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Provider Self-Disclosure Settlements

Information on the Provider Self-Disclosure Protocol can be found on the Provider Self-Disclosure Protocol page.

2018

12-27-2018
After it self-disclosed conduct to OIG, Williamson Medical, PLLC (Williamson), New York, agreed to pay $20,274.78 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Williamson submitted claims to Medicare and Tricare for incident-to services provided by a physician assistant under a physician's National Provider Identifier when Medicare and Tricare supervision requirements had not been met.
12-21-2018
After it self-disclosed conduct to OIG, Falcon Lake Health Care Ltd. d/b/a Falcon Lake Nursing Home (Falcon Lake), Texas, agreed to pay $25,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Falcon Lake submitted minimum data set (MDS) forms that were not appropriately reviewed for completeness and attested to by a Registered Nurse, as required under Medicare and Medicaid payment rules. OIG contended that the MDS forms were completed and submitted by a Licensed Vocational Nurse who improperly used the electronic signature of a former employee.
12-20-2018
After he self-disclosed conduct to OIG, David Hagan, M.D. (Dr. Hagan), Illinois, agreed to pay $24,027.10 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Hagan submitted claims to Medicare for incident-to services provided by nurse practitioners under his National Provider Identifier when the Medicare supervision requirements had not been met.
After it self-disclosed conduct to OIG, Gibson Community Hospital Association d/b/a Gibson Community Hospital, on behalf of itself and its wholly owned clinic (collectively, "GCH"), Illinois, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that GCH submitted claims to Medicare for incident-to services provided by nurse practitioners under a physician's National Provider Identifier when Medicare supervision requirements had not been met.
12-18-2018
After they self-disclosed conduct to OIG, Cancer Treatment Centers of America Global, Inc., Eastern Regional Medical Center, Inc., Southeastern Regional Medical Center, Inc., Midwestern Regional Medical Center, Inc., Southwestern Regional Medical Center, Inc., Cancer Treatment Centers of America Professional Corporation of Pennsylvania, P.C., Cancer Treatment Centers of America Professional Corporation of Georgia, P.C., Patient First, S.C., and Cancer Treatment Centers of America Professional Corporation of Oklahoma, Inc. (collectively, "CTCA"), headquartered in Florida, agreed to pay $8,220,814.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that CTCA paid improper remuneration to physicians in exchange for their referrals to CTCA's hospitals.
After it self-disclosed conduct to OIG, UMass Memorial Health Alliance - Clinton Hospital, Inc. (UMass HA-Clinton), Massachusetts, agreed to pay $2,331,641.67 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UMass HA-Clinton admitted Medicare beneficiaries and submitted claims for payment without properly documenting that an impatient psychiatric hospitalization was a reasonable and medically necessary treatment for the patient's condition. OIG also alleged that the medical records did not consistently contain the appropriate documentation to satisfy Medicare requirements for continued treatment.
After it self-disclosed conduct to OIG, Quest Diagnostics Incorporated, on behalf of its wholly-owned subsidiary, Cleveland HeartLab (CHL), agreed to pay $2,275,094.25 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. Quest acquired CHL, an Ohio based clinical laboratory, on December 1, 2017. OIG alleged that, during the period August 12, 2010 through June 30, 2014, CHL paid remuneration to physicians and physician groups in the form of collection, processing, and handling payments related to the collection of blood.
11-19-2018
After it self-disclosed conduct to OIG, Milton S. Hershey Medical Center (MHMC), Pennsylvania, agreed to pay $382,074.60 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MHMC provided outpatient radiology imaging services to Federal health care program patients when MHMC's employed radiologists did not provide personal supervision of MHMC's employed radiology assistants.
11-08-2018
After it self-disclosed conduct to OIG, Fox Rehabilitation Services, P.C. (Fox), agreed to pay $261,003 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fox, at a Fox location in New Jersey, 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, Odyssey HealthCare Operating A, LP d/b/a Kindred Hospice (Kindred), agreed to pay $32,224.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kindred, at a Kindred hospice in Arkansas, submitted claims to Federal health care programs for services provided by an unlicensed nurse.
