Source: http://oig.hhs.gov/fraud/enforcement/cmp/false_claims.asp
Timestamp: 2014-03-11 01:46:54
Document Index: 301527578

Matched Legal Cases: ['§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320', '§ 1320']

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False and Fraudulent Claims Archive
After it self-disclosed conduct to OIG, Home Care United, Inc. (HCU), Wisconsin, agreed to pay $22,867.67 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HCU submitted claims to federal health care programs using Certifications of Medical necessity (CMNs) or Detailed Physician Orders (DPOs) that had been improperly altered by one of HCU's CMN Specialists. OIG alleged that these improper alterations included cutting and pasting physician signatures from other CMN or DPO forms; handwriting in a date or parts of numbers that had been cut off when the forms were faxed to HCU from the authorized physicians' offices; and using white out to change information. January 27, 2014
After it disclosed conduct to OIG pursuant to its Integrity Agreement, Decatur Vein Clinic, LLC, Decatur Vein Clinic, PC, and Decatur Vein Clinic Hobart, PC (Decatur), Indiana, agreed to pay $140,000.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Decatur billed and received reimbursement for catheter-infusion sclerotherapy procedures as well as other procedures for the care and treatment for varicose veins of the lower extremities that were not provided as claimed and were false or fraudulent.
Humana Inc. (Humana), Kentucky, agreed to pay $1,814,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Humana submitted prescription drug event date (PDE claims) that included sales tax from Louisiana pharmacies to the Centers for Medicare & Medicaid Services (CMS) even though Medicare Part D drugs were not taxable under Louisiana law as of July 1, 2006. OIG further alleged that Humana knowingly submitted or caused to be submitted PDE claims to CMS that improperly claimed Louisiana sales tax costs and the CMS used Humana's PDE claims to calculate Medicare Part D payments.
East Los Angeles Dialysis Center (ELADC), California, agreed to pay $56,094.23 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ELADC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Ronald Goldberg, M.D. (Goldberg), and Haverhill Family Practice (HFP), Massachusetts, agreed to pay $162,676.94 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Goldberg and HFP submitted claims under Goldberg's billing number for services provided to nursing home patients that had been provided by nurse practitioners. OIG also alleged that Goldberg and HFP submitted claims for services that were not provided to patients because the patients were either hospitalized or no longer living. December 13, 2013
After it self-disclosed conduct to OIG, Seton Family of Hospitals (Seton) d/b/a Towers Nursing Home (Towers), Texas, agreed to pay $1,139,789.65 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Seton billed for posthospital extended care services furnished at Towers using certifications and recertifications that did not meet applicable Medicare criteria. December 11, 2013
Four Leaf Clover, Inc. and William Sweeney (FLC), North Carolina, agreed to pay $5,000, and to relinquish funds being held in suspension, for allegedly violating the Civil Monetary Penalties Law (CMPL) and provisions of the CMPL applicable to physician self-referrals and kickbacks. OIG alleged that FLC in connection with their contract with Team Tech Solutions, Inc. (TTS) a telemarketing company, made unsolicited telephone calls to Medicare beneficiaries to obtain orders for the furnishing of durable medical equipment (DME) for which Medicare pays. OIG alleged that FLC used the information obtained to submit claims to Medicare for the DME allegedly provided to the beneficiaries. OIG further contends that FLC knew or should have known that they submitted false or fraudulent claims because they obtained the orders for the DME through telephone solicitations prohibited by the Social Security Act's DME Telemarketing Provisions. Those provisions prohibit suppliers of DME from marketing unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of a covered item, except in three circumstances. OIG alleged that the telemarketing calls made on behalf of FLC did not fall into these exceptions. OIG contends that FLC violated the CMPL by knowingly submitting Medicare claims that they knew or should have known were false or fraudulent for DME ordered pursuant to prohibited telephone solicitations. OIG also contends that FLC offered or paid remuneration in the form of monetary payments to induce TTS to refer individuals for the provision of DME for which Medicare would pay or to arrange for or recommend ordering DME for which Medicare would pay. December 3, 2013
Best Choice Home Health Care Agency (Best Choice), Kansas, agreed to pay $93,990.32 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Best Choice employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
IASIS Healthcare Corporation (IASIS), Utah, agreed to pay $318,035.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that IASIS employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.
Spectrum Private Care Services, Inc. (Spectrum), Kansas, agreed to pay $39,033.35 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Spectrum employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, St. John's Health Care Corporation d/b/a St. John's Home (St. John's), New York, agreed to pay $42,556.29 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. John's submitted claims for occupational therapy services provided concurrently but billed as if provided individually. July 26, 2013
Team Tech Solutions, LLC and Justin Ortiz (TTS), agreed to pay $347,000 for allegedly violating the Civil Monetary Penalties Law and provisions of the Civil Monetary Penalties Law applicable to physician self-referrals and kickbacks. OIG alleged that TTS in connection with their contract with Four Leaf Clover, Inc. (FLC), a durable medical equipment (DME) company, made unsolicited telephone calls to Medicare beneficiaries to obtain orders for the furnishing of DME that Medicare would pay for. OIG alleged that FLC in turn used the information to submit claims to Medicare for DME allegedly provided to beneficiaries. OIG contends that TTS knew or should have known that they were causing the submission of false or fraudulent claims because they obtained the orders for the DME through telephone solicitations prohibited by the Social Security Act's DME Telemarketing Provisions. OIG also contends that TTS solicited or received remuneration in the form of monetary payments in return for referring individuals for the provision of DME that would be paid for by Medicare. 10-18-2013
After it self-disclosed conduct to the OIG, the City of El Paso, Texas (El Paso), agreed to pay $1,162,828.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that El Paso submitted claims to Medicare for emergency Advanced Life Support ambulance transportation services when, in actuality, the medically reasonable and necessary level of services was the lower cost emergency Basic Life Support ambulance transportation services. 09-26-2013
Anchor Safe Healthcare, Inc. (Anchor Safe), Texas, agreed to pay $47,324 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Anchor Safe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Center for Human Genetics, Inc. (CHG) and Dr. Jeffrey Milunsky (Dr. Milunsky), Massachusetts, agreed to pay $798,993 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CHG billed for single genetic tests over multiple dates of service, determined by the time span of the tests analysis. By doing so, CHG avoided "edits" built into the computerized payment systems of the government payors which would have prevented the payment of certain specific parts of Current Procedural Terminology codes on the same date of service. The OIG further alleged that Dr. Milunsky knowingly presented or caused to be presented claims for items or services that Dr. Milunsky should have known were not provided as claimed. Specifically, CHG, under Dr. Milunsky's National Provider Number, billed for services of genetic counselors "incident to" his own professional services when those genetic counselors did not provide such services under Dr. Milunsky's direct supervision because they were not located in the same office suite or at the same address. 09-09-2013
Catherine Odo Ekereuke, d/b/a Bukate Medical Supplier (Bukate), Arizona, agreed to pay $29,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bukate submitted or caused to be submitted claims to Medicare for power mobility devices and other durable medical equipment that Bukate failed to provide to beneficiaries. 08-30-2013
Radius Specialty Hospital LLC (Radius), Massachusetts, agreed to pay $333,647.25 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Radius employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Two ambulance company owners agreed to be excluded from participating in Federal health care programs for ten years under 42 U.S.C. § 1320a-7(b)(7) and 42 U.S.C. § 1320a-7(b)(16). OIG alleged that the ambulance company owners (1) knowingly made or caused to be made false statements, omissions, and misrepresentations of material fact on an application to enroll as a provider of services or supplier in the Medicare program; (2) knowingly made or caused to be made false statements, omissions, and misrepresentations of a material fact in a bid to contract with a provider to furnish ambulance services and to submit claims for payment for ambulance services furnished under a Federal health care program; and (3) knowingly made or caused to be made or used a false record or statement material to a false or fraudulent claim for payment for items and services furnished under a Federal health care program. After it self-disclosed conduct to the OIG, Dr. Susoni Health Community Services, Corp., d/b/a Dr. Cayetano Coll & Toste Regional Hospital (Cayetano), Puerto Rico, agreed to pay $381,841.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Cayetano employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
In connection with the resolution of False Claims Act liability, the owner of a lymphedema wound center agreed to be excluded from participating in Federal health care programs for ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the owner of the lymphedema wound center submitted claims to Medicare: (1) for physical therapy treatments that were performed by therapists who were not qualified to perform those treatments; (2) for physical therapy treatments in excess of the Medicare caps and limitations on the number of physical therapy treatments; (3) that violated the rules for "bundling" strapping/bandaging services with physical therapy treatments; and (4) for prescribing pneumatic compression pumps for Medicare beneficiaries when those pumps were not medically necessary. 07-17-2013
After it disclosed conduct to the OIG pursuant to its Corporate Integrity Agreement, Amerigroup Corporation (Amerigroup), Virginia, agreed to pay $30,754.93 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Amerigroup contracted with three individuals that it knew or should have known were excluded from participation in Federal health care programs and paid for prescriptions written by a fourth individual that it knew or should have known were excluded from participation in Federal health care programs.
In connection with the resolution of False Claims Act liability, an oncology medical group practice agreed to be excluded from participating in Federal health care programs for ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the oncology medical group practice purchased drugs from a foreign drug distributor in Canada that obtained the drugs from foreign sources. OIG alleged that these drugs, sometimes with labeling in foreign languages or without dosage information, were not manufactured in establishments that were registered with the United States Food and Drug Administration (FDA). OIG alleged that the versions of the drugs that the oncology medical group practice purchased were not the subject of, and did not comply with, a new drug application, abbreviated new drug application, or biologics license application approved by the FDA for commercial marketing and, therefore, the drugs were not covered by Federal health care programs because the drugs had not received final marketing approval from the FDA. 06-19-2013
In connection with the resolution of False Claims Act liability, an oncologist and hematologist agreed to be excluded from participating in Federal health care programs for fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the oncologist and hematologist knowingly submitted false and/or fraudulent claims to Federal health care programs for: (1) quantities of drugs greater than those actually administered to patients; (2) overstating chemotherapy drug infusion times; and (3) double-billing for medications.
In connection with the resolution of False Claims Act liability, an allergist and the allergy clinic he owned agreed to be excluded from participating in Federal health care programs for a period of twenty years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the allergist through his allergy clinic submitted false claims related to Healthcare Common Procedure Codes 95004, 05165 and 99214 including: misrepresentation of services and diagnoses, overutilization of procedures, billing for unapproved hormone therapy treatments, billing for services that were not medically necessary, billing for services not rendered, and misrepresenting the provider who rendered treatment. After it self-disclosed conduct to the OIG, Rutherford Hospital, Inc. (Rutherford), North Carolina, agreed to pay $706,090.46 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Rutherford submitted or caused to be submitted claims for physicians' services provided by a doctor to beneficiaries of Federal health care programs using the provider identification numbers of another doctor, who did not further the services. The OIG contends that Rutherford knowingly misused provider identification numbers, which resulted in improper billing of the claims identified and disclosed by Rutherford.
Trustees of Tufts College and Tufts University School of Dental Medicine (TUSDM), Massachusetts, agreed to pay $841,120.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that TUSDM submitted claims to Medicare for various services from four of their clinics. The OIG contends that these claims were improper because the services were provided by dentists who were not credentialed by Medicare and/or the services or the code level billed were not supported by sufficient medical record documentation. 05-21-2013
Carolyn Murray-Burton, M.D. (Murray), New Jersey, agreed to pay $136,777.59 for allegedly violating the Civil Monetary Penalties Law. The OIG contends that Murray caused her employer to submit claims for reimbursement to Medicaid and Medicaid HMOs for items and services furnished by her while she did not possess a valid medical license.
Dr. Matthew James Britton and C.F. Health Management, Inc. d/b/a Gainesville Pain Management (Gainesville), Georgia, agreed to pay $1,577,597 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Gainesville submitted false or fraudulent claims: 1) by inappropriately using Modifiers 76 and 59, to submit claims for payment for multiple units of Healthcare Common Procedure Coding System (HCPCS) codes G0431 and G0434 when only a single unit may be billed per patient encounter; and 2) by inappropriately using Modifier QW and billing for HCPCS G0431 when the less expensive services represented by HCPCS code G0434 were actually provided.
Visiting Nurse Association (VNA), Johnson County, Iowa, agreed to pay $33,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that VNA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Evergreen Oregon Healthcare Salem, LLC (Evergreen), Oregon, agreed to pay $19,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Evergreen employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Sergey Lugina and Executive Medical Care, P.C., (EMC), New York, agreed to pay $74,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that EMC submitted or caused to be submitted claims for medical services that were not provided as claimed and/or were false or fraudulent. The OIG alleges that these services were not provided as claimed because Sergey Lugina was on travel outside the United States during the periods when he claimed that he rendered services to beneficiaries.
After it disclosed conduct to the OIG pursuant to its Corporate Integrity Agreement, Vanguard HealthCare, LLC (Vanguard), Tennessee, agreed to pay $159,778.00 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Vanguard employed an individual that it knew or should have known was excluded from participation in Federal health care programs. 03-07-2013
In connection with the resolution of False Claims Act liability, a pharmacy owner 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 alleged that the pharmacy owner submitted claims for payment for drugs that were never dispensed. 03-04-2013
In connection with the resolution of False Claims Act liability, a 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 alleged that the dermatologist performed medically unnecessary adjacent tissue transfers on Medicare beneficiaries and billed Medicare for evaluation and management services that were not performed.
In connection with the resolution of False Claims Act liability, a physician 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 alleged that the physician submitted claims to Medicare and Medicaid for a more comprehensive and complex evaluation and management service than he actually provided. After it self-disclosed conduct to the OIG, CaroMont Medical Group, Inc. (CaroMont), North Carolina, agreed to pay $205,685.27 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CaroMont presented to the United States claims for items or services that CaroMont knew or should have known were not provided as claimed and were false or fraudulent. The OIG alleged that CaroMont purchased drugs and devices from foreign sources and provided those drugs to Federal health care program patients and billed Federal healthcare programs for those products for their biochemical equivalents sold in the United States.
In connection with the resolution of False Claims Act liability, a chiropractic medical group and its four owners 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 alleged that the chiropractic medical group and its four owners knowingly submitted claims to Medicare for multiple units of therapeutic activities (CPT Code 95730) for treatment sessions that did not reflect the actual time that patients were treated. 10-05-2012
After it self-disclosed conduct to the OIG, Essex Valley Healthcare, Inc., East Orange General Hospital, and Essex Valley Medical Transportation Services, Inc. (Respondents), New Jersey, agreed to pay $61,570.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the respondents employed two individuals that they knew or should have known were excluded from participation in Federal health care programs. 11-16-2012
After it disclosed conduct to the OIG pursuant to its Corporate Integrity Agreement, Touro Infirmary (Touro), Louisiana, agreed to pay $427,561.59 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Touro employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Safeway, Inc., Wyoming, agreed to pay $56,994 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Safeway, Inc. submitted claims to Medicare Part D for the branded drug Protonix when it dispensed the authorized Protonix generic drug known as pantoprazole.
