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Civil Monetary Penalties and Affirmative Exclusions

The Office of Inspector General (OIG) has the authority to seek civil monetary penalties (CMPs), assessments, and exclusion against an individual or entity based on a wide variety of prohibited conduct. In each CMP case resolved through a settlement agreement, the settling party has contested the OIG's allegations and denied any liability. No CMP judgment or finding of liability has been made against the settling party.

OIG Enforcement Cases

The cases listed below represent recently-closed cases initiated by the OIG's Office of Counsel to the Inspector General. To view additional cases, including those resolved through the provider self-disclosure protocol, click on the specific categories to the right.

11-12-2015
Nevada Mobile Imaging Provider Settles Case Involving Excluded Individual
On November 12, 2015, Quality Medical Imaging (QMI), Nevada, entered into a $34,187.34 settlement agreement with OIG. The settlement agreement resolves allegations that QMI employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an x-ray technician, provided items and services to QMI patients that were billed to Federal health care programs. Senior Counsel Katie Fink represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
11-10-2015
California Skilled Nursing Facility Settles Case Involving Excluded Individual
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 resolves allegations that Golden Hill employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a social services assistant, provided items and services to Golden Hill patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
California Skilled Nursing Facility Settles Case Involving Excluded Individual
On November 10, 2015, S&F Market Street Healthcare, LLC d/b/a Windsor Gardens Convalescent Center of North Long Beach (Windsor North Long Beach), California, entered into a $207,427.34 settlement agreement with OIG. The settlement agreement resolves allegations that Windsor North Long Beach employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, a certified nursing assistant, provided items and services to Windsor North Long Beach patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
California Skilled Nursing Facility Settles Case Involving Excluded Individual
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 resolves allegations that Windsor Oakland employed an individual who was excluded from participation in any Federal health care programs. OIG's investigation revealed that the excluded individual, an activities assistant, provided items and services to Windsor Oakland patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
11-04-2015
Oregon Physical Therapist Settles Case Involving 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 submitted claims to 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 supervise certain physical therapy services; 2) services were billed as one-on-one provider-patient physical therapy services, when, in fact, they were provided in a group setting; and 3) services were rendered by individuals not qualified to provide therapy services under Medicare guidelines. Senior Counsel Lauren E. Marziani represented OIG.
11-03-2015
California and Michigan Laboratories Settle Case Involving Excluded Individuals
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 resolves allegations that a Summit location in Michigan employed an individual to administer vaccinations who was excluded from participation in Federal health care programs, and a Unilab location in California employed a Quality Assurance Specialist who was excluded from participation in Federal health care programs. Senior Counsel Lisa Veigel represented OIG with the assistance of Paralegal Specialist Eula Taylor.
11-02-2015
South Carolina Urgent Care Centers and Owners Excluded for Default
On November 2, 2015, OIG excluded five urgent care centers located in, and around, Charleston, South Carolina, and the urgent care centers' two owners (collectively, urgent care centers), for default on their payment obligations under their Settlement Agreement (Agreement) with the Department of Justice (DOJ) and OIG. The urgent care centers and their owners had previously entered into the Settlement Agreement for allegedly submitting false claims to Federal health care programs for: (1) unnecessary laboratory tests; (2) evaluation and management services; (3) tetanus immunoglobulin injections when tetanus toxoid was given instead; and (4) radiological services that were performed by an unlicensed employee. The terms of the Agreement provided that the urgent care centers would make an initial upfront payment and two additional installment payments within one year of the Agreement. The urgent care centers failed to make the first of the two installment payments, and DOJ issued a Notice of Default to the urgent care centers on October 15, 2015.
10-28-2018
Wisconsin Home Health Agency and Owner Agree to Voluntary Exclusion
On October 28, 2015, in connection with the resolution of False Claims Act liability, a Wisconsin Home Health Agency and its owner agreed to be excluded from participating in Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the agency and its owner submitted claims to Wisconsin Medicaid for personal care worker services that were not provided, were not provided pursuant to appropriate supervision by the agency, were not medically necessary, or were referred or ordered in violation of the Anti-Kickback Statute. Senior Counsels Geeta Taylor and Tamara Forys represented OIG.
10-23-2015
Illinois Hospital Corporation Settles Case Involving Excluded Individuals
On October 23, 2015, Advocate Health and Hospitals Corporation (Advocate), Illinois, entered into a $317,660.89 settlement agreement with OIG. The settlement agreement resolves allegations that Advocate employed two individuals who were excluded from participation in any Federal health care program. OIG's investigation revealed that the excluded individuals, both registered nurses, provided items and services to Advocate patients that were billed to Federal health care programs. Senior Counsel Karen Glassman represented OIG with the assistance of Paralegal Specialist Jennifer McKoy.
10-22-2015
Texas Skilled Nursing Facility Settles Case Involving Excluded Individual