11-01-2018
After it self-disclosed conduct to OIG, McBride Clinic Orthopedic Hospital, LLC d/b/a McBride Orthopedic Hospital (McBride), Oklahoma, agreed to pay $414,649.91 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that McBride improperly submitted claims to Federal health care programs for: (1) professional services related to surgeries performed by two employee-physicians improperly appended by Modifier 51, 58, and/or 59; (2) professional and facility fees related to post-surgical patient visits performed by a licensed practical nurse without physician supervision; and (3) evaluation and management services performed by an employee-physician during office visits improperly appended by Modifier 25 and/or billed as split/shared. OIG further alleged that McBride knew of overpayments and did not report and return those overpayments in accordance with Medicare rules. Specifically, OIG alleged that McBride allowed the accrual of overpayments owed to Medicare and, when McBride became aware of these overpayments through educational audits, it failed to return those overpayments to Medicare.
10-30-2018
After they self-disclosed conduct to OIG, Riverside Spine & Pain Physicians, LLC d/b/a Riverside Spine & Pain Physicians, PL and Riverside Surgical Center, LLC (collectively, "Riverside"), Florida, agreed to pay $1,765,080.48 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Riverside billed for triamcinolone acetonide injections under Healthcare Common Procedure Coding System (HCPCS) Code J3300, but was actually using triamcinolone diacetate, which should have been billed under HCPCS Code J3302.
10-25-2018
After it self-disclosed conduct to OIG, San Luis Obispo County Health Agency (San Luis Obispo), California, agreed to pay $11,885.25 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that San Luis Obispo employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-24-2018
After they self-disclosed conduct to OIG, Presence Care Transformation Corporation, Presence Chicago Hospitals Network, and Presence Central and Suburban Hospitals Network (collectively, "Presence"), Illinois, agreed to pay $461,130.66 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Presence paid remuneration to physicians in the form of: (1) cash equivalent gift cards; (2) excessive compensation for electroencephalography and electromyography interpretation services performed by Presence Resurrection Medical Center; and (3) excessive compensation for medical director services performed for Presence Saints Mary and Elizabeth Medical Center.
10-23-2018
After it self-disclosed conduct to OIG, St. Francis Health, LLC (St. Francis), Georgia, agreed to pay $3,273,181 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that St. Francis paid remuneration to a management company in the form of incentive payments for performance metrics that were not met and were not materially updated to incentivize performance. OIG further contended that St. Francis paid remuneration to a cardiology practice in the form of a forgiven or uncollected debt owed as a result of the practice exceeding the tenant improvement allowances of their lease agreement.
10-04-2018
After it self-disclosed conduct to OIG, HVL Corp., d/b/a The Whittier Pavilion (Whittier), Massachusetts, agreed to pay $87,493.65 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Whittier improperly billed the Medicare and Medicaid programs for outpatient psychotherapy treatment sessions that were not provided as claimed.
10-02-2018
After it self-disclosed conduct to OIG, Detroit Area Agency on Aging (DAAA), Michigan, agreed to pay $583,084.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DAAA contracted with a vendor for the provision of items or services and DAAA knew or should have known the vendor was excluded from participation in Federal health care programs.
09-27-2018
After it self-disclosed conduct to OIG, Orlando Regional Medical Center (ORMC), Florida, agreed to pay $130,158.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ORMC 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, Eye Care Associates, Inc. (ECA), Alabama, agreed to pay $19,934.66 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ECA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-26-2018
After it self-disclosed conduct to OIG, Care Inn of Sequin d/b/a San Gabriel Rehabilitation and Care Center (San Gabriel), Texas, agreed to pay $129,589.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that San Gabriel 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, Surgery Partners, Inc. (SPI) agreed to pay $55,252.32 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SPI, at a SPI location in Beverly Hills, California, 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, Beacon Medical Group, Inc. (Beacon), Indiana, agreed to pay $25,302.96 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Beacon 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, Roots Community Health Center (Roots), California, agreed to pay $13,450.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Roots employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-25-2018
After it self-disclosed conduct to OIG, Froedtert Memorial Lutheran Hospital (Froedtert), Wisconsin, agreed to pay $1,972,729.90 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Froedtert submitted false claims for services rendered in its Wound Care Clinic by registered nurses, where the services were not provided pursuant to appropriate physician or non-physician practitioner supervision.
09-24-2018
After it self-disclosed conduct to OIG, Rex Hospital, Inc. d/b/a UNC Rex Healthcare (Rex), North Carolina, agreed to pay $2,277,762 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. Rex disclosed that it leased an employed physician from a community hospital for the provision of cardiology services at the community hospital. OIG contends that during this time the community hospital paid Rex a fee for the lease of the physician and Rex paid the physician salary and bonus payments for the cardiology services performed by the physician at the community hospital. OIG alleged that Rex offered and paid remuneration in the form of salary and bonus payments to the physician that were in excess of the community hospital's lease fee to Rex and that should have been paid by the community hospital.