After he disclosed conduct to the OIG pursuant to his Integrity Agreement, Dr. Akram Abraham d/b/a Abraham Medical Clinic (Dr. Abraham), Massachusetts, agreed to pay $43,014.80 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Abraham employed an individual that he knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Baptist Hospital, Inc. and Langhorne Cardiology Consultants, Inc. (Baptist and Langhorne), Florida, agreed to pay $172,604 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Baptist and Langhorne employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Dr. Akram Abraham d/b/a Abraham Medical Clinic (Dr. Abraham), Massachusetts, agreed to pay $43,014.80 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Abraham employed an individual that he knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Essex Valley Healthcare, Inc., East Orange General Hospital, and Essex Valley Medical Transportation Services, Inc. (Respondents), New Jersey, agreed to pay $61,570.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the respondents employed two individuals that it knew or should have known were excluded from participation in Federal health care programs. 10-04-2012
After it disclosed conduct to the OIG pursuant to its Corporate Integrity Agreement, Decatur Vein Clinic (Decatur), Indiana, agreed to pay $41,898.94 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Decatur employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Stephan P. Babirak, Ph.D. M.D. (Babirak) and Metabolic Leader, LLC, PA (Metabolic Leader), Maine, agreed to pay $17,087.58 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Babirak and his medical practice, Metabolic Leader, improperly billed Medicare for: (1) new patient Evaluation & Management (E&M) office visits for pre-existing patients; (2) upcoded E&M office visits; and (3) services provided by nurse practitioners that were billed under Babirak's provider number when he was not in the office.
Dr. Jorge Zamora-Quezada, Texas, agreed to pay $83,481.22 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Jorge Zamora-Quezada employed an individual that he knew or should have known was excluded from participation in Federal health care programs.
Cooperative Home Care (Cooperative), Missouri, agreed to pay $121,010 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Cooperative employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-19-2012 In connection with the resolution of False Claims Act liability, a physician agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician submitted or caused to be submitted claims to Medicaid: (1) by issuing prescriptions for Tramadol to patients that were without legitimate medical purpose or not in the usual course of professional treatment; and (2) for office visits with patients that were for services that were not medically necessary and/or not adequately supported by medical record documentation. Hy-Vee, Inc., Iowa, agreed to pay $831,871.61 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Hy-Vee, Inc. employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Jennings Healthcare Center (Jennings), Indiana, agreed to pay $81,704.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Jennings employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
On With Life, Iowa, agreed to pay $77,586 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that On With Life employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
The owner of a company that supplies durable medical equipment (DME) agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the DME supply company owner knowingly submitted or caused to be submitted false or fraudulent claims to the Medicare program. Specifically, OIG alleged that the DME supply company owner: (1) billed for an item of durable medical equipment that was never provided to the beneficiary; (2) billed for 13 motorized wheelchairs when less expensive power scooters were actually provided to beneficiaries; and (3) billed for items of durable medical equipment before the items were actually provided to the beneficiaries. 05-31-2012
In connection with the resolution of False Claims Act liability, the owner of a company that supplies durable medical equipment (DME) 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 alleged that the DME supply company owner knowingly submitted or caused to be submitted claims when he was not approved by Medicare and was ineligible to receive Medicare and TRICARE reimbursements. In connection with the resolution of False Claims Act liability, two co-owners of a hospice agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the hospice co-owners submitted claims for payment to Medicare for some patients who were either completely or partially hospice ineligible or were provided a higher level of hospice care than was necessary or allowable. 05-10-2012
After it self-disclosed conduct to the OIG, Animas Corporation (Animas), Pennsylvania, agreed to pay $1,683,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Animas submitted reimbursement to Medicare and Medicaid for infusion pumps and supplies that were based upon documentation that included signed written orders received from physicians which had been altered without the physician's approval. 05-09-2012
Halls Physicians Services (HPS), Tennessee, agreed to pay $51,972.20 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HPS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Bloomington Podiatry Center (BPC), Indiana, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BPC employed an individual that it knew or should have known was excluded from participation in Federal health care programs. 04-16-2012
Baypointe Nursing Home, Inc. d/b/a Baypointe Rehabilitation & Skilled Care Center (Baypointe), Massachusetts, agreed to pay $351,255.44 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Baypointe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
The manager of a medical group practice agreed to be excluded from participating in Federal health care programs for a period of ten years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the medical group practice manager caused the submission of claims to Medicare for medically unnecessary diagnostic tests that were not ordered by a physician. 03-26-2012
Ronald V. Myers, Sr., M.D. (Myers), Mississippi, agreed to pay $25,500 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Myers caused improper claims to be submitted to Medicare from Select Care, Inc. and Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Myers did not personally render or did not directly supervise. 03-01-2012
In connection with the resolution of False Claims Act liability, a physician agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician improperly billed Medicare for medically unnecessary pain injections that were administered by an unlicensed medical assistant. As part of the False Claims Act settlement, the physician admitted that he allowed his unlicensed medical assistant to administer at least 80% of the pain injections. 02-20-2012
In connection with the resolution of False Claims Act liability, the marketing director of a mobile ultrasound company 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 alleged that the mobile ultrasound company marketing director knowingly caused the submission of false claims for ultrasound services that were never ordered or performed.
