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.
Diagnostic Services Provider Settles Case Involving 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 resolves allegations that MDS submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which MDS submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.
Ohio Practice and Owner Settle Case Involving False Claims
- 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 submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
Kentucky Pain Management Practice Settles Case Involving False Claims
- On January 24, 2019, 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 submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. Senior Counsels Geoffrey Hymans and David Traskey represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
Oklahoma Assisted Living Facility Settles Case Involving Excluded Individual
- On January 4, 2019, Baptist Village of Owasso (BVO), Owasso, Oklahoma, entered into a $96,020.92 settlement agreement with OIG. The settlement agreement resolves allegations that BVO employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an admission specialist, provided items or services to BVO's patients that were billed to Federal health care programs.
Oklahoma Pain Management Practice and Physicians Settle Case Involving 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 resolves allegations that TPC received remuneration from Millennium Health, LLC f/k/a Millennium Laboratories, Inc. (Millennium), in the form of point of care test cups which resulted in prohibited referrals. OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and TPC caused Millennium to present claims for designated health services that resulted from the prohibited referrals. Senior Counsels Andrea Treese Berlin and Geoffrey Hymans represented OIG.
- Alabama Hospital Settles Case Involving Patient Dumping Allegations
- On December 21, 2018, Mobile Infirmary Medical Center (MIMC), Mobile, Alabama, entered into an $80,000 settlement agreement with OIG. The settlement resolves allegations that, based on OIG's investigation, MIMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for two individuals. The first patient, a 24-year-old male presented to MIMC's Emergency Department (ED) complaining of weakness and exhibited altered mental status. He was reportedly aggressive and non-compliant with staff directions. When he was leaving the ED he apparently collapsed. A security guard, a hospital employee, put him in a wheelchair and wheeled the patient off hospital property - where he was left on the ground. Approximately four hours later the patient was found cold, with decreased responsiveness. He was transported to another hospital by ambulance. He died two weeks later. The second patient, a 35-year-old male, presented to MIMC's ED accompanied by his girlfriend. The patient complained of shortness of breath and chest pain. The patient requested to see a physician and became belligerent when a nurse asked him why. That led to the patient being escorted out of the ED by security. Several minutes later, the patient returned to the ED. This time, the patient's girlfriend drove up to the ambulance bay and reported that the patient had suffered a seizure and was lying in her truck. She was informed by staff that they would not help get the patient out of the truck. In addition, the security guard told her she had to leave. 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.
California Physician and Practice Settle Case Involving False Claims
- On December 20, 2018, Michael Jadali, D.O., and the Center for Pain & Rehabilitation Medicine (collectively, "Dr. Jadali"), San Jose, California, entered into a $60,406.30 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Jadali submitted claims to Medicare for Healthcare Common Procedure Coding System codes 80500 (clinical pathology consultation; limited, without review of patient's history and medical records) and 80502 (clinical pathology consultation, comprehensive, for a complex diagnostic problem, with review of patient's history and medical records), where no consultation request had been made, no written narrative report by a consultant pathologist was produced, and no exercise of medical judgement by a consultant pathologist was required. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.
Connecticut Hospital Settles Case Involving Patient Dumping Allegation
- On December 12, 2018, Hartford Hospital (Hartford), Hartford, Connecticut, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that Hartford violated the Emergency Medical Treatment and Labor Act when it failed to provide an appropriate medical screening examination to a woman who was 23.5 weeks pregnant when she presented to Hartford's Emergency Department with symptoms of preeclampsia, an emergency medical condition. Senior Counsels Joan Matlack and Srishti Sheffner represented OIG.
Georgia Mental Health Provider and Owner Agree to Voluntary Exclusion
- On December 1, 2018, in connection with the resolution of their False Claims Act liability, Families United Services, Inc. (FUS), and Pamela McKenzie, Georgia, each agreed to be excluded from participation in all Federal health care programs for periods of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that FUS and Pamela McKenzie submitted claims to Georgia Medicaid for behavioral health services that were not provided. Senior Counsel Katie Fink represented OIG.