After it self-disclosed conduct to OIG, Southern Cancer Center, P.C. (SCC), Alabama, agreed to pay $538,545.67 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SCC allowed the accrual of overpayments owed to the Medicare and Medicaid programs and, when it became aware of these overpayments, it failed to return these overpayments to the Medicare and Medicaid programs.
After they self-disclosed conduct to OIG, Mountain West Derm - Blackhart, PLLC d/b/a Skin Cancer Dermatology Institute and MWD Management, LLC d/b/a United Derm Partners (collectively, "MWD"), Nevada, agreed to pay $105,538.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MWD billed for phototherapy services using CPT Code 96910, which requires the use of a topical agent, when such services should have been billed using CPT Code 96900, which does not involve use of a topical agent.
09-20-2018
After it self-disclosed conduct to OIG, the University of Nevada School of Medicine, Multispecialty Group Practice South, Inc. (UNSOM) agreed to pay $12,194.66 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UNSOM submitted claims to Medicare and Medicaid for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG alleged that UNSOM: (1) billed for hand replantation surgeries that were not provided; (2) billed for a fasciocutaneous advancement flap that was not performed; (3) submitted a claim for a left hand crush injury but the operative report did not support billing for that procedure; and (4) billed for replacement of a breast expander without documentation supporting billing for the CPT code associated with that procedure.
09-14-2018
After it self-disclosed conduct to OIG, The General Hospital Corporation d/b/a Massachusetts General Hospital (Massachusetts General) agreed to pay $35,327.09 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Massachusetts General employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-13-2018
After it self-disclosed conduct to OIG, Via Christi Manhattan Hospital, Inc. (VCMH), Kansas, agreed to pay $3,796,703.97 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that VCMH submitted claims to Federal health care programs for medically unnecessary bronchoscopies that lacked medical documentation.
09-07-2018
After it self-disclosed conduct to OIG, St. Joseph Hospital (St. Joseph), Maine, agreed to pay $14,232.65 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. Joseph 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, Washington Health System Orthopedics and Sports Medicine (WHS), Pennsylvania, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged WHS improperly submitted claims to Medicare for film X-rays without using the FX modifier as required by the Centers for Medicare and Medicaid Services.
08-31-2018
After they self-disclosed conduct to OIG, Daniel Umberger, D.O. and Osteopathic Treatment and Diagnostic Services, P.C. (collectively, "Osteopathic"), New York, agreed to pay $45,843.03 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Osteopathic submitted claims for physical therapy services provided by physical therapists "incident to" physician services when a physician was not present on the premises. OIG also alleged that Osteopathic submitted claims for physical therapy services provided by physical therapy assistants "incident to" physician services that were actually supervised by a physical therapist, not a physician.
08-30-2018
After it self-disclosed conduct to OIG, San Juan Regional Medical Center, Inc. (SJRMC), New Mexico, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that SJRMC paid remuneration that was above fair market value to a physician and his wife for land that was leased pursuant to a ground lease.
08-28-2018
After it self-disclosed conduct to OIG, Adventist Health System Sunbelt Healthcare Corporation (Adventist), Florida, agreed to pay $21,219.17 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Adventist employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-22-2018
After it self-disclosed conduct to OIG, DeWitt Hospital and Nursing Home (DHNH), Arkansas, agreed to pay $123,935.30 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DHNH failed to perform quarterly utilization review audits of patient charts and also failed to obtain consent for care for certain patients as required by Medicare in order to receive an all inclusive rate for covered services provided by rural health care practitioners.
08-21-2018
After it self-disclosed conduct to OIG, Prospect CharterCare RWMC, LLC (Prospect), Rhode Island, agreed to pay $78,525.25 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Prospect submitted claims to Medicare for services provided at free-standing clinics but billed as if they were provided at a provider-based location.
08-07-2018
After it self-disclosed conduct to OIG, Digestive Health Specialists, P.A. (DHS), North Carolina, agreed to pay $478,668 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that DHS received remuneration from two anesthesia practices in the form of free CO2 nasal cannulas and anesthesia-related drugs when the anesthesia practices provided anesthesia services through its employed and contracted anesthesiologists or certified nurse anesthetists at DHS's endoscopy centers.
08-06-2018
After they self-disclosed conduct to OIG, Wahiawa Hospital Association and Wahiawa General Hospital (collectively, "Wahiawa"), agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Wahiawa provided remuneration to a family health center by leasing office space at below fair market value.
