqualification of Dr. Mohammad Siddique and Shoals Medical Group, LLC (collectively Siddique) have been confirmed by OIG to knowingly making claims against Medicare for items or services that Siddique knew or ought to have known were not supplied as claimed and were false or fraudulent . Specifically, the ALJ found that through the use of Modifier 59, Siddique knowingly filed or filed multi-unit payment claims of Healthcare Common Procedure Coding System (HCPCS) code G0434 for a single patient contact, where HCPCS code G0434 is only possible once per Patient contact billed.

The ALJ also found that a $1,710,400 civil fine, a $1,057,251.78 assessment, and Siddique's ten-year suspension from all state health programs were appropriate sanctions. OIG was represented in the investigation and litigation in this matter by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin.

24.08.2016
Connecticut Physicians and Practice Settle Case of False and Fraudulent Medicare Claims
On August 24, 2016, Robert Borkowski, MD, Robert D. Malkin, MD, James St. Pierre, MD, Manny Katsetos, MD, and Lexington Cardiology Associates, LLC entered into a $30,349.14 settlement agreement with OIG. The Settlement Agreement resolves allegations that they filed claims for Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was filed; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
Texas Physicians and Practices Settle Case of False and Fraudulent Medicare Claims
On August 24, 2016, Harold J. Pean, MD, Mihaela Shuaib, MD, and Mission Internal Medicine, PA entered into a $28,757.18 settlement agreement with OIG. The Settlement Agreement resolves allegations that they filed claims for Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was filed; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
19.08.2016
Pennsylvania Audiology Practice agrees to voluntary disqualification
On August 19, 2016, in connection with the False Claims Act liability ruling, John Balko & Associates, Inc. d/b/a Senior Healthcare Associates (SHA) agreed to be disqualified from participating in all government healthcare programs for a Ten-year period under 42 U.S.C. § 1320a-7(b)(7). The OIG alleged that SHA knowingly and intentionally submitted or submitted payment claims to Medicare for wax removal procedures, nail debridement procedures, and assessment and administration services using Modifier-25 that were not medically necessary, approved, or requested by patients were not supported by the patient's medical records, lacked required medical documentation, and/or were provided in reliance on improper standing orders.
17.08.2016
Texas Hospice Provider settles false and fraudulent Medicare claims case
On August 17, 2016, Community Hospice of Texas (CHT), Texas entered into a $34,986.68 settlement agreement with OIG. The Settlement Agreement resolves allegations that CHT made claims for hospice services at the level of general inpatient care even though it knew or should have known that routine care should have been billed. Senior Counsel Geoffrey Hymans and David Traskey represented OIG.
08-12-2016
Florida doctor and practice settle case of false and fraudulent Medicare claims
On September 26, 2016, Chika E. Okereke, MD, and his medical practice Cardiovascular Partners, PA, (collectively Dr. Okereke), Florida entered into a $139,383.72 settlement agreement with OIG. The settlement agreement eliminates allegations that Dr. Okereke has made claims to Healthcare Common Procedure Coding System (HCPCS) code G0248 (Demonstrate Use Home INR Monitoring), with Dr. Okereke did not provide such services and instead should have made less frequent claims to the HCPCS code G0250 (MD INR Test Score Interpretation Management). Senior Counsel Geoffrey Hymans represented OIG.
Arizona doctor settles case of false and fraudulent Medicare claims
On August 12, 2016, Manith Mann, M.D., Arizona entered into a $66,513.50 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Mann has submitted claims for Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Kenneth Kraft and Geoffrey Hymans represented OIG.
04.08.2016
Georgia podiatrist settles case of false and fraudulent claims
On August 4, 2016, Janaki Nadarajah, DPM, Georgia, entered into a $115,000 settlement agreement with the OIG. The comparison clears up allegations that Dr. Nadarajah has filed improper claims: (1) for nail debridement and other podiatry services provided to patients in assisted living facilities when she neither personally provided nor supervised the services; and (2) for dermagraft skin replacements not provided in accordance with the product's Food and Drug Administration-approved label and applicable Medicare rules.
02.08.2016
Texas Skilled Nursing Facility adjudicates case of disfellowshipped person
On August 2, 2016, PHCC-The Pointe Rehabilitation & Healthcare Center LLC d/b/a The Pointe Rehabilitation and Healthcare Center and PHCC-Paramount Health Care Company, LLC (The Pointe), Webster, Texas settled for 408,159.53 $ Agreement with OIG. The settlement agreement resolves allegations that The Pointe employed a person who was disqualified from participating in a federal healthcare program. OIG's investigation determined that the expelled individual, an office manager, provided items or services to The Pointe patients that were billed to federal health care programs. Senior Counsel Nicole Caucci represented OIG with support from Paralegal Specialist Jennifer Hilton.
01.08.2016
The Palestine Regional Medical Center in Texas is adjudicating the case involving a patient's allegation of dumping
On August 1, 2016, the Palestine Regional Medical Center (PRMC) in Palestine, Texas entered into a $45,000 settlement agreement with OIG. The settlement agreement eliminates allegations that PRMC violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide stabilizing treatment and appropriate transfer of a patient who presented to PRMC's emergency department. OIG's investigation found that a kidney transplant patient who was undergoing dialysis was waiting in the parking lot of a local dialysis center when she experienced severe shortness of breath. The patient was transported by ambulance to the PRMC emergency department, where she was diagnosed with acute pulmonary edema and discharged on outpatient dialysis. The patient arrived at the dialysis center, where dialysis was started immediately, but the patient's condition deteriorated and she was taken back to the PRMC emergency department, where she was pronounced dead. The OIG's investigation concluded that PRMC failed to provide the necessary stabilizing treatment and transfer when the patient first presented to the emergency department. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
29.07.2016
The Missouri Pharmacy settles the case of false and fraudulent claims
On July 29, 2016, JSH Group, LLC (JSH Group), Missouri, entered into a $75,477.84 settlement agreement with the OIG. The settlement eliminates allegations that JSH Group filed claims with Medicare and Medicaid for Precision Xtra blood glucose test strips that JSH Group knew or should have known were not being supplied as claimed. In particular, OIG alleged that JSH Group filed claims for Precision Xtra blood glucose test trips that it could not have filed based on inventory records.
26.07.2016
Drug testing lab and owner agree to 7-year ban
On July 26, 2016, Nexus Medical Services, Inc. (Nexus) and its owner, French McClung (McClung), agreed for a period of seven years pursuant to 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Nexus and McClung paid compensation in the form of an inflated monthly rent to a medical practice in order to sublet a portion of the practice's office space to Nexus in exchange for recommendations from the doctor's owner. OIG also alleged that Nexus and McClung employed an individual who they knew or should have known was barred from participating in government healthcare programs.
20.07.2016
Missouri doctor and practice settles case of false and fraudulent Medicare claims
On July 20, 2016, William Boulware, MD, and Boulware Medical Clinic, LLC ("Boulware") entered into a $10,653.54 settlement agreement with OIG. The Settlement Agreement resolves allegations that Boulware filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
The Florida Ambulance Company settles the case with false claims
On July 20, 2016, Courtesy Transport Services, LLC (courtesy) of Northeast Florida entered into a $362,188 settlement agreement with OIG. The settlement agreement resolves allegations that Courtesy submitted requests for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
Florida Pharmaceutical Company settles drug price reporting case
On July 20, 2016, Nephron Pharmaceuticals Corporation (Nephron), Florida entered into a $60,000 settlement agreement with OIG. The settlement agreement resolves allegations that Nephron failed to submit certified monthly and quarterly average manufacturer's price (AMP) data for certain months and quarters in 2013, 2014 and 2015 to the Centers for Medicare and Medicaid Services (CMS). The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and enforce a national rebate agreement with the Department of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
South Carolina Pharmaceutical Company settles drug price reporting case
On July 20, 2016, Cipher Pharmaceuticals US LLC (Cipher), South Carolina, entered into a $60,000 settlement agreement with OIG. The settlement agreement resolves allegations that Cipher failed to submit certified monthly and quarterly average manufacturer's price (AMP) data for certain months and quarters in 2014, 2015 and 2016 to the Centers for Medicare and Medicaid Services (CMS). . The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and enforce a national rebate agreement with the Department of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
The Oklahoma Behavioral Health Counseling Center and the owner agree on a 5-year ban
On July 20, 2016, LXE Counseling, LLC (LXE) and its owner, Lexie Darlene George a/k/a Lexie Darlene Batchelor (Batchelor), agreed to be banned from participating in all state healthcare programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that LXE and Batchelor Medicaid knowingly filed claims for services not rendered, services rendered by unqualified persons, unauthorized telemedicine services, and claims containing falsified dates, codes and hours of service. Senior Counsel Kenneth Kraft and Nancy Brown represented OIG.
14.07.2016
Colorado Hospice is adjudicating a disfellowshipped person's case
On July 14, 2016, Pinnacle Hospice Care (PHC), Colorado entered into a $50,000 settlement agreement with OIG. The settlement agreement eliminates allegations that PHC employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual provided PHC patients with items or services that were billed to federal health care programs. Senior Counsel Ellen Slavin represented OIG with support from Paralegal Specialist Eula Taylor.
11.07.2016
OIG disqualified doctor in Alabama
Effective July 11, 2016, the OIG closed Bobby Merkle, MD under 42 U.S.C. from participation in all federal health programs. § 1320c-5 following a referral to the OIG by Kepro, the Beneficiary and Family Centered Care Quality Improvement Organization (QIO). The OIG's investigation found that Dr. Merkle breached its obligations to provide services to five Medicare beneficiaries: (1) when and to the extent they were medically necessary; (2) of a quality that meets professionally recognized standards of care; and (3) supported by appropriate evidence of medical necessity and quality in a form and at such a time as required by the QIO. dr Merkle violated his responsibilities through prescribing practices and drug selection that violated professionally accepted standards of care, through documentation that did not support the proper management of patients' chronic conditions or diseases, through failure to assess patient pain or response to treatment with chronic pain and for failure to document the patient's response to treatment or progress for pain, edema, or gastrointestinal disorders. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
08.07.2016
The Texas doctor settles the case with allegations of bribes
On July 8, 2016, Angel Perez, M.D., of Channelview, Texas, entered into a $73,939.44 settlement agreement with OIG. The OIG's investigation found that Dr. Perez received compensation from OneStep Diagnostic, Inc. (OneStep) in the form of compensation under a Medical Director Agreement. OIG claims that this financial agreement reflects the value and volume of Dr. Perez at OneStep. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
07.07.2016
Regional One Health in Tennessee settles case involving patient dumping allegation
On July 7, 2016, Regional One Health (ROH) of Memphis, Tenn. entered into a $45,000 settlement agreement with OIG. The settlement agreement eliminates allegations that ROH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide adequate screening medical evaluation and stabilizing treatment for a patient and inappropriately transferred the patient to an alternative hospital. The patient presented to ROH complaining of sudden pain in the lower right quadrant of his abdomen. OIG's investigation found that despite the fact that ROH was aware of the patient's abnormal lactic acid levels and perforated vicus, ROH did not fully assess the severity and cause of the patient's emergency condition and did not provide the patient with stabilizing sepsis treatment. Instead, ROH transferred the patient to another hospital even though ROH was able to provide the patient with the best possible care. OIG contends that the ROH's transfer was inappropriate because the patient was not informed of the risks of the transfer, the benefits of the transfer did not outweigh the risks, and the transfer unnecessarily delayed the patient's treatment. The patient died of septic shock and respiratory failure within a week of his transfer from ROH. Under EMTALA, hospitals can be fined up to $50,000 per violation. Associate Counsel Srishti Miglani represented OIG.
24.06.2016
California Ambulance Company settles case with false claims
On June 24, 2016, Enloe Medical Center (Enloe) of Butte County, California entered into a $570,912.40 settlement agreement with OIG. The settlement agreement resolves allegations that Enloe submitted requests for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
22.06.2016
Former owner of Illinois Home Health Agency enters settlement agreement with OIG based on kickback allegations
On June 22, 2016, Tariq Chaudhry entered into a $50,000 settlement agreement with OIG to resolve kickback allegations. Chaudhry is a former Chicago-area home health authority (HHA) owner. OIG alleges that Chaudhry paid a Chicago doctor illegal remuneration in exchange for the doctor referring patients to Chaudhry's HHA for home care services. The bribes were disguised as medical director's fees when no services were actually rendered. OIG also alleges that Chaudhry and the HHA he formerly owned made the payments to the doctor through one or more of his marketing associates or contractors.
Arizona Hospice Provider adjudicates false and fraudulent Medicare claims case
On June 24, 2016, Hospice of the Valley (HOTV), Arizona entered into a $91,932.16 settlement agreement with the OIG. The settlement resolves allegations that HOTV made claims for hospice services at the general inpatient level of inpatient care when it knew or should have known routine care was the correct level of hospice care to be billed for. Senior Counsel Geoffrey Hymans and David Traskey represented OIG.
The Oklahoma Chiropractic Center is adjudicating the case of a disfellowshipped person
On June 24, 2016, Simpson Chiropractic (Simpson), Oklahoma, entered into a $31,000 settlement agreement with OIG. The settlement agreement resolves allegations that Simpson employed a person who was barred from participating in a federal health program. OIG's investigation found that the disfellowshipped individual, a chiropractic assistant, provided items or services to Simpson patients that were billed to federal health care programs. Senior Counsel Ellen Slavin represented OIG with support from Paralegal Specialist Mariel Filtz.
17.06.2016
Florida doctor and practice settle case of false and fraudulent Medicare claims
On June 17, 2016, Francis Glicksman, MD and Francis Glicksman, MD, PA (Glicksman) entered into a $12,613.72 settlement agreement with OIG. The Settlement Agreement resolves allegations that Glicksman filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
13.06.2016
Florida County and its Biller Settle case with false ambulance claims
On June 13, 2016, the Board of County Commissioners of Flagler County, Florida (Flagler County) and PST Services, Inc. (PST) entered into an $86,251 settlement agreement with OIG. The Settlement Agreement eliminates allegations that between September 1, 2009 and May 30, 2011, Flagler County and PST filed or filed Medicare claims for emergency medical transportation to be provided to destinations such as qualified nursing facilities and patient residencies were at the lower non- Emergency rate charged. The Settlement Agreement also eliminates allegations that between June 1, 2011 and March 28, 2015, Flagler County (without involvement of PST) filed or submitted Medicare claims for emergency medical transportation provided to destinations such as qualified nursing facilities and patient residences that should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, worked together to reach this agreement.
06.10.2016
Louisiana hospital owner agrees to 15-year ban
On June 10, 2016, Mark Goff consented, under 42 U.S.C. Be barred from participating in all federal health programs for a period of fifteen years. § 1320a-7(b)(7). OIG alleged that Goff submitted or caused the hospital, which he co-owned and managed, to submit false or fraudulent claims to the Medicare program for Intensive Outpatient Program (IOP) psychiatric benefits. Senior Counsel Ellen Slavin represented OIG.
06.09.2016
Wisconsin podiatrist agrees to 10-year ban
On June 9, 2016, Alan Balkansky, a Wisconsin podiatrist, in connection with the resolution of liability under the False Claims Act, consented to a ten-year period under 42 U.S.C. being barred from participating in federal health programs. § 1320a-7(b)(7). OIG alleged that Balkansky and his practices submitted false claims to the Medicare program for: (1) physical therapy services provided by massage therapists rather than licensed physical therapists; (2) podiatry services not performed; (3) routine foot care services for patients who did not meet medical criteria for eligibility for such services through Medicare; and (4) foot care services that have failed to meet documentation requirements, which are Medicare payment terms. Senior Counsel Geeta Taylor represented OIG.
06.08.2016
Minnesota Specialty Nursing Facility Settles Disfellowshipped Person Case On June 8, 2016, KASKA, Inc. d/b/a St. Otto's Care Center (SOCC), Minnesota, entered into a $65,000 settlement agreement with OIG. The settlement agreement eliminates allegations that SOCC employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a certified nursing assistant, provided items or services to SOCC patients that were billed to government healthcare programs. Senior Counsel Nicole Caucci represented OIG with support from Paralegal Specialist Mariel Filtz.
31.05.2016
Tennessee doctor agrees to voluntary disqualification