On October 22, 2015, Huntington Healthcare & Rehabilitation Center, Ltd. (HHRC), Texas, entered into a $214,016.48 settlement agreement with OIG. The settlement agreement resolves allegations that HHRC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a nurse, provided items and services to HHRC patients that were billed to Federal health care programs. Senior Counsel David Blank represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
10-16-2015
Kansas Fiscal Intermediary Settles Case Involving Excluded Individual
On October 16, 2015, South Kansas Independent Living Resource Center, Inc. (SKIL), Kansas, entered into a $47,520.18 settlement agreement with OIG. The settlement agreement resolves allegations that SKIL employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a home health aide, provided items and services to SKIL patients that were billed to Kansas Medicaid. Senior Counsel Keshia Thompson represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
10-07-2015
New Jersey Pharmaceutical Company Settles Case Involving Drug Price Reporting
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's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2013 and 2014. The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and have in effect a national rebate agreement with the Secretary 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.
09-30-2015
OIG Excludes Florida Dentist
On September 30, 2015, OIG excluded Howard Sheldon Schneider, DDS, from participation in all Federal health care programs because his license to practice in the State of Florida was revoked, suspended, or otherwise lost for reasons bearing on his professional competence, professional performance, or financial integrity. OIG conducted an investigation of Dr. Schneider which revealed that the State of Florida Board of Dentistry issued a Final Order for a Disciplinary Voluntary Relinquishment of his dental license after the Florida Department of Health opened an investigation into allegations of Dr. Schneider's abuse of his pediatric dental patients. Dr. Schneider cannot apply for reinstatement until his dental license is reissued by the State of Florida. Senior Counsels Geoffrey Hymans and Geeta Taylor represented OIG.
09-29-2015
Former Arizona Hospice CEO Agrees to Voluntary Exclusion
On September 29, 2015, in connection with the resolution of False Claims Act liability, the former CEO of an Arizona hospice agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that during the tenure of the CEO, the hospice submitted false claims to Medicare for some patients who were provided a higher level of hospice care than was necessary or allowable under Medicare's hospice benefits and/or were completely partially ineligible for Medicare's hospice benefits because, during some or all of the period they received hospice, they did not have a medical prognosis of six months or less if their illnesses ran their normal course. Senior Counsel Gregory Wellins represented OIG.
09-03-2015
Massachusetts Physician and his Practice Settle Case Involving False Claims
On September 2, 2015, Dr. Ronald Goldberg and his practice, Haverhill Family Practice, LLC (collectively "Goldberg and Haverhill"), Massachusetts, entered into a $1,000,000 settlement agreement with OIG. The settlement agreement resolves allegations that Goldberg and Haverhill improperly submitted claims under Dr. Goldberg's billing number for services provided to nursing home patients that had been provided by nurse practitioners. Goldberg and Haverhill also entered into an Integrity Agreement with OIG. Senior Counsel Karen Glassman represented OIG.
09-01-2015
Ohio Durable Medical Equipment Fitter Agrees to Voluntary Exclusion
On September 1, 2015, in connection with the resolution of False Claims Act liability, an Ohio fitter of durable medical equipment agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the fitter caused the submission of false claims to Medicare and Medicaid for back braces that were not supplied, not medically necessary, resulted in the payment of a kickback, or not fitted by a person qualified to perform such services. Senior Counsel Lauren Marziani and Associate Counsel David Fuchs represented OIG.
Florida Dermatologist Agrees to Voluntary Exclusion
Effective September 1, 2015, in connection with the resolution of False Claims Act liability, a Florida dermatologist agreed to be excluded from participating in Federal health care programs for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that the dermatologist submitted claims to Medicare for Mohs surgeries that were not medically necessary or not performed, and claims for adjacent tissue transfers (also known as flaps) that were not medically necessary or not performed. Senior Counsel Karen Glassman represented OIG.
08-31-2015
New Jersey Pharmaceutical Company Settles Case Involving Drug Price Reporting
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 to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2013 and 2014. The Medicaid Drug Rebate Program requires pharmaceutical companies to enter into and have in effect a national rebate agreement with the Secretary 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.
08-14-2015
Milwaukee Pain Doctor and Medical Practice Settles False and Fraudulent Medicare Claims Case
On August 14, 2015, David Irving Stein, MD (Stein), and Milwaukee Pain Treatment Services (MPTS), a Wisconsin based pain management specialist and his practice, entered into a $374,864.78 settlement agreement with OIG. The settlement agreement resolves allegations that MPTS, through Stein, submitted false or fraudulent claims for payment for multiple units of HCPCS codes G0431 and G0434 when only a single unit may be billed per patient encounter by inappropriately using modifiers 91 and QW. OIG's 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 Exclusion
On August 12, 2015, Dr. Robert E. Hackley, Jr., DDS, agreed to be excluded from participation in all Federal health care programs for a period of three years. OIG conducted an investigation of Dr. Hackley for dental care he provided to patients at Small Smiles Dentistry for Children in Colorado Springs, Colorado. OIG's investigation revealed that Dr. Hackley furnished dental services to patients of a quality which failed to meet professionally recognized standards of care, including: performing medically unnecessary dental procedures, failing to treat existing dental conditions, and performing dental procedures that were below professionally recognized standards of care. Senior Counsels Geoffrey Hymans and Tamara Forys represented OIG.

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