08-02-2018
After it self-disclosed conduct to OIG, Monadnock Community Hospital (MCH), New Hampshire, agreed to pay $76,555.18 for alleged violating the Civil Monetary Penalties Law. OIG alleged that MCH submitted false or fraudulent claims to Medicare for intravenous iron therapy for non-End Stage Renal Disease patients with a single diagnosis of iron deficiency.
After it self-disclosed conduct to OIG, Heart of America Medical Center (HAMC), North Dakota, agreed to pay $76,262.06 for alleged violating the Civil Monetary Penalties Law. OIG alleged that HAMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-23-2018
After it self-disclosed conduct to OIG, Steuben County EMS (Steuben County), Indiana, agreed to pay $251,267.19 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Steuben County submitted claims for inter-hospital transports that were improperly billed at the emergency level instead of the non-emergency level.
07-20-2018
After it self-disclosed conduct to OIG, St. Agnes Healthcare, Inc. d/b/a St. Agnes Hospital (St. Agnes), Maryland, agreed to pay $257,594.16 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. Agnes submitted improper claims for a combination of CPT codes 93965 (noninvasive physiologic studies of extremity veins, complete bilateral study) and 93970/93971 (duplex scan of extremity veins, complete bilateral study/unilateral or limited study) for the same patient on the same date of service when the codes represent technologies that serve the same diagnostic purpose.
07-19-2018
After it self-disclosed conduct to OIG, Central City Community Health Center, Inc. (CCCHC), California, agreed to pay $112,335.57 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CCCHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-17-2018
After it self-disclosed conduct to OIG, Digestive Health Specialists, P.A. (DHS), North Carolina, agreed to pay $91,910.01 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DHS submitted claims to Federal health care programs for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG alleged that: (1) DHS submitted claims to Federal health care programs for ultrasound examinations performed at its medical office in Winston-Salem, using Current Procedural Terminology (CPT) Code 76775, when the type of ultrasound procedure performed did not support use of that code; and (2) DHS submitted claims to Federal health care programs for Remicade infusion treatments performed at its medical offices in Winston-Salem and Thomasville, using CPT Code 96415 when the duration of the infusion in certain instances did not support billing under that code.
07-16-2018
After they self-disclosed conduct to OIG, Community Dialysis Center, and its affiliates Center for Dialysis Care, Inc., Nephrology Associates of Cleveland, Ltd., ARC/CDC, Ltd., ARM/CDC, Ltd., Nephrology Associates Oakwood, Ltd., Center for Dialysis Care Home Care, and The Center for Dialysis Care at Heather Hill (collectively, "CDCI"), Ohio, agreed to pay $307,609.80 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CDCI employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-09-2018
After it self-disclosed conduct to OIG, West End Fire Company No. 3 of Phoenixville (West End), Pennsylvania, agreed to pay $24,231.69 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that West End staffed its ambulance transportation services with an individual who had not maintained registration of his Emergency Medical Technician certification with the appropriate state authority. West End then submitted claims and received payments from Federal health care programs for those transport services.
07-02-2018
After it self-disclosed conduct to OIG, Midwest Regional Medical Center, LLC d/b/a Alliance Health Midwest (Midwest), Oklahoma, agreed to pay $111,927.85 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Midwest employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-26-2018
After it self-disclosed conduct to OIG, United Family Practice Health Center (UFPHC), Minnesota, agreed to pay $518,710 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UFPHC submitted claims for services to Medicare patients that did not have proper documentation. Specifically, OIG alleged that UFPHC knew or should have known that the claims it presented for reimbursement for HCPCS codes G0402, G0438, G0439 were not properly supported by the medical record.
06-25-2018
After it self-disclosed conduct to OIG, Steward Medical Group, (SMG), Massachusetts, agreed to pay OIG $196,677 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SMG presented improper claims to federal health care programs for: (1) physician office visits by established patients of an employed physician; and (2) intraoperative ultrasounds during partial nephrectomies under CPT code 76998-26. OIG alleged these claims were improper because they were not supported by accurate medical record documentation.