Effective May 31, 2016, Dr. Jonathan Oppenheimer, a Tennessee laboratory owner who is also a physician, in connection with the resolution of liability under the False Claims Act, consented to be barred from participating in federal health programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). Based on the OIG's investigation, it was alleged that Dr. Oppenheimer, in violation of the Anti-Kickback Statute and restricting certain physician referrals, donated money toward the physician's office's purchase of electronic health record (EHR) systems. In particular, the OIG claimed that Dr. Oppenheimer: (1) directly considered the volume and/or value of referrals and transactions between his laboratory and doctor's office when deciding whether to make an EHR donation and the amount of the EHR donation; (2) incorrectly considered the volume of Medicare business delivered by the physician's office when considering an EHR donation; and (3) occasionally held EHR donation payments agreed upon until a specified number of cases/referrals are received from the physician's office. The OIG also claimed that Dr. Oppenheimer misrepresented the Medicare and TRICARE programs by charging for an uncovered form of fluorescence in situ hybridization (FISH) testing. In particular, it was alleged that Dr. Oppenheimer continued to bill for this test, although an adverse reimbursement finding indicated that this form of testing was experimental and, accordingly, non-billable. Senior Counsel Andrea Treese Berlin represented OIG.
27.05.2016
Arkansas doctor and practice settle case of false and fraudulent Medicare claims
On May 27, 2016, Koyia Latrece Figures, MD, and Alliance Senior Health, PLLC (Figures) entered into a $15,071.20 settlement agreement with OIG. The Settlement Agreement resolves allegations that Figures filed claims for Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
18.05.2016
Georgia Dermatology Practice and Owners For Default ausgeschlossen
On May 18, 2016, the OIG disfellowshipped a Georgia-headquartered dermatology practice and the two owners of the practice (collectively, “Dermatology Practice”) for failure to meet their payment obligations under their settlement agreement (Agreement) with the Department of Justice (DOJ). and OIG. The dermatology practice previously entered into the agreement for allegedly filing false claims with the Medicare program in violation of the False Claims Act because they: (1) were for lab referrals from physicians whose financial relationship with the dermatology practice violated the Stark Act, or (2) erroneously inserted a modifier 25 billing code into applications submitted for services rendered in Georgia. The terms of the contract stipulated that the dermatology practice would make an initial upfront payment plus additional payments over a five-year period. The dermatology practice made no payment in April 2016, and the DOJ issued the dermatology practice a notice of termination on May 5, 2016. Senior Counsel Karen Glassman represented OIG.
18.05.2016
The Grady Health Care System in Georgia is adjudicating the case involving an allegation of dumping of a patient
On May 18, 2016, Grady Memorial Hospital Corporation d/b/a/Grady Health System (GHS) of Atlanta, Georgia entered into a $40,000 settlement agreement with OIG. The settlement agreement eliminates allegations that GHS violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide adequate medical screening and stabilizing treatment for a patient. OIG's investigation revealed the following. The patient was removed from his home by a SWAT team and taken to the GHS Emergency Department (ED) by a police officer due to complaints of suicidal and homicidal thoughts. While at GHS, two Licensed Professional Counselors (LPCs) evaluated the patient and determined that the patient should be involuntarily held for further evaluation and treatment. Approximately five hours after the patient's arrival at the ER, the ER physician discharged the patient without consulting the LPCs or the on-call psychiatrist. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands and Associate Counsel Srishti Miglani represented OIG.
05.06.2016
Minnesota pharmaceutical company settles case involving reporting of drug prices
On May 6, 2016, Coloplast Corp. (Coloplast), Minnesota, signed a $600,000 settlement agreement with OIG. The Settlement Agreement resolves allegations that Coloplast failed to submit certified monthly and quarterly average manufacturer's price (AMP) data for certain months and quarters in 2013, 2014 and 2015 to the Centers for Medicare and Medicaid Services (CMS). The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and enforce a national rebate agreement with the Department of Health and Human Services in order for Medicaid payments to be available for the pharmaceutical company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
05.05.2016
Arizona doctor and practice settle case of false and fraudulent Medicare claims
On May 5, 2016, Eduardo Montes, DPM, and Eduardo Montes, DPM, PLLC (Montes) entered into a settlement agreement with OIG for $10,887.60. The Settlement Agreement resolves allegations that Montes filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was filed; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
Florida podiatrist agrees to 30-year ban
On May 5, 2016, Eugene A. Fox, D.P.M., agreed to reside under 42 U.S.C. be barred from participating in all federal health programs. § 1320a-7(b)(7). The OIG's investigation found that Dr. Fox filed claims with Medicare for podiatric services that were not provided or were provided by unqualified personnel. Senior Counsel Lauren Marziani and Associate Counsel David Fuchs represented OIG.
05.05.2016
Michigan Ambulance Company settles case with false allegations
On May 5, 2016, Allied EMS Systems, Inc. (Allied) of Petoskey, Michigan entered into a settlement agreement with OIG for $121,722.63. The settlement agreement resolves allegations that Allied submitted requests for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, worked together to reach this agreement.
05.05.2016
Florida care facilities adjudicate a disfellowshipped person's case
On May 5, 2016, CCRC PropCo-Cypress Village, LLC (Cypress Village) and BLC Atrium-Jacksonville, LLC (Atrium), Florida entered into a $17,881.65 settlement agreement with OIG. The settlement agreement eliminates allegations that Cypress Village and Atrium employed a person who was disqualified from participating in a federal health care program. The OIG's investigation determined that the disfellowshipped individual, a speech-language pathologist, provided articles or services to Cypress Village and Atrium patients that were billed to federal health programs. Senior Counsel Nicole Caucci represented OIG.
15.04.2016
The Texas Home Health Agency is adjudicating a disfellowshipped person's case
On April 15, 2016, Choice Home Health Care, Inc. and its former owners Patrick Fettinger and Ann Voss (collectively “CHHC”), Texas entered into a settlement agreement with OIG for $89,587.82. The settlement agreement eliminates allegations that CHHC employed a person who was disqualified from participating in a federal health care program. The OIG's investigation found that the excluded individual, a home healthcare contact/marketing specialist, provided items or services to CHHC patients that were billed to government healthcare programs. Senior Counsel Nicole Caucci represented OIG.
11.03.2016
The Utah Ambulance Company settles the case with false allegations
On March 11, 2016, Ogden City Corporation (Ogden) of Ogden, Utah entered into a $363,159.38 settlement agreement with OIG. The settlement agreement resolves allegations that Ogden submitted requests for emergency medical transport to destinations such as qualified care facilities and patient residences, which should have been billed at the lower non-emergency (upcoding) rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
Oregon physical therapy practice and owner settle case with false allegations
On March 11, 2016, Dan Ibarra and Northwest Physical Therapy (collectively NPT), Oregon entered into a $200,000 settlement agreement and three-year integrity agreement with OIG. The settlement agreement resolves allegations that NPT filed claims for payment for direct services by unlicensed Medicare workers and also filed claims for direct one-to-one services when those services were provided to multiple patients at the same time. Senior Counsel Nancy Brown represented OIG.
03.04.2016
Oklahoma doctor and practice settle case of false and fraudulent Medicare claims
On March 4, 2016, James R. Higgins, MD, and James R. Higgins, MD, Inc. ("Higgins") entered into a $10,346.96 settlement agreement with OIG. The Settlement Agreement resolves allegations that Higgins filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was filed; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
North Dakota ambulance provider settles case with false claims
On March 4, 2016, Altru Health System (Altru) of Grand Forks, North Dakota entered into a $300,974 settlement agreement with OIG. The Settlement Agreement resolves allegations that Altru filed claims with Medicare for: (1) emergency ambulance transportation with Advanced Life Support, which should have been billed at the lower Emergency Basic Life Support rate; (2) double billing; (3) ambulance services that could be reimbursed by private insurance; and (4) emergency ambulance services provided to destinations such as qualified care facilities and patient residences that should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, worked together to reach this agreement.
01.03.2016
Oregon psychiatric facility adjudicating case of disfellowshipped person
On March 1, 2016, Cascadia Behavioral Health, Inc. (Cascadia), Oregon entered into a $92,052.78 settlement agreement with OIG. The settlement agreement eliminates allegations that Cascadia employed a person who was disqualified from participating in a federal healthcare program. The OIG's investigation found that the disfellowshipped individual, a housing counselor, provided items or services to Cascadia patients that were billed to federal health care programs. Senior Counsel Nancy Brown represented OIG with support from Paralegal Specialist Eula Taylor.
26.02.2016
Connecticut Ambulance Company settles case with false allegations
On February 26, 2016, Campion Ambulance Service, Inc. (Campion) of Waterbury, Connecticut entered into a $100,804.74 settlement agreement with OIG. The settlement agreement resolves allegations that Campion submitted requests for emergency medical transport to destinations such as qualified care facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, worked together to reach this agreement.
22.02.2016
Arizona doctor settles case of false and fraudulent Medicare claims
On February 22, 2016, Ronald Dale Parker, MD (Parker) entered into a $15,036.50 settlement agreement with OIG. The Settlement Agreement resolves allegations that Parker filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no request for counseling was filed; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
Mississippi doctor settles case of false and fraudulent Medicare claims
On February 22, 2016, Michael Baker, MD (Baker) entered into a $13,238.16 settlement agreement with OIG. The Settlement Agreement resolves allegations that Baker filed claims for Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
09.02.2016
Illinois billing and ambulance companies settle case with false claims
On February 9, 2016, Andres Medical Billing, Ltd. (Andres) and Kurtz Ambulance Service (Kurtz), Illinois, entered into a $77,542.72 settlement agreement with OIG. The settlement agreement resolves allegations that Andres, as an outside biller for Kurtz, filed basic life support (emergency) claims with Medicare that failed to meet Medicare requirements for emergency transportation services and should have been billed at the lower non-emergency transportation rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, worked together to reach this agreement.
02.05.2016
Arizona doctor settles case of false and fraudulent Medicare claims
On February 5, 2016, Benjamin H. Venger, MD (Venger) entered into a $15,956.74 settlement agreement with OIG. The Settlement Agreement resolves allegations that Venger filed claims for Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was filed; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
Michigan Ambulance Company settles case with false allegations
On February 5, 2016, the White Lake Ambulance Authority (White Lake), Michigan entered into a $113,635.08 settlement agreement with OIG. The settlement agreement resolves allegations that White Lake made claims on Medicare for basic life support (emergency) and extended life support (emergency) transportation that failed to meet Medicare requirements for emergency transportation services. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, worked together to reach this agreement.
Illinois pharmacist and owner of long-life medical device supply company agrees to three-year ban
On February 5, 2016, an Illinois pharmacist and owner of a durable medical device supply business agreed, for a period of three years, under 42 U.S.C. being barred from participating in federal health programs. § 1320a-7(b)(7). OIG alleged that the individual, directly or through an employee, offered and paid kickbacks and bribes to persuade individuals representing hospitals and nursing homes to order healthcare items from his company for which payments were made under Medicare. Senior Counsel Henry Green represented OIG.
28.01.2016
The Texas doctor settles the case with allegations of bribes
On January 28, 2016, Jeffrey Ross, D.P.M., of Houston, Texas, entered into a $116,388.56 settlement agreement with OIG. The OIG's investigation found that Dr. Ross received compensation from OneStep Diagnostic, Inc. (OneStep) in the form of compensation under a medical director agreement. OIG claims that this financial agreement reflects the value and volume of Dr. Ross at OneStep. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
27.01.2016
Texas doctor settles case of false and fraudulent Medicare claims
On January 27, 2016, Martin E. Gilliland, MD (Gilliland) entered into a $49,041.58 settlement agreement with OIG. The Settlement Agreement resolves allegations that Gilliland filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
Texas doctor settles case of false and fraudulent Medicare claims
On January 27, 2016, Roger C. Willette, MD (Willette) entered into a $44,120.14 settlement agreement with OIG. The Settlement Agreement resolves allegations that Willette filed claims for Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was filed; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
Massachusetts Ambulance Company settles case with false claims
On January 27, 2016, LifeLine Ambulance Service, LLC (LifeLine) of Woburn, Massachusetts entered into a $74,414.66 settlement agreement with OIG. The settlement agreement resolves allegations that LifeLine submitted requests for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, worked together to reach this agreement.
21.01.2016
The Texas doctor settles the case with allegations of bribes
On January 21, 2016, Nicolas Nammour, M.D., of Houston, Texas, entered into a $111,709.04 settlement agreement with OIG. The OIG's investigation found that Dr. Nammour received compensation from OneStep Diagnostic, Inc. (OneStep) in the form of compensation under a Physician Management Agreement. OIG claims that this financial agreement reflects the value and volume of Dr. Nammour an OneStep considered. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
01.07.2016
Illinois cardiology practices are adjudicating a disfellowshipped person's case
On January 7th, 2016 CardioSpecialists Group, Ltd. (CSG), Illinois, entered into a $274,721.40 settlement agreement with OIG. The settlement agreement resolves allegations that CSG employed an individual who was disqualified from participating in a federal healthcare program. The OIG's investigation determined that the excluded individual, a medical biller, provided items or services to CSG patients that were billed to federal health care programs. Senior Counsel Nancy Brown represented OIG with support from Paralegal Specialist Eula Taylor.
01.06.2016
The University of Mississippi Medical Center is adjudicating the case involving a patient dumping allegation
On January 6, 2016, the University of Mississippi Medical Center (UMMC) in Jackson, Mississippi entered into a $50,000 settlement agreement with OIG. The settlement agreement eliminates allegations that UMMC failed to accept the appropriate transfer of a 64-year-old woman who required specialized skills from UMMC Hospital to stabilize her emergency medical condition. The OIG's investigation found that the operator of the UMMC denied the patient's request to be transferred due to a UMMC policy that it would not accept the transfer of Louisiana residents. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
The Floyd Medical Center in Georgia is adjudicating the case involving a patient dumping allegation
On January 6, 2016, Floyd Medical Center (FMC) in Rome, Georgia entered into a $50,000 settlement agreement with OIG. The settlement agreement eliminates allegations that FMC violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to evaluate and treat a mentally ill patient transferred from another hospital to FMC for involuntary inpatient psychiatric care. OIG's investigation revealed the following. The patient was aggressive and combative upon arrival at the FMC emergency department. Three security guards, including an off-duty police officer who worked for FMC, tried to hold the patient while a nurse got medicine to calm him down. When security personnel entered the room, the patient tried to hit one of them. A security guard then slapped the patient's head and pushed him until he fell onto the bed. The security officers then dragged the patient to the ground and handcuffed him, injuring the patient. When the nurse returned, security personnel informed her that the patient's behavior was outside of what FMC could safely control. Without a psychiatric evaluation or appropriate medical treatment, the paramedics discharged the patient medically and he was taken to prison. Although he had a psychiatrist on call and was able to treat the patient, he was never examined or treated by a psychiatrist. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
01.05.2016
Three Florida companies agree to permanent ban
Effective January 5, 2016, in connection with the resolution of liability under the False Claims Act, three Florida-based companies, American Therapeutic Corporation, American Sleep Institute and MedLink Professional Management (collectively, "the Practices") agreed to be permanently banned from participation to be excluded from federal health programs under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation found that the practices: (1) Paid kickbacks to "patient brokers" who owned assisted living facilities and transitional homes in the Miami area in exchange for referring people known not to be are eligible for treatment; (2) claims submitted or initiated to Medicare for medically unnecessary services; and (3) falsified medical records in order to obtain reimbursement from Medicare. Senior Counsel Kristen Schwendinger represented OIG.

2015

29.12.2015
Moses H. Cone Memorial Hospital in North Carolina settles case where patient was accused of dumping
On December 29, 2015, Moses H. Cone Memorial Hospital (MCMH) in Greensboro, North Carolina entered into a $35,000 settlement agreement with OIG. The settlement agreement eliminates allegations that MCMH violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide adequate medical screening and stabilizing treatment to an 86-year-old woman who presented to MCMH's emergency department after a fall at home granted. OIG's investigation found that while an emergency room physician evaluated her knee pain and performed other imaging tests, she did not fully assess her reported severe pain and inability to move. OIG claimed she was discharged with a postponed hip fracture. Senior Counsel Sandra Sands represented OIG.
23.12.2015
Vermont Municipality settles case with false allegations
On December 23, 2015, the City of Barre, Vermont (Barre) entered into a $127,669.90 settlement agreement with OIG. The settlement agreement resolves the allegation that Barre submitted claims for basic life support (emergency) and extended life support (emergency) transport that did not meet Medicare requirements for emergency transport services and should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, worked together to reach this agreement.
The Texas doctor settles the case with allegations of bribes
On December 23, 2015, Gustavo Grieco, M.D., of Houston, Texas, entered into a $208,000 settlement agreement with OIG. The OIG's investigation found that Dr. Grieco received compensation from OneStep Diagnostic, Inc. (OneStep) in the form of compensation under a medical director agreement. OIG claims that this financial agreement reflects the value and volume of Dr. Grieco at OneStep. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
21.12.2015
Mississippi Ambulance Company settles case with false claims
On December 21, 2015, South Central Regional Medical Center (SCRMC) of Laurel, Mississippi entered into a $318,885.62 settlement agreement with OIG. The settlement agreement resolves allegations that the SCRMC made claims for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, worked together to reach this agreement.
Santa Rosa Memorial Hospital in California is adjudicating case in which patient was accused of dumping
On December 21, 2015, Santa Rosa Memorial Hospital (SRMH) in Santa Rosa, California entered into a $50,000 settlement agreement with OIG. The settlement agreement eliminates allegations that SRMH violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide appropriate medical screening and stabilizing treatment for a patient found on SRMH's property. OIG's investigation revealed the following. The patient was seen in the SRMH emergency room the day before for alcohol withdrawal and neck pain. The doctor prescribed alcohol withdrawal medication and discharged the patient with instructions on alcohol withdrawal and alcohol abuse. The next morning, the patient was seen by several members of the hospital staff, including security guards, lying on the ground near SRMH's car park, possibly in need of medical attention. Despite repeated notifications that the patient may need medical attention, SRMH did not respond. Eventually, an employee who was jogging saw the patient lying on the ground and called 911. When the ambulance arrived, the patient had died shortly before the ambulance arrived. An autopsy report revealed the cause of death to be acute bacterial pneumonia in the left lung. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
Lake City Medical Center in Florida is adjudicating the case in which a patient was accused of dumping
On December 21, 2015, Lake City Medical Center (LCMC) in Lake City, Florida entered into a $25,000 settlement agreement with OIG. The settlement agreement eliminates allegations that LCMC violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide a 42-year-old woman with adequate medical screening and stabilizing treatment. OIG's investigation revealed the following. The patient came to the LCMC emergency room the day before complaining of headache, right arm pain and diarrhea. She was seen by a doctor's assistant and then asked to wait in the waiting room. There she vomited and continued to complain of pain in her right arm. The physician assistant concluded that she did not need immediate medical attention and asked the patient to leave the emergency room. When the patient resisted and her family complained, the emergency room staff called the police to escort her out of the emergency room. After unsuccessful attempts by police and paramedics to get the patient into a car, her family asked the emergency room to call an ambulance so she could be taken to another hospital. When the ambulance arrived, the patient was unresponsive and was taken to another hospital, where she was put on a ventilator in intensive care and later diagnosed with bacterial meningitis. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Senior Counsel Sandra Sands represented OIG.
Pennsylvania chiropractor agrees to 25-year ban
On December 21, 2015, in connection with the resolution of liability under the False Claims Act, a Pennsylvania chiropractor consented to reside for a period of twenty-five years under 42 U.S.C. being barred from participating in federal health programs. § 1320a-7(b)(7). The OIG alleged that the chiropractor knowingly submitted or submitted false or fraudulent claims to Medicare for services despite being barred from participating in federal health care programs. Senior Counsel Katherine Matos and Associate Counsel Kaitlyn Dunn represented OIG.
16.12.2015
Arizona doctor and practice settle case of false and fraudulent Medicare claims
On December 16, 2015, Frank Agnone, MD (Agnone) entered into a $28,863.14 settlement agreement with OIG. The Settlement Agreement resolves allegations that Agnone filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
Texas doctor and practice settles case of false and fraudulent Medicare claims
On December 16, 2015, Roberto Diaz, MD (Diaz) entered into a $13,418.56 settlement agreement with OIG. The Settlement Agreement resolves allegations that Diaz filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was filed; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
11.12.2015
St. Francis Hospital - Downtown in South Carolina is handling the case, which includes allegations of patient dumping
On December 11, 2015, St. Francis Hospital - Downtown (St. Francis) in Greenville, South Carolina entered into a $100,000 settlement agreement with OIG. The settlement agreement clears up allegations that St. Francis violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to fully evaluate and treat two shooting victims. OIG's investigation found the first patient presented to St. Francis after being robbed and shot in the left leg at point-blank range, and the second patient after being shot in the abdomen at a club. OIG alleges that although St. Francis had the capacity and ability to treat both gunshot victims, St. Francis transferred the patients to another hospital. OIG further contends that the benefits of the transfers did not outweigh the risks and unnecessarily put the health of the two shooting victims at further risk. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.
12-07-2015
Texas Ambulance Company settles case with false allegations
On December 7, 2015, EMS Mediventure, Inc. (EMS) of Lampasas, Texas entered into a $92,020 settlement agreement with OIG. The settlement agreement resolves allegations that EMS filed claims for basic life support (emergency) and extended life support (emergency) medical transport claims that did not meet Medicare requirements for emergency transport services and should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and the Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, worked together to reach this agreement.
13.11.2015
New York Ambulance Company settles case with false claims
On November 13, 2015, SeniorCare Emergency Medical Services, Inc. (SeniorCare) of Bronx, New York entered into a $103,334 settlement agreement with OIG. The settlement agreement resolves allegations that SeniorCare submitted requests for emergency medical transport to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, worked together to reach this agreement.
The Texas doctor settles the case with allegations of bribes
On November 13, 2015, Sohail Siddiqui, M.D., of Sugar Land, Texas, entered into a $75,000 settlement agreement with OIG. The OIG's investigation found that Dr. Siddiqui received compensation from OneStep Diagnostic, Inc. (OneStep) in the form of compensation under a Medical Director Agreement. OIG claims that this financial agreement reflects the value and volume of Dr. Siddiqui at OneStep. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
11-12-2015
Wisconsin Ambulance Company settles case with false claims
On November 12, 2015, Shawano Ambulance Service, Inc. (Shawano) of Shawano, Wisconsin entered into a $108,086 settlement agreement with OIG. The settlement agreement resolves allegations that Shawano filed claims with Medicare for emergency medical transportation to destinations such as qualified nursing facilities and patient residences, which should have been billed at the lower non-emergency rate. The Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, worked together to reach this agreement.
Nevada mobile imaging provider settles case of disfellowshipped person
On November 12, 2015, Quality Medical Imaging (QMI), Nevada entered into a settlement agreement with OIG for $34,187.34. The settlement agreement eliminates allegations that QMI employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, an X-ray technician, provided items and services to QMI patients that were billed to government healthcare programs. Senior Counsel Katie Fink represented OIG with support from Paralegal Specialist Mariel Filtz.
11.10.2015
California Skilled Nursing Facility adjudicates case of disfellowshipped person
On November 10, 2015, Windsor Health Care Golden Palms, LLC d/b/a Golden Hill Subacute and Rehabilitation Center (Golden Hill), California entered into a $214,303.69 settlement agreement with OIG. The settlement agreement eliminates allegations that Golden Hill employed a person who was disqualified from participating in federal health care programs. OIG's investigation found that the disfellowshipped individual, a social services worker, provided items and services to Golden Hill patients that were billed to state health care programs. Senior Counsel Nicole Caucci represented OIG with support from Paralegal Specialist Mariel Filtz.
California Skilled Nursing Facility adjudicates case of disfellowshipped person
On November 10, 2015, S&F Market Street Healthcare, LLC d/b/a Windsor Gardens Convalescent Center in North Long Beach (Windsor North Long Beach), California entered into a $207,427.34 settlement agreement with OIG. The settlement agreement eliminates allegations that Windsor North Long Beach employed an individual who was disqualified from participating in federal health programs. The OIG's investigation found that the disfellowshipped individual, a certified nursing assistant, provided items and services to patients in Windsor North Long Beach that were billed to state health programs. Senior Counsel Nicole Caucci represented OIG with support from Paralegal Specialist Mariel Filtz.
California Skilled Nursing Facility adjudicates case of disfellowshipped person
On November 10, 2015, Windsor Oakridge Healthcare Center, L.P. d/b/a Windsor Healthcare Center of Oakland (Windsor Oakland), California entered into a $34,943.48 settlement agreement with OIG. The settlement agreement eliminates allegations that Windsor Oakland employed an individual who was disqualified from participating in federal health programs. The OIG's investigation found that the disfellowshipped individual, an activity assistant, provided items and services to patients in Windsor Oakland that were billed to state health programs. Senior Counsel Nicole Caucci represented OIG with support from Paralegal Specialist Mariel Filtz.
04.11.2015
Oregon physical therapist settles case with false claims
On November 4, 2015, Michael Zingg, P.T., Oregon, entered into a $13,307.52 settlement agreement with OIG. The settlement agreement resolves allegations that Zingg filed claims with Medicare for physical medicine and rehabilitation services that were not provided as claimed or were false or fraudulent. OIG alleged the claims were false or fraudulent because: 1) Zingg failed to personally provide or directly oversee certain physical therapy services; 2) services were billed as physical therapy services between provider and patient when actually delivered in a group setting; and 3) services were provided by persons who are not qualified to provide therapy services under Medicare guidelines. Senior Counsel Lauren E. Marziani represented OIG.
03.11.2015
Laboratories in California and Michigan rule the case involving disfellowshipped persons
On November 3, 2015, Quest Diagnostics Incorporated (Quest), Summit Health, Inc. (Summit) and Unilab Corporation (Unilab) entered into a $126,599.25 settlement agreement with OIG. Summit and Unilab are subsidiaries of Quest. The Settlement Agreement eliminates allegations that a Summit Michigan location employed a vaccine administerer who was barred from participating in state health programs and a Unilab California location employed a quality assurance specialist who was barred from participating in state health programs . Senior Counsel Lisa Veigel represented OIG with support from Paralegal Specialist Eula Taylor.
02.11.2015
South Carolina Urgent Care Centers and owners disqualified for default
On November 2, 2015, the OIG closed five emergency care centers in and around Charleston, South Carolina and the two owners of the emergency care centers (collectively, Emergency Care Centers) for failure to meet their payment obligations under their settlement agreement (Agreement) with the Department of Justice (DOJ) and the OIG. The emergency care centers and their owners previously entered into the settlement agreement for allegedly making false claims to state health programs for: (1) unnecessary laboratory testing; (2) rating and administration services; (3) tetanus immunoglobulin injections when tetanus toxoid was administered instead; and (4) radiology services performed by an unlicensed employee. The terms of the agreement stipulated that the emergency care centers would make an initial upfront payment and two more installments within a year of the agreement. The emergency care centers failed to make the first of the two installments, and the DOJ issued a default notice to the emergency care centers on October 15, 2015.
30.10.2015
Texas Physician and Practice Resolves False and Fraudulent Medicare Claims Case On October 30, 2015, Tajul Chowdhury, MD, and the Center for Pain Management, PLLC (Chowdhury), entered into a $26,587.20 settlement agreement with OIG. The Settlement Agreement resolves allegations that Chowdhury filed claims for Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
Texas doctor and practice settles case of false and fraudulent Medicare claims
On October 30, 2015, Renaud Rodrigue, MD, and Bulger and Rodrigue Southwest Pain Group, PLLC (Rodrigue), entered into a $22,807.06 settlement agreement with OIG. The Settlement Agreement resolves allegations that Rodrigue filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
Delaware doctor settles case of false and fraudulent Medicare claims
On October 30, 2015, Edwin David Gar-El, MD entered into a settlement agreement with OIG for $11,954.86. The Settlement Agreement resolves allegations that Gar-El filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was filed; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
28.10.2015
Wisconsin Home Health Agency and owners agree on voluntary disqualification
On October 28, 2015, in connection with the resolution of liability under the False Claims Act, a Wisconsin Home Health Agency and its owner agreed to indemnify for a period of fifteen years under 42 U.S.C. being barred from participating in federal health programs. § 1320a-7(b)(7). The OIG alleged that the agency and its owner had submitted claims to Wisconsin Medicaid for personal care worker services that were not performed, were not performed under reasonable agency supervision, were not medically necessary, or violated the anti-kickback statute. Senior Counsels Geeta Taylor and Tamara Forys represented OIG.
23.10.2015
The Illinois Hospital Corporation is adjudicating the case involving disfellowshipped persons
On October 23, 2015, Advocate Health and Hospitals Corporation (Advocate), Illinois entered into a $317,660.89 settlement agreement with OIG. The settlement agreement eliminates allegations that Advocate employed two people who were disqualified from participating in a federal health program. The OIG's investigation found that the disfellowshipped individuals, both registered nurses, provided Advocate patient items and services that were billed to federal health care programs. Senior Counsel Karen Glassman represented OIG with support from Paralegal Specialist Jennifer McKoy.
22.10.2015
Texas Skilled Nursing Facility adjudicates case of disfellowshipped person
On October 22, 2015, Huntington Healthcare & Rehabilitation Center, Ltd. (HHRC), Texas, entered into a $214,016.48 settlement agreement with OIG. The settlement agreement eliminates allegations that HHRC employed an individual who was disqualified from participating in a federal health care program. The OIG's investigation found that the disfellowshipped individual, a registered nurse, provided items and services to HHRC patients that were billed to federal health care programs. Senior Counsel David Blank represented OIG with support from Paralegal Specialist Mariel Filtz.
16.10.2015
Kansas Fiscal Intermediary administers the case of a disfellowshipped person
On October 16, 2015, South Kansas Independent Living Resource Center, Inc. (SKIL), Kansas entered into a settlement agreement with OIG for $47,520.18. The settlement agreement resolves allegations that SKIL employed an individual who was disqualified from participating in a federal healthcare program. OIG's investigation found that the disfellowshipped individual, a home health nurse, provided items and services to SKIL patients that were billed to Kansas Medicaid. Senior Counsel Keshia Thompson represented OIG with support from Paralegal Specialist Mariel Filtz.
07.10.2015
New Jersey Pharmaceutical Company settles drug price reporting case
On October 7, 2015, Ascend Laboratories, LLC (Ascend), New Jersey entered into a $1,287,000 settlement agreement with OIG. The settlement agreement resolves allegations that Ascend failed to submit monthly and quarterly Average Manufacturer Price (AMP) data for certain months and quarters in 2013 and 2014 to the Centers for Medicare and Medicaid Services (CMS). The Medicaid Drug Rebate Program requires drug companies to enter into and take effect a national rebate agreement with the Department of Health and Human Services in order for Medicaid payments to be available for the drugs covered by the drug company. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
30.09.2015
OIG rules out dentist in Florida
On September 30, 2015, the OIG barred Howard Sheldon Schneider, DDS, from participating in all federal healthcare programs because he was revoked, suspended or otherwise lost his license to practice in the State of Florida for reasons relating to his professional competence and professional performance relate , or financial integrity. The OIG conducted an investigation by Dr. Schneider, which found that the State of Florida Board of Dentistry issued a final disciplinary order voluntarily relinquishing his dental license after the Florida Department of Health and Human Services opened an investigation into allegations of abuse by Dr. Schneider had initiated dental patients at his pediatric doctor. dr Schneider cannot apply for reinstatement until his dental license is reinstated by the State of Florida. Senior Counsel Geoffrey Hymans and Geeta Taylor represented OIG.
29.09.2015
Former CEO of Arizona Hospice agrees to voluntary exclusion
On September 29, 2015, in connection with the resolution of liability under the False Claims Act, the former CEO of an Arizona hospice agreed to serve a five-year term under 42 U.S.C. being barred from participating in government health programs. § 1320a-7(b)(7). The OIG's investigation found that during the CEO's tenure, the Hospice made false claims to Medicare for some patients who were provided a higher level of hospice care than was required or permitted under Medicare's hospice benefits and/or who fully partially ineligible for Medicare hospice benefits because they did not have a medical prognosis of six months or less during some or all of the time they received hospice care if their illnesses were running their normal course. Senior Counsel Gregory Wellins represented OIG.
17.09.2015
Tennessee Physician and Practice Sett False and Fraudulent Medicare Claims
On September 17, 2015, Dennis C. Ford, MD, and the Ford Center for Pain Management, PLLC (Ford), entered into a $32,184.74 settlement agreement with OIG. The Settlement Agreement resolves allegations that Ford filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
New Jersey doctor and practice settle case of false and fraudulent Medicare claims
On September 17, 2015, Karl T. Chen, MD, and Karl T. Chen, LLC (Chen) entered into a settlement agreement with OIG for $25,937.72. The Settlement Agreement resolves allegations that Chen filed claims under Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was made; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
New Mexico doctor and practice settle case of false and fraudulent Medicare claims
On September 17, 2015, Jesus J. Fonseca, MD, and The Medicine Clinic, LLC entered into a $17,925.24 settlement agreement with OIG. The Settlement Agreement resolves allegations that they filed claims for Healthcare Common Procedure Coding System code G0452 (Molecular Pathology Procedure; Physician's Interpretation and Report) where: (1) no consultation request was filed; (2) no written report was prepared by a consulting physician; and (3) no medical judgment by a consulting physician was required. Additionally, OIG claimed that multiple units of this code may have been submitted for each patient contact when multiple units may not have been medically necessary. Senior Counsel Geoffrey Hymans and Kenneth Kraft represented OIG.
03.09.2015
Massachusetts doctor and his practice settle case with false claims
On September 2, 2015, Dr. Ronald Goldberg and his Haverhill Family Practice, LLC (collectively, “Goldberg and Haverhill”), Massachusetts, entered into a $1,000,000 settlement agreement with OIG. The settlement agreement eliminates allegations that Goldberg and Haverhill were using Dr. Goldberg wrongfully made claims for nursing home patients provided by nurses. Goldberg and Haverhill also entered into an integrity agreement with OIG. Senior Counsel Karen Glassman represented OIG.
01.09.2015
Ohio durable medical equipment assembler agrees to voluntary disqualification
On September 1, 2015, in connection with the resolution of liability under the False Claims Act, an Ohio durable medical equipment installer consented to a five-year indemnity pursuant to 42 U.S.C. being barred from participating in government health programs. § 1320a-7(b)(7). OIG's investigation found that the fitter caused false claims to be filed with Medicare and Medicaid for back braces that were not supplied, were not medically necessary, resulted in the payment of a kickback, or were not fitted by a person responsible for the provision of such services was qualified. Senior Counsel Lauren Marziani and Associate Counsel David Fuchs represented OIG.
The Florida dermatologist agrees to the voluntary exclusion
Effective September 1, 2015, in connection with the determination of liability under the False Claims Act, a Florida dermatologist consented to, for a period of five years, pursuant to 42 U.S.C. being barred from participating in government health programs. § 1320a-7(b)(7). The OIG's investigation found that the dermatologist made Medicare requests for Mohs surgeries that were not medically required or were not performed, and requests for adjacent tissue transfers (aka flaps) that were not medically required or were not performed. Senior Counsel Karen Glassman represented OIG.
31.08.2015
New Jersey Pharmaceutical Company settles drug price reporting case
On August 31, 2015, Glenmark Pharmaceuticals, Inc. USA (Glenmark), New Jersey entered into a $2,887,300 settlement agreement with OIG. The Settlement Agreement resolves allegations that Glenmark failed to timely submit monthly and quarterly average manufacturer's price (AMP) data for certain months and quarters in 2013 and 2014 to the Centers for Medicare and Medicaid Services (CMS). The Medicaid Drug Rebate Program requires drug companies to enter into and enforce a national rebate agreement with the Department of Health and Human Services in order for Medicaid payments to be available for the drug company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Nicole Caucci represented OIG.
27.08.2015
The Texas doctor settles the case with allegations of bribes
On August 27, 2015, Marco Vargas, D.P.M., of Sugar Land, Texas, entered into a $65,000 settlement agreement with OIG. The OIG's investigation found that Dr. Vargas received compensation from OneStep Diagnostic, Inc. (OneStep) in the form of compensation under a medical director agreement. OIG claims that this financial agreement reflects the value and volume of Dr. Vargas at OneStep. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.
14.08.2015
Milwaukee Pain Physician and Medical Practice settles case involving false and fraudulent Medicare claims
On August 14, 2015, David Irving Stein, MD (Stein), and Milwaukee Pain Treatment Services (MPTS), a Wisconsin-based pain treatment specialist, and his practice entered into a $374,864.78 settlement agreement with OIG. The Settlement Agreement eliminates allegations that MPTS filed through Stein false or fraudulent payment claims for multiple units of HCPCS codes G0431 and G0434 when only a single unit can be billed per patient contact by inappropriate use of the 91 and QW modifiers. OIG Office of Audit Services and Office of Counsel to the Inspector General represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
08-12-2015
Colorado dentist agrees to voluntary disqualification
On August 12, 2015, Dr. Robert E. Hackley, Jr., DDS, agrees to be barred from participating in all federal health programs for a period of three years. OIG conducted an investigation of Dr. Hackley for the dental care he provided to patients at Small Smiles Dentistry for Children in Colorado Springs, Colorado. The OIG's investigation found that Dr. Hackley provided dental services to patients of a quality that did not meet professionally recognized standards of care, including: performing medically unnecessary dental procedures, failing to treat existing dental disease, and performing dental procedures that fell below professionally recognized standards of care. Senior Counsel Geoffrey Hymans and Tamara Forys represented OIG.
29.07.2015
The owner of a durable medical device supplier in Pennsylvania and her spouse agree to voluntary exclusions
On July 29, 2015, the owner of a durable medical equipment (DME) supplier and the owner's spouse, who was also an employee, agreed to be banned from participating in government healthcare programs. The owner consented to be barred for a fifteen-year period, and the owner's spouse consented to a thirty-year term under 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that the DME company and its owner provided supplies that were reimbursed by federal health programs through the owner's spouse, while the spouse was barred from participating in federal health programs. Senior Counsels Lauren Marziani and Katherine Matos represented OIG.
27.07.2015
OIG shuts out Georgia Laboratory
On July 27, 2015, OIG C.F. Health Management, Inc. d/b/a Gainesville Pain Management (Gainesville), Georgia, for defaulting on payment obligations under a settlement agreement with OIG. The settlement agreement, effective May 17, 2013, required Gainesville to pay $1,577,597 over a period of time. The OIG alleged that Gainesville made false or fraudulent claims: 1) by inappropriately using modifiers 76 and 59 to submit payment claims for multiple units of Healthcare Common Procedure Coding System (HCPCS) codes G0431 and G0434 when only a single unit in Can be billed per patient contact; and 2) by inappropriate use of Modifier QW and billing for HCPCS G0431 when the less expensive services represented by HCPCS code G0434 were actually provided. Gainesville's suspension will remain in effect until its default in payment is resolved and OIG reinstates Gainesville's participation in state healthcare programs. Senior Counsel Geoffrey Hymans and Andrea Treese Berlin represented OIG.
23.07.2015
Minnesota nursing home settles case of disfellowshipped person
On July 23, 2015, Itasca County, Minnesota, and its nursing home, Itasca Nursing Home d/b/a Grand Village (Itasca), a county-owned nursing home in Grand Rapids, Minnesota, entered into a $179,484.98 settlement agreement OIG. The settlement agreement resolves allegations that Itasca employed a person who was barred from participating in federal health programs. The OIG's investigation found that the disfellowshipped person, a housekeeper and health information specialist, provided Itasca patients with articles and services that were billed to federal health programs. Senior Counsel Patrick Garcia represented OIG with support from Paralegal Specialist Mariel Filtz.
20.07.2015
Indiana Lab settles case with false and fraudulent allegations
On July 20, 2015, the American Institute of Technology (AIT), Indiana, entered into a settlement agreement with OIG and agreed to pay $229,924.74 for alleged violations of the civil fines statute. The Settlement Agreement addresses conduct investigated by OIG and conduct disclosed by AIT itself. The OIG's investigation found that AIT improperly used modifiers 59 and 91 to submit payment claims for multiple units of HCPCS code G0431 when only a single unit can be billed per patient contact. In addition, AIT itself disclosed to OIG that it had employed a person it knew or should have known was barred from participating in federal health programs. The disfellowshipped individual, a clinical technician, provided items and services to AIT patients that were billed to state healthcare programs. Senior Counsel Andrea Treese Berlin and Geoffrey Hymans represented OIG.
17.07.2015
Indiana dialysis provider settles case of disfellowshipped person
On July 17, 2015, Fresenius Medical Care (Fresenius), Indiana, entered into a $120,447.23 settlement agreement with OIG. The settlement agreement resolves allegations that Fresenius employed a person who was barred from participating in federal healthcare programs. OIG's investigation found that a Fresenius location in Indiana employed a disfellowshipped nurse who provided items and services to Fresenius patients that were billed to federal healthcare programs. Senior Counsel Henry Green represented OIG.
13.07.2015
OIG issues cease and desist letter to BankRate Insurance
On July 13, 2015, OIG reported to BankRate Insurance (BankRate) that BankRate was making unauthorized and inappropriate use of the word "Medicare" and other information in its name and on the websites athttp://www.louisiana-medicare.com/potentially violating Section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and departmental emblems. Prior to litigation by OIG, BankRate agreed to: (1) increase awareness of BankRate's consumer notices, including the use of 12-16 point fonts in disclaimers and notices; (2) significantly expand BankRate's disclosure of its affiliations with non-governmental organizations in its consumer communications; and (3) provide each Medicare plan (about which BankRate provides consumer information) with a copy of or a link to BankRate's websites.
30.06.2015
Dental practice settles case of disfellowshipped person
On June 30, 2015, Adam Diasti, D.D.S., P.C. (Diasti), a provider of dental services, has entered into a $22,319.26 settlement agreement with OIG. The settlement agreement with OIG resolves allegations that Diasti employed a person who was barred from participating in federal health programs. OIG's investigation found that at two Diasti-affiliated California dental offices, the disfellowshipped registered dental assistant provided items and services to patients that were billed to state healthcare programs. Senior Counsel Keshia Thompson represented OIG with support from Paralegal Specialist Jennifer McKoy and Program Support Assistant Tynishia Gardner.
29.06.2015
New York doctor agrees to voluntary exclusion
On June 29, 2015, a New York doctor agreed under 42 U.S.C. Be barred from participating in federal health programs for a period of two years. § 1320a-7(b)(16). The OIG's investigation found that the physician filed an application with the New York Department of Health and Human Services for enrollment as a Medicaid provider that misrepresented material facts relating to the physician's prior restriction from the Medicaid program and prior denials of enrollment. Associate Counsel Kaitlyn Dunn represented OIG.
19.06.2015
The Midwest Home Health Agency is settling a disfellowshipped person's case
On June 19, 2015, Accurate Home Care, LLC (Accurate), an Otsego, Minnesota-based provider of home and personal care services, entered into a $334,651.82 settlement agreement with OIG. The Settlement Agreement eliminates allegations that Accurate employed an disqualified person to provide services to Medicaid beneficiaries. Associate Counsel Kaitlyn Dunn represented OIG.
06.08.2015
Texas Skilled Nursing Facility adjudicates case of disfellowshipped person
On June 8, 2015, Meridian Williamsburg Acquisition Partners, LP d/b/a Williamsburg Village Healthcare Campus (Williamsburg) entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services. Williamsburg agreed to pay $77,772.08 to resolve allegations that it employed a person barred from participating in federal health programs. The OIG's investigation found that the disfellowshipped individual, a board-certified nursing assistant, provided items and services to Williamsburg patients that were billed to state healthcare programs. Senior Counsel Ellen Slavin and Paralegal Specialist Mariel Filtz represented OIG.
01.06.2015
Texas Skilled Nursing Facilities administer the case involving disfellowshipped persons
On June 1, 2015, P&S Healthcare Management, LLC, the former general partner of Woodland Springs Healthcare, LP (Woodland Springs) and P&S Healthcare, LP (P&S), agreed to pay $100,000 for the alleged infringement the Civil Fines Payable Law (CMPL). OIG alleged that Woodland Springs employed an individual who was barred from participating in federal health programs. OIG also alleged that P&S employed two people who were barred from participating in federal health programs. The OIG's investigation found that these disfellowshipped individuals provided items and services to beneficiaries of federal health care programs. Senior Counsel Karen Glassman represented OIG.
31.05.2015
OIG Disqualifies District of Columbia Nuclear Cardiologists
On March 31, 2015, a nuclear cardiologist from the District of Columbia was incarcerated under 42 U.S.C. for a period of seventeen years. barred from participating in all government health programs. § 1320a-7(b)(7). The cardiologist performed and billed federal healthcare programs for nuclear cardiology services, including myocardial perfusion imaging single photon emission computed tomography (MPI SPECT) procedures (commonly known as nuclear stress testing). The OIG's investigation found that the charges billed for MPI SPECT procedures and related services did not comply with applicable federal health program rules and regulations. The cardiologist also unbundled and billed separately for services considered as part of reimbursement for the MPI-SPECT studies and double-billed for multi-study MPI-SPECT procedures. Senior Counsels Kaitlyn Dunn and Jill Wright represented OIG.
29.05.2015
Michigan doctor agrees to voluntary disqualification
On May 29, 2015, in connection with the determination of liability under the False Claims Act, a Michigan physical medicine and pain management physician agreed to a three-year period under 42 U.S.C. being barred from participating in government health programs. § 1320a-7(b)(7). The OIG's investigation found that the physician made false statements about physical therapy, electrodiagnostic testing, and/or Medicare and Medicaid home health care that the physician paid for illegal remuneration or kickbacks. Senior Counsel Patrick Garcia represented OIG.
27.05.2015
South Florida Business Owner Agrees to Voluntary Expulsion and Divestment
Tracy Nemerofsky — a private business owner from Palm Beach Gardens, Fla. — agreed to be banned from participating in all federal health programs for a period of five years. The OIG conducted an investigation into Nemerofsky for knowingly filing or causing the filing of false claims with Medicare in violation of the Anti-Kickback Act. Based on that investigation, the OIG alleged that Nemerofsky, through her company A Plus Home Healthcare, Inc. (A Plus), violated the Anti-Kickback Statute when she received A Plus payments to eight different spouses of physicians in exchange for the Medicare recommendations of physicians. OIG contended that the eight spouses were not bona fide employees of A Plus and that these arrangements did not fit the Anti-Kickback Statute's exception to the non-payments clause. OIG alleged that Nemerofsky offered and paid the compensation described above and that this behavior constituted a basis for their disqualification.

