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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.

06-24-2016
California Ambulance Company Settles Case Involving 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 claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that 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 Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.
Arizona Hospice Provider Settles 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 submitted claims for hospice services at the general inpatient level of care when it knew or should have known that routine care was the correct level of hospice care that should have been billed. Senior Counsels Geoffrey Hymans and David Traskey represented OIG.
Oklahoma Chiropractic Center Settles Case Involving Excluded Individual
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 an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded 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 the assistance of Paralegal Specialist Mariel Filtz.
06-22-2016
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 settlement agreement with OIG for $50,000 to resolve kickback allegations. Chaudhry is a former owner of a Chicago-area home health agency (HHA). OIG contends that Chaudhry paid illegal remuneration to a Chicago physician in exchange for the physician's referral of patients for home health care services to Chaudhry's HHA. The kickback was disguised as medical director fees, when, in fact, no services were performed. OIG also contends that Chaudhry and the HHA he formerly owned made the payments to the physician through one or more of its marketer employees or contractors.
06-13-2016
Florida County and its Biller Settle Case Involving 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 resolves allegations that between September 1, 2009, and May 30, 2011, Flagler County and PST submitted, or caused to be submitted, Medicare claims for emergency ambulance transportation services provided to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. The settlement agreement also resolves allegations that between June 1, 2011, and March 28, 2015, Flagler County (with no involvement of PST) submitted or caused to be submitted Medicare claims for emergency ambulance transportation services provided to destinations such as skilled nursing facilities and patient residences that 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 Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
06-10-2016
Louisiana Hospital Owner Agrees to 15 Year Exclusion
On June 10, 2016, Mark Goff, agreed to be excluded from participation in all Federal health care programs for a period of fifteen years under 42 U.S.C. 1320a-7(b)(7). OIG alleged that Goff submitted or caused the hospital he co-owned and managed, to submit to the Medicare program false or fraudulent claims for Intensive Outpatient Program (IOP) psychiatric services. Senior Counsel Ellen Slavin represented OIG.
06-08-2016
Minnesota Skilled Nursing Facility Settles Case Involving Excluded Individual
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 resolves allegations that SOCC employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a certified nursing assistant, provided items or services to SOCC patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG with the assistance of Paralegal Specialist Mariel Filtz.
05-18-2016
Grady Health System in Georgia Settles Case Involving a Patient Dumping Allegation
On May 18, 2016, Grady Memorial Hospital Corporation d/b/a/ Grady Health System (GHS), in Atlanta, Georgia, entered into a $40,000 settlement agreement with OIG. The settlement agreement resolves allegations that GHS violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment to a patient. OIG's investigation revealed the following. The patient was extracted from his apartment by a SWAT team and brought to GHS's emergency department (ED) by a police officer due to complaints of suicidal and homicidal ideations. While at GHS, two Licensed Professional Counselors (LPCs) evaluated the patient and determined that the patient should be held involuntarily for further evaluation and treatment. Approximately five hours after the patient's arrival in the ED, the ED 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.
Georgia Dermatology Practice and Owners Excluded for Default
On May 18, 2016, OIG excluded a dermatology practice headquartered in Georgia, and the practice's two owners (collectively, "dermatology practice"), for defaulting on their payment obligations under their Settlement Agreement (Agreement) with the Department of Justice (DOJ) and OIG. The dermatology practice had previously entered into the Agreement for allegedly submitting false claims to the Medicare program that violated the False Claims Act because they: (1) were for laboratory referrals from physicians whose financial relationship with the dermatology practice violated the Stark Law, or (2) improperly included a Modifier 25 billing code on claims submitted for services provided in Georgia. The terms of the Agreement provided that the dermatology practice would make an initial upfront payment plus additional payments over a five-year period. The dermatology practice failed to make a payment in April 2016, and DOJ issued a Notice of Default to the dermatology practice on May 5, 2016. Senior Counsel Karen Glassman represented OIG.
05-06-2016
Minnesota Pharmaceutical Company Settles Case Involving Drug Price Reporting
On May 6, 2016, Coloplast Corp. (Coloplast), Minnesota, entered into 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 to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2013, 2014, and 2015. 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.
05-05-2016
Florida Podiatrist Agrees to 30 Year Exclusion
On May 5, 2016, Eugene A. Fox, D.P.M., agreed to be excluded from participation in all Federal health care programs for a period of thirty years under 42 U.S.C. § 1320a-7(b)(7). OIG's investigation revealed that Dr. Fox submitted claims to Medicare for podiatric services that were not rendered or were rendered by unqualified personnel. Senior Counsel Lauren Marziani and Associate Counsel David Fuchs represented OIG.
05-05-2016
Michigan Ambulance Company Settles Case Involving False Claims
On May 5, 2016, Allied EMS Systems, Inc. (Allied), of Petoskey, Michigan, entered into a $121,722.63 settlement agreement with OIG. The settlement agreement resolves allegations that Allied submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that 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 Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.
05-05-2016
Florida Skilled Nursing Facilities Settle Case Involving Excluded Individual
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 resolves allegations that Cypress Village and Atrium employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, a speech-language pathologist, provided items or services to Cypress Village and Atrium patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG.
04-15-2016
Texas Home Health Agency Settles Case Involving Excluded Individual
On April 15, 2016, Choice Home Health Care, Inc., and its former owners Patrick Fettinger and Ann Voss (collectively "CHHC"), Texas, entered into a $89,587.82 settlement agreement with OIG. The settlement agreement resolves allegations that CHHC 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 community liaison/marketing specialist, provided items or services to CHHC patients that were billed to Federal health care programs. Senior Counsel Nicole Caucci represented OIG.

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