After it self-disclosed conduct to OIG, Schryver Medical, LLC (Schryver), Colorado, agreed to pay $35,837.75 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Schryver employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-21-2018
After it self-disclosed conduct to OIG, NorthStar Services (NorthStar), Nebraska, agreed to pay $74,615.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NorthStar employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-11-2018
After it self-disclosed conduct to OIG, Magee Benevolent Association d/b/a Magee General Hospital (Magee), Mississippi, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Magee provided remuneration to physicians and physician practices in the form of office space, transcription services, and/or personnel services at rates that were below fair market value. OIG further alleged that the remuneration described above created financial relationships and that Magee presented claims for designated health services that resulted from the prohibited referrals.
06-08-2018
After it self-disclosed conduct to OIG, LSU Health Sciences Center Shreveport (LSU Health Shreveport), Louisiana, agreed to pay $732,854.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LSU Health Shreveport, in certain cases of three or more concurrent neurosurgical procedures performed at its partner hospital, submitted claims for physician services by teaching surgeons when those services were supervisory services to the hospital rather than a physician service to individual patients.
After it self-disclosed conduct to OIG, Tremont Rehabilitation and Skilled Care Center (TRSCC), Massachusetts, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Tremont employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-01-2018
After it self-disclosed conduct to OIG, Adventist Health System Sunbelt Healthcare Corporation (Adventist), Florida, agreed to pay $671,461.17 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Adventist employed two individuals that it knew or should have known were excluded from participation in Federal health care programs
After it self-disclosed conduct to OIG, Join Implant Surgeons, Inc. (JIS), Ohio, agreed to pay $11,491.55 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that JIS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-23-2018
After it self-disclosed conduct to OIG, Millennium Healthcare Management, Inc. (MHM), with locations in Louisiana, agreed to pay $321,411 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MHM submitted claims at twelve urgent care centers that were not supported by sufficient documentation to justify the assigned code level, primarily because: (1) there was insufficient detail on the Patient Family and Social History component in the patient's record, and/or (2) there was insufficient detail to support the inclusion of Medical Decision Making as a component in determining the code level.
05-21-2018
After it self-disclosed conduct to OIG, Aspen Trace Health and Living Community (ATHLC), Indiana, agreed to pay $16,115.25 717 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ATHLC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-15-2018
After they self-disclosed conduct to OIG, HVHC LLC; Visionworks of America, Inc., formerly known as Eye Care Centers of America, Inc.; Visionary Properties, Inc.; Visionworks, Inc., formerly known as Eyemasters, Inc.; and Empire Vision Center, Inc. (collectively, "Visionworks"), headquartered in Texas, agreed to pay $3,668,961 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Visionworks paid excess remuneration to certain optometrists in the form of space and equipment leases that were below fair market value and/or by failing to collect one or more rental amounts under space and equipment leases.
After it self-disclosed conduct to OIG, Cheyenne Regional Medical Center (CRMC), Wyoming, agreed to pay $2,099,462.30 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that CRMC paid remuneration to a physician practice pursuant to a Practice Lease Agreement, where the remuneration was greater than fair market value or was for costs that the physician practice should have borne.
After it self-disclosed conduct to OIG, Monadnock Community Hospital (MCH), New Hampshire, agreed to pay $498,717 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MCH submitted claims to Medicare for technical services associated with Transthoracic Echocrdiograms performed by two non-credentialed individuals.
After they self-disclosed conduct to OIG, the Count of Sullivan and Sullivan County Ambulance Services (Sullivan County), Indiana, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Sullivan County submitted claims for reimbursement to Medicare for ambulance services provided by an employee crew member who lacked a current EMT certification for the State of Indiana.
05-14-2018
After it self-disclosed conduct to OIG, Kettering Medical Center d/b/a Kettering Behavioral Medicine Center (Kettering), Ohio, agreed to pay $1,298,249 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kettering submitted claims for group psychotherapy services provided by unlicensed mental health technicians.
After it self-disclosed conduct to OIG, Chesapeake Eye Care and Laser Center, P.C. (Chesapeake), Maryland, agreed to pay $613,617.39 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Chesapeake improperly billed for services rendered by new providers under already-credentialed provider's Medicare Provider Transaction Access Numbers or National Provider Numbers.
After it self-disclosed conduct to OIG, Bronx Physical Therapy and Rehabilitation (Bronx PT), New York, agreed to pay $13,587 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bronx PT submitted claims for services provided by an unlicensed physical therapist.
05-09-2018
After it self-disclosed conduct to OIG, Advanced Urology Institute, LLC (AUI), Florida, agreed to pay $716,518.89 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AUI submitted claims to Medicare and Medicaid for radiation oncology services without providing the requisite level of physician supervision for those services.
04-27-2018
After it self-disclosed conduct to OIG, Tuscarawas County General Health District (Tuscarawas), Ohio, agreed to pay $55,203.42 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Tuscarawas employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-24-2018
After it self-disclosed conduct to OIG, Hartford Hospital, Connecticut, agreed to pay $423,017.45 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Hartford Hospital provided remuneration to a medical practice in the form of office space, where Hartford Hospital charged the practice rent at less than fair market value. The remuneration created a financial relationship between Hartford Hospital and the practice that caused Hartford Hospital to present claims for health services that resulted from prohibited referrals in violation of the Stark law.
04-19-2018
After it self-disclosed conduct to OIG, Pecos County Memorial Hospital (Pecos), Texas, agreed to pay $136,436.94 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pecos billed for services by an employed physician who included incomplete or inappropriate documentation for the level of visit billed, submitted documentation of re-occurring or frequency of visits not meeting medical necessity guidelines, or who duplicated progress notes on multiple visits.
04-12-2018
After it self-disclosed conduct to OIG, DLP Marquette General Hospital, LLC for Marquette General Hospital (Marquette), Michigan, agreed to pay $545,663.69 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Marquette presented claims for reimbursement on behalf of a physician for hyperbaric oxygen therapy which were excessive.
04-05-2018
After it self-disclosed conduct to OIG, Shands Teaching Hospital and Clinics, Inc. d/b/a UF Health Shands (Shands), Florida, agreed to pay $249,413 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Shands employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-02-2018
After they self-disclosed conduct to OIG, BenchMark Rehabilitation Partners, LLC, BenchMark Growth Partners, LLC, BenchMark Premier Partners, LLC, BenchMark East Partners, LLC, BenchMark Development Partners, LLC and BenchMark West Partners, LLC (collectively, "BenchMark"), with locations in Tennessee, Georgia, Alabama, South Carolina, North Carolina, Texas and Kansas, agreed to pay $3,157,771.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BenchMark submitted claims to Medicare and Tricare for time-based outpatient rehabilitation therapy services provided when Benchmark's therapists did not provide constant attendance or direct one-on-one contact because the therapy services were provided concurrently with another Medicare or Tricare beneficiary.
After it self-disclosed conduct to OIG, The Mary Lanning Memorial Hospital Association d/b/a Mary Lanning HealthCare (Mary Lanning HealthCare), Nebraska, agreed to pay $677,239.56 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mary Lanning HealthCare contracted with a hospital for one of its employed physician to provide professional medical services, on a part-time bases to patients at Mary Lanning HealthCare's Blue Hill Clinic, a rural health clinic owned and operated by Mary Lanning HealthCare. The physician reassigned his billing rights for services performed under the agreement to Mary Lanning HealthCare, which then billed for his services. OIG alleged the physician documented and billed E&M; codes for services performed in nursing homes that were not medically necessary and did not meet the requirements of the E&M; code billed and Mary Lanning HealthCare billed for these codes.
03-29-2018
After it self-disclosed conduct to OIG, Tri-Med Ambulance, LLC (Tri-Med), Washington, agreed to pay $71,880.66 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Tri-Med filed duplicate claims for ambulance transportation services provided to Medicare beneficiaries. Additionally, OIG alleged that Tri-Med identified the overpayments related to the submission of these duplicate claims, but Tri-Med failed to timely return those overpayments.
03-28-2018
After it self-disclosed conduct to OIG, Allen's Nursing Home, d/b/a South Kingstown Nursing and Rehabilitation Center (SKNRC), Rhode Island, agreed to pay $42,734.62 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SKNRC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-25-2018
After it self-disclosed conduct to OIG, Copiah Community Care Center, LLC d/b/a Copiah Living Center (Copiah), Mississippi, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Copiah employed an unlicensed individual to provide nursing services as a Licensed Practical Nurse that were paid for by Federal health care programs.
03-12-2018
After it self-disclosed conduct to OIG, Christian Living Neighborhoods (CLN), Colorado, agreed to pay $42,775.78 or allegedly violating the Civil Monetary Penalties Law. OIG alleged that CLN submitted claims for services provided by an unlicensed nurse at one of its skilled nursing facilities.
03-08-2018
After it self-disclosed conduct to OIG, AGA Home Health, Inc. (AGA), Utah, agreed to pay $77,817.56 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AGA submitted claims to Medicare for unnecessary home health services that lacked medical documentation.
03-07-2018
After it self-disclosed conduct to OIG, City of Hammond (Hammond), Indiana, agreed to pay $247,752.17 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Hammond submitted claims for ambulance transports by crew members that lacked a current EMT-Basic certification.
03-05-2018
After it self-disclosed conduct to OIG, Florida Hospital Medical Group, Inc. (FHMG), Florida, agreed to pay $298,242 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that FHMG submitted claims for outpatient and inpatient hospital visits by an employed physician when those outpatient and inpatient visits were not performed.
02-23-2018
After it self-disclosed conduct to OIG, Nazareth Hall d/b/a Nazareth Living Care Center (Nazareth), Texas, agreed to pay $3,910,846.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Nazareth did not follow Medicare requirements when submitting Change of Therapy forms for rehabilitative therapy services.
02-20-2018
After it self-disclosed conduct to OIG, Scotland Memorial Hospital, Inc. (Scotland), North Carolina, agreed to pay $252,455.56 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Scotland submitted claims in violation of the provider-based billing requirements for sleep diagnostic and treatment services provided at Scotland Sleep Center and as a result was paid more than it should have been by Medicare and TRICARE.
02-13-2018
After it self-disclosed conduct to OIG, Northwell Health Inc. (Northwell), New York, agreed to pay $12,736,087 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Northwell hospitals submitted claims to Medicare that they knew or should have known did not meet the requirements of Medicare Local Coverage Determination, "Veterbroplasty and Vertebral Augmentation - Percutaneous, L26439," because the supporting documentation for those claims failed to demonstrate: (1) that non-surgical medical treatment typically lasting at least six weeks had failed, or (2) the existence of pathological fracture (including osteoporotic fracture), and not simply a fracture attributable to traumatic causes.
02-09-2018
After they self-disclosed conduct to OIG, CHRISTUS Health and CHRISTUS Santa Rosa Health Care Corporation, d/b/a Santa Rosa Hospital (collectively, "CHRISTUS"), agreed to pay $148,095 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to physician self-referrals and kickbacks. OIG alleged that CHRISTUS paid remuneration that was above fair market value to a medical distributorship owned by a physician in exchange for the physician's referrals of Federal healthcare beneficiaries to two hospitals owned and operated by CHRSITUS hospitals.
After they self-disclosed conduct to OIG, Fennis Bledsoe and Atlanta Dental Clinic, Inc. (collectively, "Atlanta Dental"), Indiana, agreed to pay $125,446 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Atlanta Dental submitted claims to Indiana Medicaid for dental services provided by non-credentialed dentists under the names of dentists who were credentialed with Indiana Medicaid.
02-08-2018
After it self-disclosed conduct to OIG, Highland Rivers Community Service Board, d/b/a Highland Rivers Health (Highland Rivers), Georgia, agreed to pay $133,067.26 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Highland Rivers submitted or caused the submission of claims for psychiatric telehealth services provided to Medicare beneficiaries at certain Highland Rivers locations when the locations were not eligible for Medicare telehealth reimbursement because they were not "originating sites".
01-31-2018
After they self-disclosed conduct to OIG, Central Virginia Pharmacy Consultants, PC d/b/a Rustburg Family Pharmacy and James V. Ettare II (collectively, "Rustburg"), Virginia, agreed to pay $60,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rustburg submitted false and fraudulent claims to Medicare Part D for compounded drugs that used bulk pharmaceutical powder, instead of crushed tablets of Food and Drug Administration approved drugs.
01-30-2018
After they self-disclosed conduct to OIG, Shands Jacksonville Medical Center, Inc. d/b/a UF Health Jacksonville (Medical Center) and University of Florida Jacksonville Physicians, Inc. (UFJPI), Florida, agreed to pay $4,476,123.63 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the Medical Center and UFJPI presented claims to Medicare and Medicaid for hospital and professional services associated with surgical procedures performed by an ophthalmologist, at the Medical Center, when the record did not support medical necessity for the procedures performed.
01-23-2018
After it self-disclosed conduct to OIG, Miller Holdings Sunrise, Inc. d/b/a Sunrise Homes (Sunrise Homes), Ohio, agreed to pay $15,815.88 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Sunrise Homes employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-17-2018
After it self-disclosed conduct to OIG, Wahiawa General Hospital (Wahiawa), Hawaii, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Wahiawa employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-05-2018
After it self-disclosed conduct to OIG, St. Agnes Healthcare, Inc. (St. Agnes), Maryland, agreed to pay $2,231,722.50 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that St. Agnes paid remuneration to a physician in the form of excessive compensation that included an inflated salary and improper incentive and administrative payments.
01-03-2018
After it self-disclosed conduct to OIG, East Tennessee Personal Care Services, LLC (ETPCS), Tennessee, agreed to pay $85,131.56 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ETPCS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2017

12-22-2017
After it self-disclosed conduct to OIG, Cavalier County Memorial Hospital Association (CCMHA), North Dakota, agreed to pay $750,000 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that CCMHA paid improper remuneration to two physicians and a nurse practitioner in the form of excessive compensation. OIG also contended that such remuneration created prohibited financial relationships with the two physicians and that CCMHA presented claims for designated health services that resulted from prohibited referrals made by the physicians.
12-20-2017
After it self-disclosed conduct to OIG, Seton Medical Center (Seton), California, agreed to pay $27,225 for alleged violating the Civil Monetary Penalties Law. OIG alleged that Seton submitted claims to Medicare for cataract extraction procedures when it did not supply the specialized Intraocular Lens (IOL) and should not have been reimbursed for the IOL supply.
12-19-2017
After it self-disclosed conduct to OIG, Heart Center of Philadelphia, P.C. (Heart Center), Pennsylvania, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Heart Center received remuneration from a laboratory company in the form of "process, handling, and collection" payments related to the collection of blood. OIG also contended that Heart Center received remuneration from the laboratory company in the form of "consulting" fees. OIG contended that Heart Center received the remuneration from the laboratory company in exchange for Heart Center referring patients for laboratory testing services, which were paid by Federal health care programs.
12-12-2017
After they self-disclosed conduct to OIG, Meriwether Healthcare, LLC d/b/a Warm Springs Medical Center and Warm Springs Nursing Home (collectively, "Warm Springs"), Georgia, agreed to pay $253,398.32 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Warm Springs 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, Friendly Medical Transportation, LLC (FMT), North Carolina, agreed to pay $54,812.25 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that FMT employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-06-2017
After it self-disclosed conduct to OIG, HVL Corp d/b/a The Whittier Pavilion (Whittier), Massachusetts, agreed to pay $51,021 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Whittier 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, Keystone Behavioral Pediatrics, LLC (Keystone), Florida, agreed to pay $26,245.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Keystone presented claims to TRICARE for behavioral health supervision services that were not actually provided.
12-01-2017
After they self-disclosed conduct to OIG, Kennon Stuart Legacy Trusts and the QTIP Trust, through its companies Victoria Special Care Center, Inc. d/b/a Shea Family Care Victoria and Magnolia Special Care Center, Inc. d/b/a Shea Family Care Magnolia (collectively, "Shea Family Care"), California, agreed to pay $399,700.45 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Shea Family Care employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
11-09-2017
After it self-disclosed conduct to OIG, Fisher & Paykel Healthcare, Inc. (Fisher & Paykel), California, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Fisher & Paykel paid remuneration to durable medical equipment suppliers that took the form of credits of amounts the suppliers owed for resupply services provided when continuous positive airway pressure masks, nasal interfaces, and headgear manufactured by affiliated entities of Fisher & Paykel were resupplied.
11-06-2017
After they self-disclosed conduct to OIG, Arkansas Family Care Network, P.A., Michael Beard, M.D., and Michael Kittell, M.D. (collectively, "AFCN"), agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that AFCN solicited and received remuneration from a laboratory company in the form of "process and handling" payments related to the collection of blood. OIG contended that AFCN solicited and received the remuneration in exchange for AFCN referring patients for laboratory testing services, which were paid by Medicare.
11-03-2017
After it self-disclosed conduct to OIG, EyeCare Associates of East Texas (ECA), Texas, agreed to pay $13,562.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ECA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-26-2017
After it self-disclosed conduct to OIG, St. Vincent Frankfurt Hospital, Inc. (SVFH), Indiana, agreed to pay $120,066.17 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that SVFH provided remuneration to a physician practice and a physician in the form of medical office spaces, where SVFH charged the practice and the physician rent at less than fair market value.
10-25-2017
After it self-disclosed conduct to OIG, DaVita Medical Management Services Nevada, LLC (DaVita), Nevada, agreed to pay $3,320,483.34 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DaVita submitted claims to Federal health care programs for Routine Home Care and General Inpatient services, provided by a hospice company DaVita acquired, when the medical record did not support the patient's eligibility for those hospice services or the level of care provided.
10-10-2017
After it self-disclosed conduct to OIG, MAS Medical Staffing Corporation (MAS), