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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.

04-04-2019
Maine Mental Health Service Provider Settles Case Involving Excluded Individual
On April 4, 2019, Aroostook Mental Health Services, Inc. (AMHS), Caribou, Maine, entered into a $17,750.12 settlement agreement with OIG. The settlement agreement resolves allegations that AMHS employed an individual who was excluded from participating in MaineCare, Maine's Medicaid program. OIG's investigation revealed that the excluded individual, a counselor, provided items or services to AMHS's patients that were billed to MaineCare.
03-13-2019
Kentucky Laboratory Settles Case Involving 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 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 Medical Group Practice Settles Case Involving False Claims
On March 13, 2019, Medical Specialist of Kentuckiana, PLLC (MSK), Louisville, Kentucky, entered into a $69,776.24 settlement agreement with OIG. The settlement agreement resolves allegations that MSK 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.
03-08-2019
Oklahoma Skilled Nursing Facility Settles Case Involving Excluded Individual
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 an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an office manager, provided items or services to Cleveland Manor's patients that were billed to Federal health care programs.
03-01-2019
Tennessee Skilled Nursing Facility Settles Case Involving Excluded Individual
On March 1, 2019, MHC, Inc. d/b/a Maplewood Health Care Center (Maplewood), Jackson, Tennessee, entered into an $81,419.42 settlement agreement with OIG. The settlement agreement resolves allegations that Maplewood employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a registered nurse, provided items or services to Maplewood's patients that were billed to Federal health care programs. Senior Counsel Kenneth Kraft represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.
02-13-2019
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.
02-07-2019
Tennessee Prosthetics Company Settles Case Involving Kickback Allegations
On February 7, 2019, Amputee Associates, LLC (AA), Nashville, Tennessee, entered into a $681,774 settlement agreement with OIG. The settlement agreement resolves allegations that AA offered and paid illegal remuneration to two surgical practices and a prosthetist in the form of fee reductions and payments. 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 business to AA. OIG also alleged that AA made payments to a prosthetist employed by a Georgia surgical practice in order to induce the prosthetist to refer prosthetics business to AA. In addition, OIG alleged that AA made payments to a Tennessee surgical practice in order to induce the practice to recommend the purchasing of goods and services from AA. Senior Counsel Michael Torrisi represented OIG.
02-06-2019
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.
01-24-2019
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.
01-04-2019
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.

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