Enforcement Actions

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MP Primary Care Services Agreed to Pay $72,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Not Provided

University of California Irvine Health Agreed to Pay $482,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Improperly Billed Critical Care Services

All Star Physical Therapy Agreed to Pay $1.2 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services by Non-enrolled or Uncredentialed Providers

All Star Physical Therapy Specialists, Confluent Health, and Confluent Health California Agreed to Pay $636,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services by Non-enrolled or Uncredentialed Providers

Adventist Health System Agreed to Pay $628,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services in Spaces Not Identified for Clinical Use or Supplemental Outpatient Services

Citadel Care Center – Sterling Agreed to Pay $639,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

Lorien Nursing & Rehab Center-Elkridge Agreed to Pay $117,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Provided by Unlicensed Individuals

Advanced Clinical Laboratory Agreed to Pay $33,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

Northwell Healthcare Agreed to Pay $411,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Not Performed, that Did Not Meet Coverage Criteria, or Were Upcoded

Pinnacle Peak Recovery Agreed to Pay $31,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

Cook County Health Agreed to Pay $451,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services that Were Ineligible for Payment

City of Wheeling, West Virginia Fire Department Agreed to Pay $36,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Ambulance Services with False Signatures

Perry Avenue Family Medical Center Agreed to Pay $600,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Not Provided as Claimed

Children’s Hospital of Philadelphia Agreed to Pay $23,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Individual Excluded from Pennsylvania Medicaid

Community Mental Health Affiliates Agreed to Pay $130,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

Capital Health System Agreed to Pay $528,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Remote Physiologic Monitoring that Did Not Meet Coverage and Payment Requirements

City of Bristol, Tennessee Agreed to Pay $20,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Provided by an Unlicensed Individual

Delmarva Spine and Pain Agreed to Pay $311,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Upcoded Evaluation and Management Claims and Claims that Misidentified the Place of Services

The University of Texas Health Science Center at Houston and U.T. Physicians Agreed to Pay $78,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Orders or Referrals Signed by Medical Assistants

Tulse Bone and Joint Associates Agreed to Pay $769,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Medically Unnecessary Services Related to Knee Replacement Surgeries

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