A radiation oncologist 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 alleged that the radiation oncologist knowingly submitted or caused the submission of false or fraudulent claims to Medicare, under various CPT codes, by: (1) excessively billing; (2) lacking documentation justifying the level of services billed; (3) billing for professional components of tests when only technical components were provided; and (4) billing under more complex CPT codes when less complex procedures were actually performed. 01-20-2012
LP Lexington Pimlico, LLC d/b/a Bluegrass Care and Rehabilitation Center (Bluegrass), Kentucky, agreed to pay $11,994.88 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bluegrass employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Buchanan County Health Center (BCHC), Iowa, agreed to pay $406,030 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BCHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Nathaniel Brown, M.D. (Brown), Mississippi, agreed to pay $108,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Brown caused improper claims to be submitted to Medicare from Mississippi Care Partners, Inc., for physical therapy and related health care items or services that Brown did not personally render or did not directly supervise. 2011
The owner of a pain clinic agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the pain clinic owner improperly billed or caused to be billed claims using CPT Code 97032 rather than G0329 for the provision of Microvas treatment. OIG alleged that Microvas and other electrical stimulation/electromagnetic therapy (ES/ET) devices are only covered for treatment of chronic Stage III or Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers that have not healed within 30 days after occurrence following appropriate standard wound therapy. OIG alleged that Medicare was billed for treatment of patients with neuropathy, rather than with ulcer/wound conditions contained in the National Coverage Determination. Further, OIG alleged that ES/ET is covered by Medicare, if performed by a physician, physical therapist, or incident to a physician service. OIG alleged that many of the Microvas procedures billed to Medicare were performed by the pain clinic owner or other unlicensed office staff. 11-30-2011
In connection with the resolution of False Claims Act liability, the chief operating officer (COO) of an ambulance company 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 alleged that the ambulance company COO caused to be submitted for payment claims falsely representing to Medicare and Medicaid that Advanced Life Support (ALS) services were appropriate and furnished by ambulance personnel when in fact no ALS-service was rendered and/or the patient did not require an ALS transport. 09-15-2011
In connection with the resolution of False Claims Act liability, the biller for a clinic specializing in obstetrics and gynecology (OB/GYN) 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 alleged that the biller for the OB/GYN clinic unbundled services or billed for different services than actually provided. 08-29-2011
Mainstream Living, Inc. (Mainstream), Iowa, agreed to pay $132,925.49 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mainstream employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
In connection with the resolution of False Claims Act liability, a medical group practice agreed to be permanently excluded from participating in Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that a physician at the medical group practice represented in patient medical records and reimbursement claims to Medicare and Medicaid that he examined and evaluated numerous patients using CPT Code 99214, although the requirements set forth in CPT Code 99214 were not met. OIG also alleged that the physician did not write prescriptions that authorized routine refills, which resulted in unnecessary and or upcoded office visits. 06-24-2011
An anesthesiologist 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 alleged that the anesthesiologist billed for a consultation every time he performed a catheterization for another physician and that the consultations were not ordered by the other physician, as required by Medicare, or performed by the anesthesiologist. 06-23-2011
In connection with the resolution of False Claims Act liability, a psychotherapy practice and its two owners, a social worker and a psychologist, agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the psychotherapy practice and its two owners submitted claims for payment to Medicare for social worker consultation services that were falsely represented to have taken place face to face. 05-31-2011
In connection with the resolution of False Claims Act liability, a physician and his practice agreed to be excluded from participating in Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the physician and his practice submitted, or caused to be submitted, improper claims to Medicare and Medicaid for: (1) nursing facility care services allegedly performed on patients located in nursing homes when, in fact, those patients were not present in the nursing homes but were instead hospital inpatients; and (2) hospital care services in which the medical note in the patient's chart reflected that the services in question were performed by hospital residents or Advanced Practice Registered Nurses, and the physician merely countersigned the note and did not include his own note to reflect any services he allegedly performed as the attending physician.
In connection with the resolution of False Claims Act liability, the owner of a company that sold diabetic shoe inserts 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 diabetic shoe insert company owner: (1) sold custom diabetic shoe inserts that were not, in fact, custom as defined by Medicare because they were not created with a unique image of each foot; and (2) sold heat moldable diabetic shoe inserts that did not comply with the Medicare requirements for those inserts and did not conform to the heat moldable diabetic inserts that were submitted to Medicare for coding verification.
Betty J. Feir, PhD, Texas, agreed to pay $61,270 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Feir submitted claims to Medicare for initial diagnostic services performed by auxiliary personnel instead of her and for services performed by auxiliary personnel while she was not present and did not provide direct supervision.
In connection with the resolution of False Claims Act liability, an individual who was the owner, president and CEO of an intra-operative neurophysiology testing service agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the individual submitted, or caused to be submitted, claims to Medicare for intraoperative neurophysiology testing services, billed pursuant to CPT code 99920, that contained an excessive number of units/hours and/or were provided by the same monitoring physician to multiple patients simultaneously, contrary to the relevant Medicare policy. 11-02-2011
Phillip L. Barnes, D.O. (Barnes), Mississippi, agreed to pay $49,419 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Barnes caused improper claims to be submitted to Medicare from Select Care, Inc. and Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Barnes did not personally render or did not directly supervise. Reginald W. Stewart, (Stewart), Mississippi, agreed to pay $88,810 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Stewart caused improper claims to be submitted to Medicare from Mississippi Care Partners, Inc. and Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Stewart did not personally render or did not directly supervise.