Nemerofsky agreed to a voluntary disqualification with OIG for a period of five years after resolving the above conduct through a monetary settlement under the False Claims Act with the United States, a settlement in which OIG expressly reserved its disqualification power. To also release their companies' exclusionary liability, Nemerofsky also agreed to divest five healthcare companies: A Plus; A Plus private care services; Ocean Therapy Group, Inc.; Professional Touch Rehab, Inc.; and RockHill Rehab Services Inc. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.

(Video) Elder Justice Coordinating Council (EJCC) Meeting | June 2020 | Part 1 of 2

15.05.2015
Michigan Nurse Practitioner agrees to voluntary disqualification
On May 15, 2015, a Michigan Nurse Practitioner (NP) consented under 42 U.S.C. Be barred from participating in federal health programs for a period of five years. § 1320a-7(b)(7). The OIG's investigation found that the NP knowingly and intentionally referred patients for physical therapy and home health services that were billed to government health programs in exchange for illegal kickbacks. Senior Counsel Patrick Garcia represented OIG.
08.05.2015
Kansas Pharmaceutical Company is adjudicating the case involving the reporting of drug prices
On May 8, 2015, B.F. Ascher & Company, Inc. (B.F. Ascher), a Kansas pharmaceutical manufacturer, entered into a $178,000 settlement agreement with OIG. The settlement agreement eliminates allegations that B.F. Ascher failed to submit certified monthly and quarterly average manufacturer's price (AMP) data for specific months and quarters from 2012 through 2014 to the Centers for Medicare and Medicaid Services (CMS). The Medicaid Drug Rebate Program requires drug companies to enter into and enforce a national rebate agreement with the Department of Health and Human Services in order for Medicaid payments to be available for the drug company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsels Geeta W. Kaveti and Nicole Caucci represented OIG.
05.06.2015
New Jersey Pharmaceutical Company settles drug price reporting case
On May 6, 2015, Seton Pharmaceuticals (“Seton”), a Manasquan, New Jersey-based specialty pharmaceutical company, entered into a $91,800 settlement agreement with OIG. The settlement agreement resolves allegations that Seton failed to submit certified monthly and quarterly average manufacturer's price (AMP) data for certain months and quarters in 2012 and 2013 to the Centers for Medicare and Medicaid Services (CMS). The Medicaid Drug Rebate Program requires drug companies to enter into and enforce a national rebate agreement with the Department of Health and Human Services in order for Medicaid payments to be available for the drug company's covered drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsels Geeta W. Kaveti and Nicole Caucci represented OIG.
27.04.2015
Texas Nursing Facility settles case of disfellowshipped person
On April 27, 2015, Town Hall Estates-Arlington, Inc. (Town Hall), a nursing home in Arlington, Texas, entered into a $70,000 settlement agreement with OIG. The settlement agreement with OIG resolves allegations that City Hall employed an individual who was barred from participating in federal health programs. OIG's investigation found that the disfellowshipped individual, a licensed professional nurse, provided City Hall patients with items and services billed to state health care programs. Senior Counsel Karen Glassman represented OIG.
15.04.2015
Georgia optometrist agrees to voluntary disqualification
On April 15, 2015, a Georgia optometrist agreed to reside under 42 U.S.C. being barred from participating in federal health programs. § 1320a-7(b)(7). The OIG's investigation found that the Georgia Medicaid optometrist made claims for services that were not medically necessary and overstated the level of services provided. Associate Counsel David Fuchs represented OIG.
10.04.2015
Florida mental health counselor settles case with false allegations
On April 10, 2015, Timothy Fennell, a Florida licensed mental health counselor, entered into a settlement agreement with OIG under which Fennell would pay $120,000 and be barred for twelve years. The settlement agreement with OIG resolves allegations that Fennell made false claims to Medicare for psychotherapy and other services allegedly provided at Fennell's former company, Lakemont Clinic. Fennell used the provider information of an Orlando-area doctor to make claims for services not provided or supervised by a doctor. Senior Counsels Lauren Marziani and Katherine Matos represented OIG.
04.06.2015
The Pennsylvania Home Care Agency is adjudicating a disfellowshipped person's case
On April 6, 2015, YCB, Inc. d/b/a Home Helpers (Home Helpers), a Drexel, Pennsylvania, provider of non-medical and personal home care, entered into a $69,130 ​​settlement agreement with OIG. The Settlement Agreement resolves allegations that Home Helpers employed an excluded person from July 1, 2010 to December 12, 2011. OIG alleged that the disfellowshipped person provided services to Medicaid recipients. Senior Counsel Lauren Marziani represented OIG.
23.03.2015
Indiana Health Systems is adjudicating the case of a disfellowshipped lab technician
On March 23, 2015, Parkview Health System, Inc. (Parkview), a not-for-profit, community-based healthcare system serving northeast Indiana and northwest Ohio, entered into a $129,216.80 settlement agreement with OIG. The settlement agreement resolves allegations that Parkview employed a person who was disqualified from participating in federal health programs. OIG's investigation found that the disfellowshipped individual, a lab technician, provided items and services to Parkview patients that were billed to federal health care programs. Senior Counsel Henry Green represented OIG.
19.03.2015
OIG Shuts Out Illinois Home Health Agency
Ambulatory Health Services, LTD. - A home health agency in Skokie, Illinois was banned from participating in all federal health programs for a three-year period for employing a disqualified nurse. The OIG's investigation found that Ambulatory Health Care Services, LTD billed state health care programs for services provided by the disfellowshipped nurse to Medicare and Medicaid beneficiaries. The ban, effective March 19, 2015, prohibits Ambulatory Health Care Services, LTD from participating in the state's healthcare programs. Ambulatory Health Care Services, LTD is no longer in operation. Senior Counsels David M. Blank and Lauren Marziani, along with Paralegal Specialist Eula Taylor, represented OIG.
18.03.2015
Oklahoma Prosthetics Suppliers settles case with false claims
On March 18, 2015, La Fuente Ocular Prosthetics, LLC (La Fuente), an Oklahoma City, Oklahoma-based prosthetics supplier, entered into a $90,000 settlement agreement with OIG. The settlement agreement eliminates allegations that La Fuente submitted false or fraudulent claims to Medicare and created false records of a false claim. OIG alleges that La Fuente filed claims for benefits (1) when the treating physician failed to provide La Fuente with a purchase order or other required documentation prior to billing the Medicare program, and (2) fitted patients with prosthetic devices containing products containing higher functional level than necessary. OIG's Office of Audit Services, Office of Investigations and Office of Counsel to the Inspector General, represented by Associate Counsel Paul Westfall and Senior Counsel Geoffrey Hymans, worked together to reach this agreement.
17.03.2015
Newton Medical Center in Kansas is adjudicating the EMTALA case
A Newton, Kansas, hospital that failed to provide an adequate medical exam to a pregnant woman who was later rushed to another hospital and gave birth to a stillborn baby has agreed to pay $45,000 to help Office of the Inspector General's (OIG) allegations to be settled. from the US Department of Health and Human Services that these actions violate the Emergency Medical Treatment & Labor Act (EMTALA). The OIG alleged that Newton Medical Center failed to conduct an adequate medical evaluation for a patient who presented to Newton's ER at 38 weeks gestation complaining of abdominal and lower back pain. Newton did not take the patient's medical history, take any vital signs, perform fetal monitoring, test fetal movements, or perform any examination on the patient. Instead, Newton directed the patient to see her GP. The patient left Newton in a private vehicle and presented to the emergency department of another hospital, where she was admitted and gave birth to a stillborn baby.

The settlement, effective March 17, 2015, settles Newton's liability for civil penalties under the EMTALA. The maximum penalty under EMTALA for a large hospital is $50,000. Senior Counsel Geeta Taylor and Associate Counsel David Fuchs represented OIG.

17.03.2015
Pennsylvania Staffing Agency settles case of disfellowshipped person
On March 17, 2015, Flexible Staffing Solutions, Inc. d/b/a OneSource Medical Staffing (OneSource), a healthcare staffing firm based in Wilkes-Barre, Pennsylvania, entered into a $24,775.56 settlement agreement with OIG. The settlement agreement eliminates allegations that OneSource employed a person who was disqualified from participating in federal healthcare programs. The disfellowshipped person provided licensed practical nurse (LPN) items and services in nursing facilities that billed federal health care programs. Senior Counsel Nicole Caucci represented OIG.
11.03.2015
New Jersey Pharmaceutical Company settles case in which Medicare misrepresented drug prices
On March 11, 2015, Sandoz, Inc. (Sandoz), a New Jersey-based generic drug company, entered into a $12,640,000 settlement agreement with OIG. The settlement agreement resolves allegations that Sandoz misrepresented drug pricing data to the Medicare program. Federal law requires drug manufacturers to report both accurate and timely "average selling price" information to the Centers for Medicare & Medicaid Services (CMS). CMS uses this information to determine payment amounts for most Medicare Part B covered drugs. Inaccurate pricing information can result in Medicare overpaying for these drugs. Senior Counsels Geeta W. Kaveti and Nicole Caucci represented OIG.press release
27.02.2015
The Texas doctor agreed to the voluntary exclusion
On February 27, 2015, a Texas physician and two companies he operates, a research firm and a consulting firm, agreed to be barred from participating in federal health programs for a period of three years in connection with the resolution of liability under the False Claims Act are used under 42 U.S.C. § 1320a-7(b)(7). The OIG's investigation found that the doctor and his company received bribes in return for recommending or promoting the use of a surgical product. Senior Counsel Sandra Sands represented OIG.
25.02.2015
Denver Skilled Nursing Facility regelt den CMP-Fall
A qualified nursing facility in Denver, Colorado that employed a person who was barred from participating in all federal healthcare programs and provided items and services to residents who were Medicare and Medicaid beneficiaries has agreed to pay a civil fine of $242,434.92 to be paid, according to the US Department of Health and Human Services Inspector General (OIG). OIG's investigation found that Denver North Care Center had employed a disfellowshipped nurse who provided Denver North Care Center patients with items and services paid for by Medicare and Medicaid. The effect of an OIG disqualification is that no government health care program may make payment for any item or service provided by a disfellowshipped person. The settlement agreement, effective February 25, 2015, was entered into with both the OIG and the State of Colorado. Senior Counsels David M. Blank and Patrick Garcia, along with Paralegal Specialist Eula Taylor, represented OIG.
24.02.2015
Alabama doctor and medical practice settles case involving false and fraudulent Medicare claims
Stevenson Medical Center and Alan J. Wayne, M.D. (collectively Stevenson), a Stevenson, Alabama, physician and his practice, which performed in-office urine drug testing, entered into a $225,000 settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective May 24, 2018. February 2015. The agreement resolves allegations that Stevenson submitted false or fraudulent claims to Medicare. Specifically, the OIG alleges that Stevenson submitted high and low/moderate complexity urine drug test claims to Medicare that exceeded Medicare's allowable number of units by using inappropriate code to circumvent computer programs that would otherwise reject such claims had. The OIG also alleges that Stevenson filed claims on high-complexity drug tests even though it performed less-expensive, low/moderate-complexity drug tests. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, worked together to reach this agreement.
24.02.2015
California pharmacy settles case of false and fraudulent Medicare claims
On February 24, 2015, a pharmacy in Los Angeles, California, and its owner agreed to pay US$1,342,295.50 to settle allegations by the US Department of Health and Human Services' Office of Inspector General (OIG) under the Civil Penalties Act. The agreement with OIG clears up allegations that Hyundai Drugs and its owner Sang Kim filed claims with Medicare Part D for brand-name prescription drugs that it could not have released based on inventory records. The case was investigated as part of Operation Pharm Fury, a joint effort by the Office of Investigations, the Office of Evaluation and Inspections and the Office of Counsel to the Inspector General. Senior Counsel Tamara Forys represented OIG.
02.09.2015
Loxahatchee, Florida Hospital settles EMTALA case
On February 9, 2015, Palms West Hospital (Palms), a hospital in Loxahatchee, Fla., agreed to a settlement agreement with OIG to pay a maximum fine of $50,000. The agreement clears up allegations that Palms refused to accept the transfer of an infant who took Drano. The mother of an 18-month-old infant took her daughter to a hospital emergency room for ingestion of an unknown amount of Drano. Poison Control recommended that the toddler be treated by a pediatric gastroenterologist (GI), which this hospital did not have. The ED doctor contacted the Hospital Corporation of America Transfer Center (TC) to arrange for the patient to be transferred. As protocols required, TC had a copy of Palms' ready list. TC called Palms to confirm pediatric GI services were available and to arrange the infant's transfer. Palms' ED doctor accepted the transfer, but later revoked it because she believed she had made a mistake with on-call duty. The toddler was then transferred to another hospital. However, Palms had a pediatric GI on call when the request was made to transfer the toddler. TC failed to timely review the transfer request and learned of the rejection after the patient was transferred to another facility. Senior Counsel Sandra Sands represented OIG.
02.06.2015
Arizona behavioral and developmental services provider settles case involving disfellowshipped nurses
On February 6, 2015, Community Provider of Enrichment Services (CPES), a Tucson, Arizona provider of adult day programs, adult residential facilities, and other behavioral and developmental services for behaviorally and intellectually challenged adults and children, settled a settlement of $250,000 agreement with the OIG. The settlement agreement eliminates allegations that CPES employed two people who were barred from participating in federal health programs. The excluded nurses provided items and services for CPES patients that were billed to federal health care programs. Senior Counsel Nancy Brown, representing OIG with support from Paralegal Specialist Eula Taylor.
02.04.2015
Group home in Arizona settles case of disqualified provider
A residential group that provides services to people with disabilities has settled with the HHS office of the inspector general over allegations that it employed a nurse who was barred from participating in state health programs and allowed that person to care for residents. The facility, Agape Homes, LLC, in Avondale, Arizona, also offers day care services. Under federal law, a provider who has been disqualified from federal health care programs cannot provide services to, or have Medicare or Medicaid pay for, Medicare or Medicaid beneficiaries. Agape agreed to pay $41,995.30 to settle these allegations. Senior Counsel Nancy W. Brown represented OIG.
30.01.2015
Alabama Hospital adjudicating disfellowshipped person's case
Affinity Medical Center, LLC, a community hospital in Birmingham, Alabama, operating under the name Trinity Medical Center, entered into a settlement agreement with the U.S. Department of Health and Human Services' Office of Inspector General (OIG) effective December 15, 2014. The $111,969.11 settlement settles allegations that the hospital employed a person who was disqualified from participating in federal health care programs and then billed the federal health programs for items and services provided by the disqualified person.

The excluded individual was identified through a data analysis project initiated by the OIG's Office of Evaluation and Inspections. The OIG Office Evaluation and Inspections and the Office of Counsel to the Inspector General, represented by Senior Counsel Kenneth D. Kraft, worked together to reach this agreement.

23.01.2015
Ownership of Minnesota Pharmacy during foreclosure results in settlement with OIG
Minnesota pharmacist Joseph C. Moon entered into a $96,259.57 settlement agreement with the U.S. Department of Health and Human Services' Office of Inspector General (OIG), effective January 20, 2015. As of December 2013, Moon owned and managed a pharmacy participating in state health programs participated while barred from participating in those programs. Senior Counsel David M. Blank and Paralegal Mariel Filtz represented OIG.
20.01.2015
Georgia doctor settles case of false and fraudulent Medicare claims
Dennis Conrad Harper, M.D. (Harper), a Georgia doctor who overcharged for in-office urine drug testing, agreed to enter into a $305,168.54 settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG), effective January to conclude 20, 2015. The settlement resolves allegations that Harper made false or fraudulent claims to Medicare. Specifically, the OIG alleges that Harper submitted claims to Medicare for low- and medium-complexity urine drug tests that exceeded Medicare's allowable number of units by using inappropriate code to circumvent computer programs that would otherwise have rejected such claims. OIG also alleges that he filed claims for high-complexity drug tests when he was doing less-expensive, low- or medium-complexity drug tests. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoff Hymans, worked together to reach this agreement.
20.01.2015
Tristar Summit Medical Center in Tennessee clears up allegations of patient dumping
A Tennessee hospital that allegedly transferred an unstable patient for insurance will pay $40,000 in a settlement with the Department of Health and Human Services' Office of the Inspector General (OIG), it was announced today. Tristar Summit Medical Center in Hermitage, TN, is investigating allegations by the OIG that it broke the law when it transferred a patient who came to its emergency room after consuming a bottle of antifreeze without first assessing the patient's medical condition stabilize. Allegedly, the ER staff decided that the patient should be taken to an ICU and despite the availability of a bed in the Tristar Summit ICU, the patient was sent elsewhere because the hospital would not accept the patient's insurance. The Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 — often referred to as the Patient Anti-Dumping Act — requires a hospital to stabilize a patient's emergency condition to the extent of its ability prior to transfer, and a hospital must not treat an unstable patient transfer unless the patient requests transfer or a doctor certifies that the benefits of transfer outweigh the risks. Under EMTALA, hospitals can be fined up to $50,000 per violation.

2014

29.12.2014
Atmore Community Hospital regelt EMTALA-Fall
A small hospital in Atmore, Alabama, has settled claims it refused to give painkillers to a man who was shot in the arm. The 65-year-old man was taken to Atmore Community Hospital by ambulance to be flown to a hospital that could treat his injury. However, it was too foggy for the helicopter to land, so the paramedics had to drive him to the hospital, an hour away. The patient didn't think he could make the journey without pain medication, so he asked for pain relief for his severe pain - something Atmore was able to provide. As paramedics unloaded the patient from the ambulance, Atmore's paramedic and a nurse came to the ambulance and refused to let the patient into the hospital because they did not have a trauma surgeon on staff. Both the paramedic and the patient explained that the patient wanted pain relief for the long journey, but the doctor and nurse returned to the house with the locked doors closing behind them.

The Department of Health and Human Services' Office of Inspector General (OIG) claimed this behavior violated the Emergency Medical Treatment & Labor Act, which requires hospitals to provide stabilizing care to patients with medical emergencies, including severe pain. On December 29, 2014, Atmore agreed to pay $25,000 - the maximum fine for a small hospital - to resolve these allegations. Senior Counsel Sandra Sands represented OIG.

29.12.2014
Memorial Health Care System regelt EMTALA-Fall
A small hospital in Hixson, Tenn. that failed to provide stabilizing treatment to an 18-year-old with severe pain and multiple fractures has settled allegations by the US Department of Health and Human Services' Office of Inspector General (OIG) that it violated the Emergency Medical Treatment & Labor Act . EMTALA requires hospitals to provide stabilizing treatment to any patient with a medical emergency. The patient presented to the emergency room at Memorial North Park, one of the Memorial Health Care System's satellite hospitals, with severe pain in his feet, ankles and right shin after jumping off a twenty-foot wall and landing on concrete. Although Memorial had an orthopedic surgeon on call, emergency room staff did not consult him or treat the patient's pain or cast his legs before transferring him to the trauma center. Finally, the trauma center did not consider the patient to be a trauma case.

The hospital agreed to pay $20,000 in a settlement agreement with the OIG effective December 29, 2014. Under EMTALA, the maximum penalty for hospitals with fewer than 100 beds is $25,000. Senior Counsel Sandra Sands represented OIG.

(Video) RAC Audits and the Office of Inspector General

29.12.2014
Baptist Medical Center – Princeton regelt EMTALA-Fall
A medical center in Birmingham, Alabama, which refused to accept the reasonable transfer of a 61-year-old woman, has agreed to settle allegations that it violated the Emergency Medical Treatment & Labor Act. EMTALA requires hospitals with specialized skills - in this case, a neurosurgeon - to transfer patients who need those services.

The patient, who was found unresponsive at home, was initially taken to a facility unable to treat her condition. The hospital diagnosed her with an altered mental state caused by a change in brain function: she had a subdural hematoma and required emergency surgery, which the hospital could not afford. When the ED doctor called Baptist to make arrangements for transferring the patient to Baptist, Baptist transferred the call to his ER and the transferring doctor was told to speak to the neurosurgeon on duty. The call was then transferred to the hospital doctor, who repeated that he needed to speak to the neurosurgeon on duty. The referring emergency physician was then put through to the neurosurgeon and explained the patient's condition. The neurosurgeon replied that it sounded like the patient was brain dead. The ED doctor explained that she wasn't and that he paralyzed her in order to intubate her for medical purposes. The neurosurgeon repeated that she sounded brain dead and declined the transfer. Before hanging up, the neurosurgeon said he was willing to consult on the case but would not accept the patient's transfer to Baptist. The ED doctor then transferred the patient to another hospital, where she underwent successful surgery and was discharged to a rehabilitation facility five days later. After learning of his refusal to admit this patient, Baptist ordered the neurosurgeon to call Baptist back and admit the patient, which he did, but the patient had already been admitted to another hospital.

Baptist agreed on December 29, 2014 to pay $40,000 to resolve allegations of EMTALA violations being investigated by the US Department of Health and Human Services' Office of Inspector General (OIG). The maximum penalty for violating the so-called “patient dumping” law for a large hospital is $50,000. Senior Counsel Sandra Sands represented OIG.

29.12.2014
Caldwell Medical Center settles EMTALA case
Caldwell Medical Center, a small hospital in Princeton, Kentucky, has settled allegations that it failed to assess a patient's headache or provide stabilizing treatment. A 72-year-old woman lost consciousness and fell face first onto a concrete floor. About five hours later, she regained consciousness, called an ambulance, and was taken to the Caldwell Emergency Department (ED). She had bruises and abrasions on her nose, two black eyes and a skin tear on her right arm. She complained of severe pain in her face and head. Her abrasions and skin tears were cleaned and she was discharged home just over an hour after arriving at the emergency room. She received no diagnostic tests, including a CAT scan, and she received no treatment for her headache.

The patient continued to have pain: she could not chew and vomited blood. The next morning, she called an ambulance again and returned to Caldwell's emergency room. This time she received an appropriate medical examination, which revealed multiple head fractures. She was then transferred to a hospital with neurosurgical capabilities, underwent multiple surgeries, and was discharged thirteen days later.

Caldwell agreed to pay $10,000 in a settlement with the US Department of Health and Human Services' Office of Inspector General (OIG), effective December 29, 2014. Senior Counsel Sandra Sands represented OIG.

(Video) Michael Horowitz testifies before the Senate Judiciary Committee | full video

19.12.2014
Denver Hospital System settles allegations of false claims
Effective December 19, 2014, the Denver Health and Hospital Authority entered into a settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG). The $51,803.86 settlement resolves allegations that Denver Health made Medicare claims for services to individuals it knew or should have known were incarcerated or in custody. In most cases, Medicare does not pay health care benefits for people who are incarcerated or incarcerated. Senior Counsel Tamara Forys and Geeta Taylor represented OIG.
18.12.2014
Hospice owners settle case of false and fraudulent Medicare claims
The current and former owners of Premier Hospice and Palliative Care, LLC and Premier Hospice & Palliative Care - Indiana, LLC jointly entered into a $2,674,895.79 settlement agreement with the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services 18. December 2014. The settlement resolves allegations that Premier filed hospice claims with Medicare from October 1, 2009 to April 30, 2013 for patients whose medical records indicated they were ineligible for such services. SP Management, Inc. and Jeff L. Smith owned the hospices when the alleged behavior began. They sold the hospices to Abode Healthcare, Inc. on December 31, 2012, and shortly thereafter Abode itself disclosed potential civil fines statute violations to OIG. This settlement resolves allegations for all parties: SP Management, Jeff L. Smith and Abode. Senior Counsel Tamara Forys represented OIG.
18.12.2014
A medical practice, doctor in New York settles the case of false and fraudulent claims
Jennan Comprehensive Medical, P.C. (Jennan) -- a medical group practice in New York -- and its owner, Henry Chen, M.D., entered into a $694,887.02 settlement agreement with the U.S. Department of Health and Human Services' Office of Inspector General (OIG), effective May 18, 2014. The Settlement clears up allegations that Jennan and Dr. Chen knowingly filed or submitted false and/or fraudulent claims to Medicare for physical therapy services from May 15, 2008 to December 31, 2013. In particular, OIG alleged that these claims were false and/or fraudulent for one or more of the following reasons: 1) physical therapy services were not provided or supervised by the animal treatment provider; 2) Group services were billed as individual physiotherapeutic services by provider and patient; 3) services were rendered by unqualified persons; and/or 4) Claims for time-based physical therapy services did not accurately reflect the actual time spent providing the services. Senior Counsels David M. Blank, Tamara T. Forys, and Lauren E. Marziani, along with Paralegal Specialist Mariel Filtz, represented the OIG.

This case developed as a result of OIG's previous investigationJoseph A. Raia, MD, a former Jennan employee. dr Raia reached a $1.5 million settlement with OIG on February 11, 2014 and agreed to be barred from participating in the federal health program for at least 15 years.

03.12.2014
Texas Otolaryngology Practice Compares Case to False and Fraudulent Medicare and Medicaid Claims
Ear Nose and Throat Associates of Corpus Christi, LLC -- a medical practice providing ENT services in Corpus Christi, TX -- entered into a Settlement Agreement with the U.S. Department of Health and Human Services' Office of Inspector General (OIG) effective December 3, 2014 The $200,630 settlement resolves allegations that the practice had wrongfully filed claims with Medicare and Texas Medicaid for nearly three years for hearing assessment services performed by unqualified technicians. Senior Counsel Ellen Slavin represented OIG.
26.11.2014
Ohio chiropractor agrees to voluntary disqualification
On November 26, 2014, an Ohio chiropractor consented under 42 U.S.C. be barred from participating in government health programs for a period of ten years. § 1320a-7(b)(7). OIG's investigation found that the chiropractor billed Medicare for custom orthotics and associated add-on codes when in fact it provided standard equipment that: (1) could not be billed to Medicare; (2) billed at a higher reimbursement rate than is reasonable; (3) provided to patients who were not eligible for such devices; and (4) not medically necessary. OIG also alleged that the chiropractor improperly solicited prospective nursing home clients, ordered devices without proper clinical evaluation, ordered orthotics for both feet without medical necessity, told patients there would be no cost for the devices, and waived co-payments would . Senior Counsel Geeta W. Kaveti represented OIG.
17.11.2014
South Carolina's Trident Health Care System settles EMTALA case with allegations of patient dumping
Effective November 17, 2014, the Trident Health System (Trident) in South Carolina entered into a settlement agreement with the Office of Inspector General (OIG) for the United States Department of Health and Human Services to resolve claims that it did not provide stabilizing treatment for a patient in one of its emergency rooms. Specifically, OIG alleged that on February 12, 2012, a 58-year-old male patient, who was then detained, was transported by an EMS (Emergency Medical Services) vehicle to Moncks Corner Medical Center, a Trident facility. EMS contacted the EMS staff to inform them of the patient's transportation, but when the patient arrived at the ER, a nurse informed the EMS staff that the medical center could not treat the patient because Trident received an "entering." forbidden” command for him. EMS then took the patient to a nearby hospital and Trident never performed a medical screening of the patient. This $40,000 settlement relieves Trident's liability for civil penalties under the Patient Dumping Statute.
30.10.2014
DCH Regional Medical Center settles EMTALA case
Effective October 30, 2014, DCH Regional Medical Center — a 583-bed hospital in Tuscaloosa, Alabama — entered into a settlement agreement with the Office of Inspector General (OIG) on behalf of the U.S. Department of Health and Human Services to resolve its civil penal liability issues after the Emergency Medical Treatment and Labor Act (EMTALA). DCH paid $40,000 to resolve allegations that it violated EMTALA by failing to conduct an adequate medical screening and failing to stabilize a patient who presented to the DCH ER with a medical emergency.

Specifically, the patient came to the emergency room of the DCH with a gunshot wound in the abdomen. The ER physician determined that the general surgeon on duty needed to examine and treat the patient, and the staff contacted the general surgeon on duty multiple times. The general surgeon on duty stated that he was performing a previously planned elective surgery in the operating room. The DCH Emergency Department was unable to find another general surgeon to evaluate the patient and provide stabilizing care. The general surgeon on duty then performed a second previously planned elective surgery in the operating room without first evaluating and stabilizing the patient in the emergency department. After approximately two hours of waiting at the DCH, the patient died without ever having received evaluation or stabilizing treatment from a general surgeon.

24.10.2014
The Texas company settles the case involving disfellowshipped people
Daybreak Venture, LLC, the general partner of 74 qualified nursing and long-term care facilities across Texas, entered into a settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG) effective October 24. 2014. $357,341.96 settlement resolves allegations that seven Daybreak-operated facilities each employed one person who was barred from participating in federal health programs. These facilities then billed the state health care programs for the items or services provided by the disfellowshipped individuals.

Five of the seven individuals were identified through a data analysis project initiated by the OIG's Office of Audit Services. During OIG's investigation, Daybreak identified two other employees who were also disfellowshipped. The Office of Investigations, the Office of Audit Services and the Office of Counsel to the Inspector General, represented by Senior Counsel Karen Glassman, worked together to reach this settlement.

24.10.2014
New Jersey doctor enters into settlement agreement with OIG over kickback allegations
dr Rajan Shah - a gastroenterologist from Newark, NJ - entered into a settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG) effective October 24, 2014 received compensation from Orange Community MRI, LLC, an imaging facility in Orange, NJ. in exchange for patient referrals. Senior Counsel David M. Blank and Lauren E. Marziani represented OIG in this case.
17.10.2014
Texas Doctor Reaches Settlement Agreement With OIG Over Kickback Allegations
dr Jimmy Dung Doan -- a general practitioner in Houston, TX -- entered into a settlement agreement effective October 17, 2014 with US Department of Health and Human Services' Office of Inspector General (OIG) Dr. Doan received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of services received under a Referral Coordinator contract. OIG claimed that this financial agreement increased the value and volume of Dr. Doan at Fairmont took into account. Senior Counsel Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Reaches Settlement Agreement With OIG Over Kickback Allegations
dr Dan Kelly Eidman - an orthopedic surgeon from Houston, TX - entered into a settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG) effective October 17, 2014. Eidman received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of monthly payments made under a medical director contract. OIG claimed that this financial agreement increased the value and volume of Dr. Eidman at Fairmont took into account. Senior Counsel Kristen Schwendinger and Robert M. Penezic represented OIG.
16.10.2014
Utah Skilled Nursing Facility adjudicating case involving disfellowshipped nursing assistant
Manor Care of South Ogden UT, LLC d/b/a ManorCare Health Services - South Ogden (MCHS - South Ogden), a qualified nursing facility in Utah, entered into a settlement agreement with the Office of Inspector General (OIG) for the US Department of Health and Human Services, effective October 16, 2014. The $41,129.76 settlement resolves allegations that MCHS - South Ogden employed a person who was disqualified from participating in federal health programs. The OIG's investigation found that the disfellowshipped person, a certified nursing assistant, provided items and services to South Ogden MCHS patients that were billed to the state health programs. Senior Counsel Nicole Caucci and Associate Counsel Kaitlyn L. Dunn represented OIG in this case.
02.10.2014
Texas Doctor Reaches Settlement Agreement With OIG Over Kickback Allegations
dr Robert L. Burke - an orthopedic surgeon from Houston, TX - entered into a settlement agreement effective October 2, 2014 with the US Department of Health and Human Services' Office of Inspector General (OIG) Dr. Burke received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of money paid above a compensation rate negotiated in a Medical Director Agreement . OIG claimed that this financial agreement increased the value and volume of Dr. Burke at Fairmont accounted for. Senior Counsel Kristen Schwendinger and Robert M. Penezic represented OIG.
29.09.2014
Connecticut Laboratory Compares Case to False and Fraudulent Medicare Claims
Clinical Lab Partners (CLP), a Newington, CT lab that performs urine drug testing, agreed to settle with the US Department of Health and Human Services' Office of Inspector General (OIG) effective April 29, 2014. The settlement resolves allegations that CLP made false or fraudulent claims to Medicare. Specifically, the OIG alleges that CLP submitted claims to Medicare for highly complex urine drug tests that exceeded Medicare's allowable number of units by using code to circumvent computer programs that would otherwise have rejected such claims. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoff Hymans, worked together to reach this agreement.
12.09.2014
Overland, Ordal, Thorson, and Fennell Pulmonary Consultants, P.C. (OOTFPC), Oregon, agreed to pay $79,792.33 for alleged civil fines statute violations. The OIG alleged that OOTFPC filed claims with Medicare for assessment and administration services (CPT codes 99204, 99214, 99205, and 99215) and counseling services (CPT codes 99244 and 99245) using a higher-paying CPT code than the medical documentation. The OIG also alleged that OOTFPC filed claims for an extended service code (CPT 99354) when the service failed to meet Medicare guidelines.
10.09.2014
Ohio Retirement Community settles case involving disfellowshipped nurse
Effective September 10, 2014, the Wesley Glen Retirement Community - a non-profit retirement community in Columbus, OH - entered into a settlement agreement with the Office of Inspector General (OIG) of the US Department of Health and Human Services. The $19,890 settlement resolves claims that Wesley Glen employed a person who was barred from participating in federal health programs. OIG's investigation found that Wesley Glen employed a disfellowshipped nurse to provide items or services that were reimbursed by state health programs.
10.09.2014
Illinois Physician Practice clears up allegations of false and fraudulent Medicare claims
Pain Specialists of Greater Chicago (PSGC), an Illinois medical practice that performs in-office urine drug testing, filed with the U.S. Department of Health and Human Services' Office of Inspector General (OIG) effective April 10, 2014. The settlement resolves allegations that PSGC submitted to Medicare with false or fraudulent claims. Specifically, the OIG alleges that PSGC submitted claims to Medicare for high and low/moderate complexity urine drug tests that exceeded Medicare's allowable number of units by using code to circumvent computer programs that would otherwise have rejected such claims . The OIG also alleges that PSGC filed claims for high-complexity drug tests even though it performed less-expensive, low- or medium-complexity drug tests. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, worked together to reach this agreement.
09.09.2014
Texas Doctor Reaches Settlement Agreement With OIG Over Kickback Allegations
dr Thanh A. Nguyen - a urologist from Houston, TX - entered into a settlement agreement with the Office of Inspector General (OIG) of the US Department of Health and Human Services effective September 9, 2014. Nguyen received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation under a Medical Director Agreement. OIG claimed that this financial agreement increased the value and volume of Dr. Nguyen at Fairmont took into account. Senior Counsel Kristen Schwendinger and Robert M. Penezic represented OIG.
03.09.2014
Springfield Hospital (Springfield), Vermont agreed to pay $50,000 to release its liability for civil fines under the Patient Dumping Act. OIG alleged that: (1) Springfield failed to provide stabilizing treatment to a patient with an emergency psychiatric illness before he was criminally charged and sent to prison; and (2) Springfield failed to provide a second patient with an adequate medical evaluation before being criminally charged and sent to prison.
24.08.2014
Iowa Skilled Nursing Facility settles case involving employment of disfellowshipped person
Rock Rapids Health Center (RRHC), a qualified nursing facility in Iowa, entered into a settlement agreement with the Office of Inspector General (OIG) of the Department of Health and Human Services, effective August 24, 2014. RRHC employed one individual exempt from participation excluded from federal health programs. The disfellowshiped person provided items and services to RRHC patients that were billed to federal health care programs. Senior Counsel Nicole Caucci represented OIG in this case.
Florida Respiratory Therapist and his sleep clinic agree to voluntary disqualification
On August 24, 2014, in connection with the settlement of liability under the False Claims Act, a Florida respiratory therapist and his sleep clinic agreed to be barred from participating in federal health care programs under USC for an eight-year period. § 1320a-7(b)(7). OIGs revealed that the respiratory therapist and his sleep clinic submitted claims to polysomnographic sleep studies and psychological tests that were not medically necessary, were not performed by the appropriately licensed individuals, or were not actually performed. Senior Counsel Kristen Schwendinger represented OIG.
21.08.2014
Florida-based distributor reaches settlement agreement with OIG over bribery allegations
Zimmer-Deptula, Inc. (ZDI) - a former Florida-based distributor of Zimmer, Inc. - entered into a $123,000 settlement agreement with the U.S. Department of Health and Human Services' Office of Inspector General (OIG), effective August 21, 2014. This settlement clears up allegations that ZDI violated the Civil Fines Act by paying bribes. Specifically, OIG alleges that two independent ZDI contractors paid third parties to recommend Zimmer, Inc. products to physicians in Florida. OIG alleges that ZDI knowingly and intentionally offered and paid kickbacks to third parties in order to induce them to recommend and arrange for the purchase of Zimmer, Inc. products paid for by government healthcare programs. Senior Counsel David M. Blank, Robert M. Penezic and Lauren E. Marziani represented OIG in this case.
15.08.2014
A physician and his wife consented, under 42 U.S.C. be barred from participating in federal health programs for a period of fifteen years. § 1320a-7(b)(7). The OIG alleged that the doctor and his wife had filed claims with state health programs for: (1) treating migraines through the use of protracted, multi-day infusions of dihydroergotamine (DHE) billed as chemotherapy and administered should injection instead of infusion; and (2) Physician visits, upcoded to Level 5 plus “extended services” that were not supported by medical records and/or did not include medical records.
08.11.2014
Texas Doctor Reaches Settlement Agreement With OIG Over Kickback Allegations
dr Gary Stephen Hurwitz - a urologist from Houston, TX - entered into a settlement agreement effective August 11, 2014 with the US Department of Health and Human Services' Office of Inspector General (OIG). Hurwitz received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation under a Medical Director Agreement. OIG claimed that this financial agreement increased the value and volume of Dr. Hurwitz at Fairmont accounted for. Senior Counsel Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Reaches Settlement Agreement With OIG Over Kickback Allegations
dr Dilipkumar Chotabhai Patel -- a primary care physician and internist from LaPorte, TX -- entered into a settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG) effective August 11, 2014. The $146,000 settlement resolves claims that Dr. Patel received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation under a Medical Director Agreement. OIG claimed that this financial agreement increased the value and volume of Dr. Patel at Fairmont accounted for. Senior Counsel Kristen Schwendinger and Robert M. Penezic represented OIG.
08.11.2014
A Florida lab agreed to pay $50,000 to settle its liability for violating select agent regulations. OIG alleged that the Laboratory violated Elected Representatives regulations by: (1) its responsible officer failing to ensure compliance with Elected Representatives regulations; (2) failure to ensure an accurate and up-to-date inventory of each selected agent in long-term storage; and (3) failure to notify the CDC and appropriate federal, state, or local law enforcement agencies when a missing Selected Agent is discovered.
08.05.2014
Saint Joseph's Medical Center in New York is settling the case in which a patient was accused of dumping
Effective August 5, 2014, Saint Joseph's Medical Center (SJMC), a 332-bed hospital in Yonkers, NY, entered into a settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG). In the settlement agreement, SJMC agreed to pay $50,000 to release its liability for civil fines under the Patient Dumping Statute. Specifically, the OIG alleged that SJMC violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide an adequate medical evaluation to a patient who presented to SJMC's emergency department with a medical emergency. Associate Counsel Patrick Garcia and Paralegal Specialist Mariel Filtz represented OIG in this matter.
08.05.2014
Florida Laboratory compares case to allegations of false or fraudulent Medicare claims
Florida Family Laboratories, LLC (FFL), a Florida urine drug testing company, agreed to enter into a $197,400.09 settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG), effective August 5, 2014. The settlement resolves allegations FFL filed with Medicare with false or fraudulent claims. Specifically, OIG alleges that FFL submitted claims to Medicare regarding highly complex urine drug tests that exceeded Medicare's allowable number of units by using inappropriate code to circumvent computer programs that would otherwise have rejected such claims. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoff Hymans, worked together to reach this agreement.
31.07.2014
Missouri Health Care IT and Pharmacy Benefits Manager adjudicating case involving alleged fraudulent Medicare Part D claims
Argus Health Systems, Inc. — a provider of healthcare information management services and manager of pharmacy services headquartered in Kansas City, MO — has entered into a settlement agreement with the U.S. Department of Health and Human Services' Office of Inspector General (OIG), effective July 31, 2014. Im As part of the agreement, Argus agreed to pay OIG $2,029,210 to resolve allegations that the company submitted prescription drug (PDE) data to Medicare that included sales tax from Louisiana pharmacies, despite complying with Medicare Part D drugs were not taxable under Louisiana law as of July 1, 2006. Specifically, OIG alleges that from July 1, 2006 through December 31, 2009, Argus knowingly filed or filed PDE claims with the Centers for Medicare & Medicaid Services (CMS). who have wrongly claimed Louisiana sales tax costs. CMS then used these PDE claims to calculate Medicare payments to Part D sponsors that Argus contracted with, unreasonably increasing reimbursement to the sponsors. Senior Counsel Christina McGarvey and Senior Counsel John O'Brien represented OIG in this case.
28.07.2014
Florida doctor settles case alleging false claims
Nabil Attalla Barsoum, M.D. (Barsoum), a Florida physician who performed in-office urine drug testing, agreed to enter into a $334,538.90 settlement agreement with the U.S. Department of Health and Human Services' Office of Inspector General (OIG), effective July 25, 2014. Settlement resolves allegations that Barsoum submitted false or fraudulent claims to Medicare. Specifically, the OIG alleges that Barsoum submitted claims to Medicare about low- and medium-complexity urine drug tests that exceeded Medicare's allowable number of units by using inappropriate code to circumvent computer programs that would otherwise have rejected such claims . He also submitted requests for high-complexity drug tests when conducting less-expensive, low- or medium-complexity drug tests. The OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoff Hymans, worked together to reach this agreement.
24.07.2014
Tennessee Senior Living Community Chain settles case involving allegations of employment of disfellowshipped persons
Brookdale Senior Living, Inc. and three subsidiaries (collectively Brookdale) -- a chain of senior living communities headquartered in Brentwood, TN -- entered into a settlement agreement with the United States Department of Health and Human Services' Office of Inspector General (OIG), effective July 24, 2014 The $353,248.82 settlement resolves allegations that Brookdale employed two people who were disqualified from participating in federal health programs. After one of the individuals disclosed to OIG that she had worked as a documentary trainer at Brookdale during her disqualification, OIG launched an investigation to determine whether Brookdale had employed any other disfellowshipped individuals. During the course of the investigation, Brookdale disclosed that she employed another disfellowshipped person as a nurse during the time of her disfellowshipping.
11.07.2014
The Utah health care system adjudicates the case involving the employment of disfellowshipped persons
The University of Utah (UOU) — a university-level health care system with 4 neighborhood hospitals and 10 health centers — entered into a settlement agreement with the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) effective July 8, 2014. The settlement amounted to $197,839.94 settles allegations that UOU employed three people who were disqualified from participating in federal health programs. OIG's investigation found that UOU employed a disfellowshipped nurse who provided items or services paid for by state health programs. During the investigation, UOU disclosed that it employed two other disfellowshipped individuals.
11.07.2014
The Kentucky Long Term Care Organization is resolving the case involving the employment of a disfellowshipped person
The Bradford Heights Health & Rehab Center -- a nonprofit, faith-based long-term care organization in Hopkinsville, KY -- entered into a settlement agreement with the U.S. Department of Health and Human Services' Office of Inspector General (OIG), effective July 1, 2014. The settlement amounted to $30,121.82 $ resolves allegations that Bradford employed a person who was disqualified from participating in federal health programs. OIG's investigation found that Bradford employed an expelled nurse to provide items or services that were reimbursed by state health programs. Senior Counsel David M. Blank and paralegal Jennifer McKoy represented OIG in the case.
08.07.2014
A clinical psychologist and her psychological practice agreed to stay under 42 U.S.C. being barred from participating in government health programs. § 1320a-7(b)(7). OIG alleged that the psychologist and her practice filed or submitted claims to Medicare and Missouri Medicaid for benefits billed to the psychologist's NPI number for psychotherapy services that the psychologist did not personally provide. Specifically, the OIG alleged that the psychologist and her practices had filed claims for psychotherapy services provided at inpatient care facilities in Missouri, using medical records that falsely portrayed her as the "on-site psychologist" for those services. OIG claimed that because the psychologist was treating patients in Texas, the psychologist was not typically on-site or even available for a consultation. In addition, the OIG claimed that the services were in fact provided by unsupervised licensed clinical consultants.
26.06.2014
Texas Doctor Reaches Settlement Agreement With OIG Over Kickback Allegations
dr Steven A. Fein - a gastroenterologist from Houston, TX - entered into a settlement agreement with the Office of Inspector General (OIG) of the US Department of Health and Human Services effective June 26, 2014. Fein received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation under a Medical Director Agreement and the service of a referral coordinator, compensation for which was paid by Fairmont. OIG claimed that these financial arrangements increased the value and volume of Dr. Finely considered at Fairmont. Senior Counsel Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Reaches Settlement Agreement With OIG Over Kickback Allegations
dr Jerry McShane - an occupational health specialist in Houston, TX - entered into a settlement agreement with the Office of Inspector General (OIG) of the US Department of Health and Human Services effective June 26, 2014. McShane received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation under a Medical Director Agreement and for the benefit of a referral coordinator whose compensation was paid by Fairmont. OIG claimed that these financial arrangements increased the value and volume of Dr. McShane at Fairmont accounted for. Senior Counsel Kristen Schwendinger and Robert M. Penezic represented OIG.
20.06.2014
Pennsylvania Health Care Staffing Agency is adjudicating the case involving the employment of a disfellowshipped person
ePeople Healthcare, Inc., a Pennsylvania healthcare recruitment agency, entered into a settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG), effective June 20, 2014. ePeople employed one person who was barred from participating in government healthcare programs was. The disfellowshipped person was a licensed practical nurse who provided nursing facilities with items and services billed to state health care programs. Senior Counsel Nicole Caucci represented OIG in this case.
06.09.2014
Winter Haven Hospital (Winter Haven), Florida agreed to pay $75,000 to release its liability for civil fines under the Patient Dumping Act. OIG alleged that Winter Haven: (1) did not accept the transfer of two patients who required special skills or facilities available in Winter Haven; and (2) failed to provide medical evaluation and treatment, within the capabilities of Winter Haven's staff and facilities, to stabilize a third patient's condition.
06.06.2014
Trinity Medical Center d/b/a Trinity Bettendorf (Trinity), Iowa agreed to pay $40,000 to release its liability for civil fines under the Patient Dumping Act. OIG alleged that Trinity failed to provide adequate screening or stabilization treatment for an individual who presented to Trinity's Emergency Department with a medical or psychiatric emergency.
06.05.2014
Indiana Hospital settles EMTALA case with allegations of patient dumping
Effective June 5, 2014, the US Department of Health and Human Services' Office of Inspector General (OIG) entered into a settlement agreement with St. Vincent Jennings Hospital (SVJH). SVJH agreed to pay $25,000 to release its liability for civil fines under the Patient Dumping Act. Specifically, the OIG alleged that SVJH violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide an adequate medical evaluation to a patient who was ambulanced to SVJH's Emergency Department with an emergency. OIG was represented in this matter by Associate Counsel Patrick Garcia and Eula Taylor.
06.05.2014
California hospital settles EMTALA case amid allegations of patient dumping
Olive View - UCLA Medical Center - a county hospital in Sylmar, CA - entered into a settlement agreement with the U.S. Department of Health and Human Services' Office of Inspector General (OIG), effective May 23, 2014, that Olive View violated the Emergency Medical Treatment and Labor Act (EMTALA ) violated by failing to provide an individual with an appropriate screening medical exam (MSE) to determine if they had a medical emergency, within the capabilities of the hospital's emergency department.

Specifically, the person presented to the Olive View emergency room with signs of appendicitis and severe abdominal pain, which he rated out of 10 on a 10-point scale. Despite his severe pain and symptoms, he had to wait several hours to receive MSD. After waiting 6.5 hours, he went to another hospital for medical evaluation and treatment, where he was diagnosed with acute appendicitis with a large peritoneal abscess and underwent immediate laparoscopic appendectomy. According to EMTALA, when a person comes to the emergency department of a hospital and an evaluation or treatment for a medical condition is requested on their behalf, the hospital must provide an appropriate MSE, within the capabilities of the emergency department, to determine if this is the case or not no medical emergency. OIG was represented by Associate Counsel Odies Williams, IV. Olive View was represented by Brandi M. Moore of the Los Angeles County Attorney's Office.

(Video) News At 10 | 29/11/2022

04.06.2014
CVS Pharmacy settles $1.2 million with OIG over double billing
Effective May 28, 2014, CVS Pharmacy, Inc. (CVS) entered into a Settlement Agreement with the US Department of Health and Human Services' Office of Inspector General (OIG) for $1,216,147.19 for causing duplicate claims to be filed with both Medicare Part B and Medicare Part D plan sponsors or the sponsors' agents. Specifically, CVS allegedly double-billed for immunosuppressive medications for the same patients on the same date of service.

OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsel Geoffrey Hymans and Associate Counsel Katherine Matos, worked together to reach this agreement.

30.05.2014
Leer's Quality Home Health Care Services Inc. (Leer's), Texas, agreed to pay $39,000 for the alleged civil fines statute violation. The OIG alleged that there was an individual employed by Leer's who it knew or should have known was barred from participating in federal health programs.
29.05.2014
Texas Health Care Center settles charges of employing disfellowshipped person with OIG
Rayburn Health Care & Rehabilitation (RHCR) - a nursing and rehabilitation center in Jasper, TX - entered into a settlement agreement effective May 15, 2014 with the Office of Inspector General (OIG) of the US Department of Health and Human Services. The $110,712.60 settlement resolves allegations that RHCR employed a person who was barred from participating in federal health care programs. When the disfellowshipped individual applied to be reinstated in federal health care programs, she indicated in her application that she was employed as a registered nurse by RHCR for two years during her disfellowshipment. During her employment, she allegedly provided items or services that were reimbursed by government health programs, which is prohibited for disfellowshipped persons.
21.05.2014
New Jersey doctor enters into settlement agreement with OIG over kickback allegations
Ansar Sharif, M.D. - Former owner of a medical practice in Kearny, NJ - entered into a settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG), effective May 20, 2014. The $52,280 settlement resolves allegations that Sharif received kickbacks from Orange Community MRI, LLC, a diagnostic testing facility, in exchange for patient referrals.

To date, the United States Attorney for the District of New Jersey has convicted 17 defendants - including 15 physicians - in connection with the ongoing government investigation into illegal payments from Orange MRI. The investigation by OIG's Office of Investigations revealed that Sharif received money from Orange MRI for patient referrals. This case marks the first Civil Penalty Code resolution to emerge from the government's investigation into Orange MRI. OIG was represented by Senior Counsel David M. Blank and Lauren E. Marziani. Sharif was represented by Carmine Campanile.

15.05.2014
Mercy Hospital in Miami, FL is adjudicating the EMTALA case
Mercy Hospital -- a campus of Plantation General Hospital in Miami, FL -- agreed to pay $45,000 to resolve allegations that it failed to provide an adequate medical evaluation for a 24-day-old baby who was hospitalized because of a medical emergency taken to the hospital emergency room, including persistent low body temperature. The US Department of Health and Human Services' Office of Inspector General (OIG) alleged that Mercy Hospital violated the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide adequate evaluation and treatment because of the low temperature of the patient newborns have been received Has it ordered further laboratory tests, e.g. B. a complete blood count, blood chemistry lab, or urinalysis before telling the parents to take the baby home? Minutes after being discharged from the hospital, the baby suffered cardiac arrest, kidney injury and possible brain injury from lack of oxygen from an intestinal problem known as necrotic bowel. OIG asserts that EMTALA is designed to protect vulnerable patients such as newborns who are unable to articulate their own needs, and healthcare professionals must consider appropriate diagnostic techniques and listen appropriately to family members showing the baby's key symptoms.
25.04.2014
Harper's Hospice Care, Inc. (Harper's Hospice), Mississippi, agreed to pay $150,000 for alleged violations of the Civil Fines Act provisions governing self-referrals and physician kickbacks. OIG alleged that Harper's Hospice paid a physician compensation in the form of medical director fees. In particular, the OIG alleges that Harper's Hospice paid the physician's fee in exchange for the physician referring patients to Harper's Hospice for hospice services and singing blank prescription forms for patients treated by Harper's Hospice.
25.04.2014
An Arizona research university has agreed to pay $165,000.00 to discharge its liability for violating selected agent regulations by failing to: (1) maintain current and accurate inventory records relating to certain selected agents ; (2) implement biosecurity and containment procedures appropriate to the risks associated with the selected agents and toxins in its possession; and (3) compliance with the requirement of 42 C.F.R. part 73
24.04.2014
Texas doctor agrees to voluntary disqualification with OIG over bribery allegations
A primary care physician in Houston, TX agreed, under 42 U.S.C. Be barred from participating in government health programs for a period of three years. § 1320a-7a(a)(7), 1320a-7(b)(6)(B) and 1320a-7(b)(7). OIG alleged that the physician received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation under a Medical Director Agreement. OIG claimed that this financial arrangement reflected the value and volume of the doctor's referrals to Fairmont. OIG further alleged that the doctor admitted to the Texas Medical Board that his medical practice fell below standard of care in treating eight patients and that he administered controlled substances to the patients without proper treatment plans or documentation.
15.04.2014
Gregory Bohn, M.D., Iowa, agreed to pay $35,000 to release his liability for civil fines under the Patient Dumping Act. OIG claimed that Dr. Bohn, the surgeon on duty at Trinity Bettendorf, refused to examine or treat a patient who had a medical emergency that required surgery.
04.08.2014
In connection with the settlement of liability under the False Claims Act, an oncologist and his oncology practice agreed for a period of ten years under 42 U.S.C. being barred from participating in federal health programs. § 1320a-7(b)(7). The OIG alleged that the oncologist and his practice filed or caused to be filed with Medicare and Medicaid for chemotherapy drug claims in excess of amounts actually provided.
13.03.2014
In connection with the determination of liability under the False Claims Act, an optometrist agreed, under 42 U.S.C. be barred from participating in federal health programs for a period of twenty years. § 1320a-7(b)(7). OIG alleged that the ophthalmologist provided or caused false or fraudulent payment claims to be submitted to Medicare and Medicaid for: (1) repeat argon laser trabeculoplasties, a procedure to treat open-angle glaucoma, that were not appropriate and necessary; (2) repeated adhesion lysis, a procedure to correct a rare complication of cataract surgery that was inappropriate and necessary; and (3) repeated peripheral laser iridotomies, a procedure used to treat angle-closure glaucoma, that were inappropriate and necessary.
03.04.2014
HealthCare Partners, LLC (HCP), California, agreed to pay $341,309.93 for alleged civil fines statute violations. The OIG alleged that HCP employed two people it knew or should have known were barred from participating in federal health programs.
21.02.2014
OIG issues a case and cease and desist letter to CarePoint Medical
On February 21, 2014, OIG CarePoint Medical (CarePoint) notified that CarePoint's unauthorized and improper use of the word "Medicare" and other misleading language in its mailings to beneficiaries may violate Section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and departmental emblems. Prior to litigation by OIG, CarePoint agreed: (1) to no longer use the word "Medicare" or any other language in a manner that would suggest CarePoint's association or affiliation with the Medicare program, the Centers for Medicare and Medicaid Services or the United States has Department of Health and Human Services; and (2) include in all future mailings promoting CarePoint's products and services a clear disclaimer stating that neither CarePoint nor its operations are affiliated with, approved, sponsored, or authorized by the US Department of Health and Human Services.
20.02.2014
PALMS Medical Transport, L.L.C. (PALMS), Georgia, agreed to pay $420,000 for alleged civil fines statute violations. OIG alleged that PALMS submitted ambulance claims for Medicare beneficiaries using HCPCS billing code A0434 for one-way Specialty Care Transport (SCT) from a qualified care facility or place of residence to a non-hospital-based end-stage kidney disease facility. OIG alleges that these shipments did not qualify as SCT because: (1) non-hospital dialysis facilities do not qualify as “facilities” for purposes of SCT, and (2) PALMS did not provide medically necessary supplies and services at levels beyond the range of the EMT paramedic.
14.02.2014
Medicus Laboratories, LLC (Medicus), Texas agreed to pay $5,000,000 for alleged violations of the Civil Fines Act. OIG alleges that Medicus made false or fraudulent claims to Medicare by: 1) improperly using modifier 59 to submit payment claims for multiple units of HCPCS code G0431 when only a single unit can be billed per patient contact; and 2) by making inappropriate claims for HCPCs codes 83986 (pH of body fluid), 82570 (creatinine, other sources), 81005 (urinalysis, qualitative or semi-quantitative, except immunoassays), and 81003 (urinalysis, by dipstick or table). ). reagent) if the test was used for screening purposes and was not medically useful or necessary.
02.11.2014
The doctor agrees to a $1.5 million payment and a 15-year ban to settle the civil fine case
Joseph A. Raia, MD, a physiatrist in New Jersey, agreed to pay $1,500,000 for the alleged violation of the civil fines statute and agreed to be waived from participating in federal health programs under 42 for a period of fifteen years USC to be excluded. § 1320a-7(b)(7). OIG claimed Dr. Raia improperly used chiropractors to provide physical therapy services "besides" his job. In addition, the OIG claimed that Dr. Raia filed claims with Medicare for the provision or supervision of physical therapy and related services while he was not in the state where the services were allegedly being provided.press release
10.02.2014
Altru Health System (Altru), North Dakota, agreed to pay $241,137.76 for alleged civil fines statute violations. OIG alleged that Altru employed an individual it knew or should have known was barred from participating in government health care programs.
02.07.2014
Claiborne County Medical Center (CCMC), Mississippi, agreed to pay $25,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that the CCMC failed to provide an appropriate medical check-up to a patient presenting to its emergency department.
02.04.2014
Arizona Bridge to Independent Living, Inc. (ABIL), Arizona, agreed to pay $85,000 for alleged civil fines statute violations. The OIG alleged that ABIL employed three people who it knew or should have known were barred from participating in federal health programs.
01.06.2014
Texas Doctor Reaches Settlement Agreement With OIG Over Kickback Allegations
dr Amir Ghebranious - a general practitioner from Houston, TX - entered into a settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG) effective January 6, 2014. Ghebranious received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation under a Medical Director Agreement and for the benefit of a referral coordinator whose compensation was paid by Fairmont. OIG claimed that these financial arrangements increased the value and volume of Dr. Ghebranious at Fairmont. Senior Counsel Kristen Schwendinger and Robert M. Penezic represented OIG.
Texas Doctor Reaches Settlement Agreement With OIG Over Kickback Allegations
dr Mary Campbell-Fox -- a primary care physician in Houston, TX -- entered into a settlement agreement with the US Department of Health and Human Services' Office of Inspector General (OIG) effective January 6, 2014 that Dr. Campbell-Fox received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation under a Medical Director Agreement and from the Referral Coordinator Benefit , whose remuneration was paid by Fairmont. OIG claimed that these financial arrangements increased the value and volume of Dr. Campbell-Fox at Fairmont. Senior Counsel Kristen Schwendinger and Robert M. Penezic represented OIG.

2013

30.12.2013
In connection with the resolution of liability under the False Claims Act, an individual who was the former president, CEO and chairman of the board of directors of a nationwide provider of aged care agreed to be barred from participating in federal health care programs for a period of three years under the age of 42, per USC § 1320a-7(b)(7). OIG alleged that the individual filed or filed claims with Medicare for allegedly engaging in upcoding by charging beneficiaries for services rendered in their homes, even though the services were instead rendered in assisted living facilities.
23.12.2013
Humana Inc. (Humana), Kentucky, agreed to pay $1,814,000 for alleged violations of the civil fines statute. The OIG alleged that Humana filed the event date for prescription drug (PDE) claims, which included sales tax from Louisiana pharmacies to the Centers for Medicare & Medicaid Services (CMS), even though Medicare Part D drugs have been under Louisiana law since were not taxable as of July 1, 2006. The OIG further alleged that Humana knowingly submitted or submitted PDE claims to CMS that improperly claimed Louisiana sales tax expenses, and that CMS used Humana's PDE claims to calculate Medicare Part D payments.
19.12.2013
The East Los Angeles Dialysis Center (ELADC), California, agreed to pay $56,094.23 for the alleged civil fines statute violation. OIG alleged that ELADC employed an individual it knew or should have known was barred from participating in federal health programs.
15.12.2013
Ronald Goldberg, M.D. (Goldberg) and Haverhill Family Practice (HFP), Massachusetts, agreed to pay $162,676.94 for alleged civil fines statute violations. The OIG alleged that Goldberg and HFP made claims for nursing home patients provided by nursing staff using Goldberg's invoice number. OIG also alleged that Goldberg and HFP filed claims for services not provided to patients because the patients were either hospitalized or dead.
13.12.2013
A physician assistant (PA) consented to reside for a period of five years under 42 U.S.C. being barred from participating in federal health programs. § 1320a-7(b)(7). The OIG alleged that the PA knowingly and intentionally received unlawful remuneration in exchange for patient referrals for the provision of items or services for which payment may be made in whole or in part under a government healthcare program. The OIG further alleged that the PA, in violation of the Anti-Kickback Statute, referred patients to health facilities for physical therapy and home health care in exchange for illegal bribes.
04.12.2013
Carolinas Medical Center (Carolinas), North Carolina agreed to pay $50,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that Carolinas failed to provide appropriate medical evaluation or stabilizing treatment to a patient requiring psychiatric treatment.
03.12.2013
A durable medical device (DME) company and its owner agreed to pay $5,000 and waive suspended monies for alleged violations of the Civil Penalties Act (CMPL) and the CMPL's provisions governing self-referrals and Kickbacks from doctors apply. The DME company and its owner also agreed to be permanently refrained from participating in federal health programs under 42 U.S.C. to be excluded. § 1320a-7(b)(7). OIG alleged that in connection with its contract with a telemarketing company, the DME company made unsolicited phone calls to Medicare beneficiaries to receive orders for the provision of DME, which Medicare pays for. The OIG alleged that the DME company used the information it received to file claims with Medicare for the DME, which it said was provided to the beneficiaries. OIG further alleges that the DME company knew or should have known that it was making false or fraudulent claims because it received the orders for the DME through telephone inquiries governed by the DME telemarketing provisions of the Social Security Act are forbidden. These provisions prohibit DME providers from making unsolicited phone calls to Medicare beneficiaries regarding the provision of an insured item, except in three cases. OIG claimed that the telemarketing calls made on behalf of the company DME did not fall under those exceptions. OIG alleges that the DME company violated the CMPL by making Medicare claims it knew or should have known to be false or fraudulent for DME ordered pursuant to prohibited solicitations. OIG also alleges that the DME company offered or paid monetary compensation to induce the telemarketer to refer people to provide DME that Medicare would pay for or to arrange for DME to be ordered or recommended for which Medicare would pay.
19.11.2013
Best Choice Home Health Care Agency (Best Choice), Kansas, agreed to pay $93,990.32 for alleged civil fines statute violations. OIG alleged that Best Choice employed an individual it knew or should have known was barred from participating in federal health programs.
19.11.2013
IASIS Healthcare Corporation (IASIS), Utah, agreed to pay $318,035.40 for the alleged civil fines statute violation. The OIG alleged that IASIS employed three people who it knew or should have known were barred from participating in government health programs.
13.11.2013
Spectrum Private Care Services, Inc. (Spectrum), Kansas, agreed to pay $39,033.35 for alleged violations of the civil fines statute. OIG alleged that Spectrum employed a person it knew or should have known was barred from participating in government healthcare programs.
25.10.2013
In connection with the settlement of liability under the False Claims Act, a pediatrician agreed for a period of twenty years under 42 U.S.C. being barred from participating in government health programs. § 1320a-7(b)(7). The OIG claimed that the pediatrician: (1) billed for urinalysis testing using CPT code 81001 for automated urinalysis with microscopy when microscopy was not performed, and (2) billed CPT code 92585 for comprehensive auditory evoked response testing to be carried out even though the comprehensive test was not actually carried out.
24.10.2013
In connection with the settlement of liability under the False Claims Act, the CEO of a company providing hospice services agreed to stay for a period of three years under 42 U.S.C. being barred from participating in government health programs. § 1320a-7(b)(7). The OIG alleged that the CEO caused the filing of false claims for Medicare hospice care for 19 patients who did not meet eligibility requirements for Medicare hospice benefit because each of those patients received a hospice during some or all of the time they received hospice care Hospice did not have a medical prognosis of six months or less if their illnesses ran their normal course.
21.10.2013
In connection with the settlement of liability under the False Claims Act, two owners of a durable medical device company agreed to settle for a period of twenty years under 42 U.S.C. being barred from participating in government health programs. § 1320a-7(b)(7). OIG alleged that the owners had contracts with marketing companies through their company whereby the company paid for referrals from marketing companies when Medicare beneficiaries ordered diabetic items, in violation of the Anti-Kickback Act.
18.10.2013
The Regional Medical Center in Memphis (RMC), Tennessee, agreed to pay $50,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that RMC failed to provide a medical check-up to a patient who was denied emergency room access and instead went to a nearby hospital.
17.10.2013
Henry Schein, Inc. (Henry Schein), of New York, agreed to pay $1,140,260 for alleged violations of the Civil Fines Act provisions governing self-referrals and physician kickbacks. The OIG alleged that Henry Schein offered and paid customers who are members of its Henry Schein Medical Privileges Program rewards in the form of points redeemable for products and services that do not qualify as "discounts" or "discounts" within the meaning of the Anti-kickback apply statutes.
04.10.2013
The President/CEO of two urine drug testing facilities agreed to stay under 42 U.S.C. being barred from participating in federal health programs. § 1320a-7(b)(7). OIG alleged that the President/CEO knowingly filed or filed claims for urine drug testing that lacked a physician's order, was medically unnecessary, and was fraudulently coded, and for the provision of Medicare-reimbursable services, which violates the President's/CEO's policy prior disqualification. OIG further alleged that the President/CEO knowingly provided or caused Medicare to provide: (1) payment claims under a provider number obtained by knowingly providing false information to the State of Michigan and the Medicare Administration Contractor for the State of Michigan; (2) payment entitlements for non-physician urinalysis tests; (3) separate payment claims for diagnostic urine tests under separate CPT codes where only one CPT was eligible; and (4) payment claims encoded to bypass computer processing to fraudulently increase payments from Medicare for services not ordered or rendered.
02.10.2013
A physician agreed, under 42 U.S.C. be barred from participating in government health programs for a period of ten years. § 1320a-7(b)(7). The OIG alleged that the physician unbundled injections at the site of origin/insertion of a tendon in a single physician visit under CPT code 20551, even though Medicare and Medicaid laws and regulations require such injections to be bundled and presented as a single requirement under CPT -Code 20553 will be charged.
19.09.2013
Anchor Safe Healthcare, Inc. (Anchor Safe), Texas, agreed to pay $47,324 for alleged civil fines statute violations. The OIG alleged that Anchor Safe employed an individual it knew or should have known was barred from participating in government health programs.
06.09.2013
Catherine Odo Ekereuke, née Bukate Medical Supplier (Bukate), Arizona, agreed to pay $29,000 for alleged civil fines statute violations. The OIG alleged that Bukate submitted or submitted requests to Medicare for electric mobility devices and other durable medical devices that Bukate failed to provide to beneficiaries.
03.09.2013
Northeast Georgia Medical Center (Northeast), Georgia agreed to pay $50,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that Northeast refused to accept a reasonable transfer of a patient who required Northeast's specialized skills.
28.08.2013
Texas Doctor and Medical Practice Enters into Settlement Agreement with OIG over Kickback Allegations
dr Victor Van Phan - an orthopedist from Houston, TX, and his orthopedic practice Victor Van Phan, D.O., P.A. - a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services effective August 28, 2013. The $188,000 settlement resolves allegations that Dr. Van Phan and his practice received compensation from Jack L. Baker, MD and Fairmont Diagnostic Center and Open MRI, Inc. (Fairmont), an imaging facility in Houston, TX, in the form of compensation under personal service agreements and an employment fee for Dr. Phan as medical director for Fairmont. OIG claimed that these financial arrangements increased the value and volume of Dr. Van Phan and his practice at Fairmont were aware. Senior Counsel Kristen Schwendinger and Robert M. Penezic represented OIG.
15.08.2013
Finley Hospital (Finley), Iowa agreed to pay $30,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that Finley violated the requirements of the Patient Dumping Statute when it delayed providing stabilizing treatment to a patient when it transferred him to another facility, in part because of his status as an IowaCare patient.
08-12-2013
Radius Specialty Hospital LLC (Radius), Massachusetts, agreed to pay $333,647.25 for alleged civil fines statute violations. The OIG alleged that Radius employed an individual it knew or should have known was barred from participating in government health programs.
08.07.2013
Two owners of ambulance companies consented to, under 42 U.S.C. being barred from participating in federal health programs for ten years. § 1320a-7(b)(7) and 42 U.S.C. § 1320a-7(b)(16). OIG alleged that the owners of the ambulance company (1) knowingly made or made false statements, omissions, and misrepresentations of material facts in an application to enroll as a service provider or supplier in the Medicare program; (2) knowingly made or caused false statements, omissions, or misrepresentations of a material fact in an offer to contract with a provider for the provision of emergency medical services and to submit payment claims for emergency medical services provided under a federal health care program; and (3) knowingly made or caused false records or testimonies to support a false or fraudulent claim for payment for items and services provided under a government healthcare program.
St. Luke's Hospital (St. Luke's), Iowa agreed to pay $25,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that St. Luke's violated the requirements of the Patient Dumping Statute when it failed to conduct an appropriate medical screening exam by transferring the patient to another facility, in part because of his IowaCare patient status.
26.07.2013
Bravo Health Pennsylvania, Inc. (Bravo), Pennsylvania, agreed to pay $225,000 for alleged civil fines statute violations. The OIG alleged that Bravo provided the OIG's Office of Audit Services (OAS) with medical records in connection with an OAS audit that were intentionally altered prior to their submission or re-submission.
An employee of a durable medical device (DME) company agreed to be permanently exempt from participating in federal health programs under 42 U.S.C. to be excluded. § 1320a-7(b)(7). OIG alleged that the DME company employee arranged unsolicited phone calls to Medicare beneficiaries to obtain orders for the provision of DME. The DME company later filed claims with Medicare for DME, which allegedly were paid to beneficiaries who received the unsolicited phone calls. OIG alleges that the DME company employee knew or should have known that he was causing the filing of false or fraudulent claims because orders for the DME were based on telephone solicitations prohibited by the DME telemarketing provisions of the Social Security Act are. OIG also alleges that the DME company employee offered or paid compensation in the form of monetary payments to telemarketing companies for recommending individuals for the provision of DME, which would be paid for by Medicare. OIG alleges that the offer and payment of the compensation described above by the employee of the DME company violates federal anti-kickback statutes.
A telemarketing company and its owner agreed to pay $347,000 for alleged violations of the Civil Penalty Code and provisions of the Civil Penalty Code that apply to doctor referrals and kickbacks. The telemarketer and its owner also agreed, pursuant to 42 U.S.C. be barred from participating in government health programs for a period of ten years. § 1320a-7(b)(7). OIG alleged that in connection with its contract with a durable medical device (DME) company, the telemarketing company made unsolicited phone calls to Medicare beneficiaries to receive orders for the provision of DME, which Medicare would pay for. OIG alleged that the DME company, in turn, used the information to file claims with Medicare for DME, which it said was provided to the beneficiaries. OIG alleges that the telemarketer knew or should have known that it was causing false or fraudulent claims to be filed because it received the orders for the DME through telephone solicitations, which are prohibited by the DME telemarketing provisions of the Social Security Act are. OIG also alleges that the telemarketer solicited or received compensation in the form of monetary payments in exchange for referring people to provide DME, which would be paid for by Medicare.
24.07.2013
Mahaska Health Partnership (Mahaska), Iowa, agreed to pay $20,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that Mahaska failed to provide appropriate medical evaluation, stabilizing treatment, or adequate transfer for a person presenting to Mahaska with a serious medical emergency.
19.07.2013
In connection with the settlement of liability under the False Claims Act, the owner of a lymphedema wound center consented to a 10-year warranty under 42 U.S.C. being barred from participating in government health programs. § 1320a-7(b)(7). The OIG alleged that the owner of the lymphedema wound center filed claims with Medicare: (1) for physical therapy treatments performed by therapists who were not qualified for those treatments; (2) for physical therapy treatments that exceed Medicare limits and limitations on the number of physical therapy treatments; (3) who have violated the rules for "bundling" strapping/bandaging services with physical therapy treatments; and (4) for prescribing pneumatic compression pumps to Medicare beneficiaries when such pumps were not medically necessary.
15.07.2013
East Texas Medical Center Carthage (ETMC Carthage), Texas agreed to pay $20,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that ETMC Carthage breached the requirements of the patient dumping statute by failing to provide an adequate medical check-up to a patient who was 24 weeks pregnant. The patient presented to ETMC Carthage with complaints of uterine contractions and abdominal pain. The patient was told to seek treatment in Henderson, Texas since ETMC Carthage did not have an obstetrics (OB) service or obstetrician on staff. The patient then left the ETMC Carthage in a private vehicle.
01.07.2013
Mercy Hospital of Franciscan Sisters (Mercy), Iowa agreed to pay $20,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that Mercy violated the requirements of the Patient Disposal Act when it failed to provide appropriate medical evaluation, stabilizing treatment or appropriate transfer for a patient who presented to Mercy's emergency room after ingesting window de-icer, a product containing the poison was methanol.
28.06.2013
In connection with the resolution of liability under the False Claims Act, an oncology group medical practice agreed to be waived from participating in federal health programs under 42 U.S.C. to be excluded. § 1320a-7(b)(7). OIG alleged that the oncology group medical practice purchased drugs from a foreign drug distributor in Canada, who obtained the drugs from foreign sources. OIG claimed that these drugs, sometimes with foreign language labeling or no dosage information, were not manufactured in facilities registered with the U.S. Food and Drug Administration (FDA). The OIG claimed that the versions of the drugs that the oncology group medical practice purchased were not the subject of a new drug application, an abbreviated new drug application, or a biologics application approved by the FDA for commercial marketing was approved and did not comply with them. As such, the drugs were not covered by government health programs because the drugs had not received final marketing approval from the FDA.
21.06.2013
In connection with the settlement of liability under the False Claims Act, a physical rehabilitation and pain management clinic (clinic) agreed to be waived for twenty years from participating in state health programs under 42 U.S.C. to be excluded. § 1320a-7(b)(7). The OIG alleged that the clinic: (1) filed Medicare and Medicaid claims for physical therapy, electrodiagnostic testing, and/or home health care referred to businesses owned or operated by the clinic's owner for unlawful compensation and/or kickbacks; and (2) submitted claims to Medicare and Medicaid using medical billing codes that reflected more complex and expensive services than the services actually provided to patients.
19.06.2013
In connection with the determination of liability under the False Claims Act, an oncologist and hematologist consented, under 42 U.S.C. Being barred from participating in federal health programs for fifteen years. § 1320a-7(b)(7). The OIG alleged that the oncologist and hematologist knowingly submitted false and/or fraudulent claims to government health programs for: (1) amounts of drugs in excess of those actually administered to patients; (2) exaggeration of infusion times of chemotherapeutic agents; and (3) double billing of medications.
In connection with the determination of liability under the False Claims Act, an allergist and his allergy clinic agreed, pursuant to 42 U.S.C. be barred from participating in federal health programs for a period of twenty years. § 1320a-7(b)(7). OIG alleged that the allergist made false claims through his allergy clinic related to Healthcare Common Procedure Codes 95004, 05165 and 99214, including: misrepresentation of services and diagnoses, overuse of procedures, billing for unauthorized hormone therapy treatments, billing for not medically necessary services, the billing of services not rendered and the false indication of the provider who rendered the treatment.
13.06.2013
A former pharmaceutical sales representative and sales manager for Sanofi agreed to be waived from participating in federal health programs under 42 U.S.C. to be excluded. § 1320a-7(b)(7). OIG alleged that the sales representative provided physicians with samples of the viscosule Hyalgan with the expectation that the physicians would bill Medicare for the samples. OIG further alleged that the sales agent provided an agreed number of samples with each order of a certain size, that these off-the-books discounts constituted anti-kickback statute compensation (42 U.S.C. § 1320a-7b(b)(2 ) ) and that these alleged bribes were made to ensure doctors continued using the product.
29.05.2013
OIG Issues Cease and Desist Letter to MedicareWire.com
On May 29, 2013, OIG notified MedicareWire.com (MedicareWire) that MedicareWire may have violated Section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and departmental emblems. Specifically, MedicareWire made inappropriate and unauthorized use of words and symbols owned by the US Department of Health and Human Services and used other misleading expressions on MedicareWire's "Medicare" webpage, which can be found athttp://medicarenursing.com(may or may not work). Prior to litigation by the OIG, MedicareWire agreed to: (1) remove the inappropriate words and symbols from its website; (2) add header and footer disclaimers to its website; and (3) not use any words or names related to Social Security or Medicare in a manner that might create the false impression that MedicareWire or its programs and services are approved, sponsored, affiliated with, or authorized by Medicare, Medicaid, Social Security are or the US Department of Health and Human Services.
22.05.2013
Trustees from Tufts College and Tufts University School of Dental Medicine (TUSDM), Massachusetts agreed to pay $841,120.88 for the alleged civil fines statute violation. The OIG alleged that TUSDM filed claims with Medicare for various services from four of its clinics. The OIG contends that these claims were unreasonable because the services were provided by dentists who were not accredited by Medicare and/or the services billed or code level billed were not supported by sufficient medical documentation.
21.05.2013
Carolyn Murray-Burton, M.D. (Murray), New Jersey, agreed to pay $136,777.59 for alleged violations of the civil fines statute. The OIG alleges that Murray caused her employer to submit claims to Medicaid and Medicaid HMOs for items and services she provided despite not having a valid medical license.
17.05.2013
dr Matthew James Britton and C.F. Health Management, Inc. d/b/a Gainesville Pain Management (Gainesville), Georgia agreed to pay $1,577,597 for alleged civil fines statute violations. The OIG alleged that Gainesville made false or fraudulent claims: 1) by inappropriately using modifiers 76 and 59 to submit payment claims for multiple units of Healthcare Common Procedure Coding System (HCPCS) codes G0431 and G0434 when only a single unit in Can be billed per patient contact; and 2) by inappropriate use of Modifier QW and billing for HCPCS G0431 when the less expensive services represented by HCPCS code G0434 were actually provided.
02.05.2013
The Visiting Nurse Association (VNA), Johnson County, Iowa, agreed to pay $33,000 for the alleged violation of the Civil Fines Act. The OIG alleged that VNA employed an individual it knew or should have known was barred from participating in federal health programs.
26.04.2013
Evergreen Oregon Healthcare Salem, LLC (Evergreen), Oregon, agreed to pay $19,000 for alleged violations of the civil fines statute. The OIG alleged that Evergreen employed an individual it knew or should have known was barred from participating in government health programs.
Emory University Hospital (Emory), Georgia agreed to pay $50,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that Emory refused to accept an appropriate transfer of a patient who required Emory's specialized skills.
04.08.2013
Sergey Lugina and Executive Medical Care, P.C., (EMC), New York, agreed to pay $74,000 for alleged civil fines law violations. The OIG alleged that EMC filed or filed claims for medical services that were not performed as claimed and/or were false or fraudulent. The OIG alleges that these services were not provided as claimed because Sergey Lugina was traveling outside of the United States during the periods that he claimed to have been providing services to beneficiaries.
04.04.2013
Donalsonville Hospital, Inc. (Donalsonville), Georgia agreed to pay $25,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that Donalsonville failed to provide adequate medical evaluation for a patient who presented to the emergency department complaining of shortness of breath and chest pain. The patient was not seen by a doctor and was told he would have to pay a minimum fee of $100 to continue further treatment. The patient chose not to pay the fee and was discharged without having received an adequate medical check-up. The delay in providing an adequate medical check-up and the setting of a minimum fee for obtaining an adequate medical check-up are unreasonable.
04.03.2013
Paul Lux, M.D., Missouri, agreed to pay $63,900 for alleged violations of the Civil Fines Act provisions governing self-referrals and physician kickbacks. The OIG claimed that Dr. Lux received compensation from a medical device manufacturer in the form of payments under a clinical registry agreement.
03.07.2013
OIG issues cease and desist letter to Policy Issues Institute
On March 7, 2013, the OIG notified the Policy Issues Institute (PII) that PII's unauthorized and inappropriate use of the word "Medicare" in its "Emergency Committee to Save Medicare" mailings may violate Section 1140 of the Social Security Act, 42, violates USC § 1320b-10(a), which prohibits misuse of certain words and departmental emblems. Prior to litigation by the OIG, PII agreed to: (1) stop sending the "Emergency Committee to Save Medicare" mailing; and (2) not to use any words or names related to Social Security or Medicare in a manner that might create the misleading impression that PII or its programs and services are approved, sponsored, affiliated with, or associated with Medicare, Medicaid, Social Security authorized or the US Department of Health and Human Services.
The OIG issues a cease and desist letter to the National Center for Public Policy Research
On March 7, 2013, the OIG notified the National Center for Public Policy Research (NCPPR) that the NCPPR may have violated Section 1140 of the Social Security Act, 42 U.S.C. § 1320b-10(a), which prohibits the misuse of certain words and departmental emblems. Specifically, NCPPR used the words "Medicare," "Medicaid," "Social Security," and "Health and Human Services" and other misleading terms inappropriately and without authorization in its Health Care Reform Task Force mailings to Medicare beneficiaries. Prior to litigation by the OIG, NCPPR agreed to: (1) stop mailing the Health Care Reform Task Force letter; and (2) not to use any words or names related to Social Security or Medicare in a manner that might create the false impression that NCPPR or its programs and services approve, sponsor, affiliate with, or are affiliated with Medicare, Medicaid, Social Security authorized or the US Department of Health and Human Services.
03.07.2013
In connection with the settlement of liability under the False Claims Act, a pharmacy owner agreed for a period of five years under 42 U.S.C. being barred from participating in federal health programs. § 1320a-7(b)(7). OIG claimed the pharmacy owner filed payment claims for drugs that were never dispensed.
25.02.2013
Edward Desser (Desser), a Florida resident, agreed to pay OIG $120,000 for allegedly violating the provisions of the civil fines statute that apply to kickbacks. OIG alleged that Desser International owned and operated Orthopedic Solutions (IOS), an orthopedic medical device distributor that sold Ortho Development Corporation products, and ECM Solutions, LLC (ECM), a medical consulting/business development company. OIG alleged that Desser received compensation from and through ECM for recommending the ordering of orthopedic products from Zimmer, Inc. (Zimmer) by a Florida-based physician. OIG also alleged that Desser paid two people a fee to induce them to recommend the purchase of medical equipment by orthopedic surgeons in Florida. OIG alleges that Desser knowingly and intentionally solicited and received the compensation described above in order to induce one or more individuals to order Zimmer orthopedic products for which payment was made by government healthcare programs. OIG also alleges that Desser knowingly and intentionally offered and paid compensation to two individuals in order to induce them to recommend the ordering of orthopedic products that may have received payments from government healthcare programs.
22.02.2013
Sacred Heart Hospital (SHH), IL agreed to pay $50,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged SHH failed to perform a medical check-up on a 63-year-old woman who presented to the emergency room not breathing. SHH failed to screen and called the Chicago Fire Department, who transferred her to another hospital, where she was pronounced dead.
02-11-2013
In connection with the settlement of liability under the False Claims Act, a dermatologist agreed for a period of five years under 42 U.S.C. being barred from participating in government health programs. § 1320a-7(b)(7). The OIG alleged that the dermatologist performed medically unnecessary adjacent tissue transfers on Medicare beneficiaries and billed Medicare for assessment and administration services not performed.
28.01.2013
Holmes Regional Medical Center (HRMC), FL agreed to pay $50,000 to release its liability for civil fines under the Patient Dumping Act. The OIG alleged that HRMC failed to conduct a medical screening and adequate stabilization of a 30-year-old pregnant woman who presented to her emergency room with chest pains and possible cardiac arrest and was unresponsive. Both the patient and her baby died.
01.09.2013
Heritage Medical Partners, LLC, Thomas Lenns, M.D., Paul Long, M.D., Michael Mayes, M.D., and William Petty II, M.D. (collectively Heritage), South Carolina, agreed to pay $170,260 for alleged civil fines statute violations. The OIG alleged that Heritage knowingly provided, or caused to be provided, payment requests to Medicare beneficiaries in violation of an assignment agreement.

Videos

1. AWA@50 conf, Panel 8 - AWA Enforcement
(Harvard Animal Law)
2. Where’s George? Moving Your Ideas Forward - Fara Damelin, CNCS OIG
(Council of the IGs on Integrity & Efficiency CIGIE)
3. OIG Outlook 2014
(OIGatHHS)
4. Management Challenges and Oversight of Department of State and USAID Programs (EventID=109749)
(House Appropriations Committee)
5. Public Protection - 2022 New York State Budget
(NYSenate)
6. Public Briefing, Civil Rights and Protections in the Federal Response to Hurricanes María and Harvey
(USCCR)
Top Articles
Latest Posts
Article information

Author: Gregorio Kreiger

Last Updated: 04/20/2023

Views: 6260

Rating: 4.7 / 5 (57 voted)

Reviews: 88% of readers found this page helpful

Author information

Name: Gregorio Kreiger

Birthday: 1994-12-18

Address: 89212 Tracey Ramp, Sunside, MT 08453-0951

Phone: +9014805370218

Job: Customer Designer

Hobby: Mountain biking, Orienteering, Hiking, Sewing, Backpacking, Mushroom hunting, Backpacking

Introduction: My name is Gregorio Kreiger, I am a tender, brainy, enthusiastic, combative, agreeable, gentle, gentle person who loves writing and wants to share my knowledge and understanding with you.