In connection with the resolution of False Claims Act liability, a physician 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 alleged that the physician caused the submission of claims to Medicare and Medicaid for his office visits that were false or fraudulent because they did not accurately reflect the level of professional service that he provided to the beneficiaries. 10-06-2011
Daniel Herrington, the owner of One Source Medical Services a durable medical equipment (DME) company, Florida, agreed to pay $124,141.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Herrington, through the DME company, billed Medicare for custom molded diabetic shoe inserts when in fact only prefabricated inserts were provided to beneficiaries.
Beth Israel Deaconess Medical Center in Boston, Massachusetts (BIDMC) agreed to pay $233,932.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BIDMC improperly billed Medicare for Lupron drug injections to male patients under HCPCS Code J1950 when BIDMC should have known that the proper code for these claims was the lower reimbursed HCPC Code J9217.
Beth Israel Deaconess Hospital in Needham, Massachusetts (BIDH-N) agreed to pay $59,701.60 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BIDH-N improperly billed Medicare for Lupron drug injections to male patients under HCPCS Code J1950 when BIDH-N should have known that the proper code for these claims was the lower reimbursed HCPCS Code J9217.
Gary Sinopoli, Jr., M.D. (Sinopoli), Mississippi, agreed to pay $133,333.16 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Sinopoli caused improper claims to be submitted to Medicare from Progressive Physical Medicine, Inc., for physical therapy and related health care items or services that Sinopoli did not personally render or did not directly supervise.
After it self-disclosed conduct to the OIG, Calvin Community, Iowa, agreed to pay $56,663 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Calvin Community employed an individual that it knew or should have known was excluded from participation in Federal health care programs. 03-21-2011
Betty J. Feir, PhD, Texas, agreed to pay $61,270 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Feir billed Federal health care programs for services provided by auxiliary personnel instead of her and for services performed by the auxiliary personnel while she was not present. 03-11-2011
Deaconess Hospital (Deaconess), Indiana, agreed to pay $76,592.52 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Deaconess employed an individual that it knew or should have known was excluded from participation in Federal health care programs. 03-09-2011
Herman T. Palmer, M.D. (Palmer), Mississippi, agreed to pay $29,200 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Palmer caused improper claims to be submitted to Medicare from Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Palmer did not personally render or did not directly supervise.
Logan Emergency Ambulance Service Authority (Logan), West Virginia, agreed to pay $79,176 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Logan employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Edward D. Henderson, Jr., M.D. (Henderson), Mississippi, agreed to pay $68,100 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Henderson caused improper claims to be submitted to Medicare from Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Henderson did not personally render or did not directly supervise.
Chadley T. Vega, M.D. (Vega), Mississippi, agreed to pay $46,200 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Vega caused improper claims to be submitted to Medicare from Primary Physical Medicine, Inc., for physical therapy and related health care items or services that Vega did not personally render or did not directly supervise.
Long Term Care, Inc. (LTC), North Carolina, agreed to pay $170,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that LTC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Alliance Nursing, Inc. (Alliance), Washington, agreed to pay $14,907.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Alliance employed an individual that it knew or should have known was excluded from participation in Federal health care programs. 10-18-2010
Signature Healthcare, LLC (Signature), California, agreed to pay $104,747.06 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Signature employed an individual that it knew or should have known was excluded from participation in Federal health care programs. 09-30-2010
After it self-disclosed conduct to the OIG, Mercy Medical Center and St. Alexius Medical Center (collectively the Centers), North Dakota, agreed to pay $88,331.63 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Centers' employed the same individual that they knew or should have known was excluded from participation in Federal health care programs. 09-02-2010
Hackley Professional Pharmacy, Inc. (Hackley), Michigan, agreed to pay $158,565.97 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Hackley employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Mt. Tam Orthopedics, Inc. (Mt. Tam), California, agreed to pay $106,649.06 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mt. Tam employed an individual that it knew or should have known was excluded from participation in Federal health care programs. 07-09-2010
Beechwood Rehabilitation and Nursing Center (BRNC), Connecticut, agreed to pay $42,203 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BRNC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Adventist Health System d/b/a Huguley Memorial Medical Center (Adventist), Texas, agreed to pay $68,831.82 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Adventist employed an individual that it knew or should have known was excluded from participation in Federal health care programs.06-25-2010
After it self-disclosed conduct to the OIG, San Juan Regional Medical Center (SJRMC), New Mexico, agreed to pay $197,098.07 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SJRMC employed two individuals that it knew or should have known were excluded from participation in Federal health care programs. 06-14-2010
Lake Region Lutheran Home d/b/a Heartland Care Center (Heartland), North Dakota, agreed to pay $133,973.28 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Heartland employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
Elder Service Plan of the North Shore (ESPNS) agreed to pay $308,709.00 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ESPNS contracted with a dentist that ESPNS should have known was excluded from participation in Federal health care programs. ESPNS participates in the Program of All-Inclusive Care for the Elderly (PACE), which receives funding from the Medicare and Medicaid programs. 05-18-2010
After it self-disclosed conduct to the OIG, Tenet Healthcare Corporation and Tenet HealthSystem KNC, Inc., (collectively Tenet), California, agreed to pay $1.9 million for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Tenet submitted claims to the Federal health care programs for clinical research-related items or services rendered at a hospital that were billed to or reimbursed by the Federal health care programs, including: 1) items or services that were paid for by clinical research sponsors or grants under which the clinical research was conducted; 2) items or services that were indicated as free of charge in the research informed consent; 3) items or services that were for research purposes only and not for the clinical management of the patient; and/or 4) items or services that were otherwise not covered under the Centers for Medicare and Medicaid Services Clinical Trial Policy.
After it self-disclosed conduct to the OIG, State University of New York Upstate Medical University Hospital (SUNY), New York, agreed to pay $11,799.29 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SUNY employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, PolyMedica Corporation (PolyMedica), Florida, agreed to pay $151,963.40 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PolyMedica employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, LRG Healthcare d/b/a Lakes Region General Hospital (LRGH), New Hampshire, agreed to pay $42,900.75 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that LRGH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Kinney Drugs (Kinney), New York, agreed to pay $8,002.95 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that a Kinney pharmacist filled unauthorized telephone prescriptions and submitted claims for those prescriptions to Medicare. After it self-disclosed conduct to the OIG, Alpine Health Clinic (Alpine), California, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Alpine submitted false claims for services that were never provided.
After it self-disclosed conduct to the OIG, La Videa Llena, Inc. (LVL) New Mexico, agreed to pay $250,078.11 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that LVL submitted false claims to the United States for oxygen services. Robert J. Kramer and Kramer Physical Therapy Associates, Inc. (KPTA), Massachusetts, agreed to pay $122,474 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Kramer and KPTA improperly billed Medicare for physical therapy services that were not properly supervised by a licensed physical therapist. 01-13-2010
After they self-disclosed conduct to the OIG, Bel Pre Leasing Co, LLC, Liberty Leasing Co, LLC, Marlboro Leasing Co, LLC, Fayette Leasing Co, LLC, RMNH EMP, LLC, CHSI EMP, LLC, Communicare of Columbus, Inc., Prime Care Four, LLC, Regency Leasing Co, LLC, and Resident Care Consulting, LLC, Ohio, agreed to pay $135,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the entities employed two individuals that they knew or should have known were excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Heartland Surgical Specialty Hospital (Heartland), Kansas, agreed to pay $33,187 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Heartland employed an individual that it knew or should have known was excluded from participation in Federal health care programs. 10-31-2009
After it self-disclosed conduct to the OIG, Coram, Inc., New York, agreed to pay $72,500 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Coram, Inc. employed an individual that it knew or should have known was excluded from participation in Federal health care programs. 10-15-2009
After it self-disclosed conduct to the OIG, ABCM Corporation, Iowa, agreed to pay $40,137 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ABCM Corporation employed an individual that it knew or should have known was excluded from participation in Federal health care programs. After it self-disclosed conduct to the OIG, Margaretville Memorial Hospital and Margaretville Nursing Home, Inc., New York, agreed to pay $80,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Margaretville inappropriately billed Medicare Part D and State health care plans for drugs provided by Margaretville Hospital to Margaretville Nursing Home residents when the residents were covered by Medicare Part A. 09-08-2009
After it self-disclosed conduct to the OIG, Pocahontas Manor Care Center (PMCC), Iowa, agreed to pay $106,862 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PMCC employed an individual that it knew or should have known was excluded from participation in Federal health care programs. 09-11-2009
After it self-disclosed conduct to the OIG, Medicalodge of Butler (Medicalodge), Missouri, agreed to pay $67,715.26 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Medicalodge employed an individual that it knew or should have known was excluded from participation in Federal health care programs. 08-12-2009
Clifford Koon, Jeffrey Cowan, and William Dorvall (respondents), Florida, former owners and officers of Matrix, Diabetics, Inc. (a durable medical equipment (DME) company), agreed to pay $260,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the respondents caused Matrix to pay telemarketing firms to make unsolicited telephone calls to Medicare beneficiaries to market DME on behalf of the company. The DME company in turn submitted claims for these items for Medicare reimbursement. Section 1834(a)(17) of the Social Security Act prohibits DME suppliers from making unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of a covered item, except in certain situations that were not present in this case. Section 1834(a)(17)(B) of the Act prohibits payment to a supplier who knowingly submits a claim generated pursuant to prohibited telemarketing calls.
Alexander Zeuli and Physical Therapy Health Services (Respondents), Massachusetts, agreed to pay $18,532 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents improperly billed Medicare under certain CPT codes for physical therapy services when lower reimbursed codes and/or fewer units of these codes should have been billed.
Ravenwood Nursing Home, Inc. (RNH), Maryland, agreed to pay $28,252.95 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that RNH employed an individual that RNH knew or should have known was excluded from participation in Federal health care programs.
Claxton-Hepburn Medical Center (CHMC), New York, agreed to pay $168,597 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CHMC employed two individuals that CHMC knew or should have known were excluded from participation in Federal health care programs.
Wayne Wittenberg, M.D. and his medical practice, Nature Coast Neurosurgery (Respondents), Florida, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
Ediberto Soto-Cora, M.D., Texas, agreed to pay $534,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Soto-Cora submitted false or fraudulent claims by using CPT codes that would generate a higher reimbursement than justified by the medical documentation or that he submitted claims without any supporting medical documentation. 03-13-2009
West Valley Imaging Limited Partnership and two physicians (West Valley), Nevada, agreed to pay $2 million and to enter into a 5-year integrity agreement for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that West Valley performed radiology tests and exams that were not ordered by Medicare beneficiaries' treating physicians. 03-11-2009
After it self-disclosed conduct to the OIG, HealthWorks Rehab & Fitness, (HealthWorks), West Virginia, agreed to pay $8,132.16 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HealthWorks inappropriately billed Medicare for the performance of iontophoresis services, which is not a covered service under Medicare because it is deemed experimental. 01-06-09
Methodist Health Care-Memphis Hospitals (Methodist), Tennessee, agreed to pay $136,627 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Methodist employed an individual that Methodist knew or should have known was excluded from participation in Federal health care programs. 2008
Haven Nursing Home, Inc. (Haven), Maryland, agreed to pay $90,921.06 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Haven employed an individual that Haven knew or should have known was excluded from participation in Federal health care programs. 12-12-2008
After it self-disclosed conduct to the OIG, Ellsworth Municipal Hospital (Ellsworth), Iowa, agreed to pay $46,165.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Ellsworth employed an individual that Ellsworth knew or should have known was excluded from participation in Federal health care programs. 11-18-2008
After it self-disclosed conduct to the OIG, City of Chicago, Illinois, agreed to pay $6.9 million for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the City of Chicago submitted claims to Medicare for ambulance services that were not medically necessary, billed at the wrong level of service, and submitted claims without the patient's or other appropriate person's signature as required by CMS regulations.
After it self-disclosed conduct to the OIG, Skilled Healthcare LLC (Skilled), California, agreed to pay $190,746 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that eight skilled nursing facilities and one rehabilitation services contract provider for which Skilled provided administrative services, including compliance services, employed individuals that Skilled and the nine providers knew or should have known were excluded from participation in Federal health care programs. Skilled paid $190,746 on behalf of the following nine providers: Briarcliff Nursing and Rehabilitation Center LP (Texas), Pacific Healthcare and Rehabilitation Center, LLC (California), Rossville Healthcare and Rehabilitation Center, LLC (Kansas), Town & Country Manor LP (Texas), St. Elizabeth Healthcare and Rehabilitation, LLC (California), Hallmark Rehabilitation GP, LLC (California), Royalwood Care Center, LLC (California), Eureka Healthcare and Rehabilitation Center, LLC (California), and Grenada Healthcare and Rehabilitation Center, LLC (California).
After it self-disclosed conduct to the OIG, Courtyard Manor of Farmington Hills (Courtyard Manor), Michigan, agreed to pay $1.7 million for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Courtyard Manor received federal health care program funds while the entity was excluded. Courtyard Manor also agreed to be excluded from Medicare, Medicaid, and all other Federal health care programs for two years in addition to its original 10-year period of exclusion.
07-26-2008 After it self-disclosed conduct to the OIG, FutureCare Irvington, LLC (FutureCare), Maryland, agreed to pay $36,290.79 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that FutureCare employed an individual that FutureCare knew or should have known was excluded from participation in Federal health care programs.
Whole Health Pharmacy (WHP), Colorado, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that WHP employed an individual that WHP knew or should have known was excluded from participation in Federal health care programs.
07-16-2008 St. Barnabas Hospital, New York, agreed to pay $132,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the hospital employed three individuals that the hospital knew or should have known were excluded from participation in Federal health care programs.
Southern Illinois Healthcare Foundation (SIHF), Illinois, agreed to pay $562,021 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SIHF employed an individual that SIHF knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Sparks Health System, Sparks Medical Foundation, and Sparks Regional Medical Center (collectively, Respondents), Arkansas, agreed to pay $1,142,973 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents billed Medicare for medically unnecessary hospital services.
After it self-disclosed conduct to the OIG, Sabine County Hospital District, Texas, agreed to pay $82,341, for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Sabine fraudulently included a physician recruiting fee on its cost report as a reimbursable expense.
After it self-disclosed conduct to the OIG, Biotronic West, LLC, NeuralWatch, LLC, and The Regents of the University of California, for its University of California Davis Medical Center (collectively, Respondents), agreed to pay $41,488.24 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents employed an individual that the Respondents knew or should have known had been excluded from participation in Federal health care programs.
04-03-2008 After it self-disclosed conduct to the OIG, Caritas Christi, Massachusetts, agreed to pay $250,060 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Caritas Christi employed or contracted with five individuals that Caritas Christi knew or should have known were excluded from participation in Federal health care programs.
Newton Memorial Hospital (NMH), New Jersey, agreed to pay $89,279.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NMH employed an individual that NMH knew or should have known was excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Shands at Alachua General Hospital (Shands), Florida, agreed to pay $119,838 and to enter into a 3-year certification of compliance agreement for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Shands employed an individual that Shands knew or should have known had been excluded from participation in Federal health care programs.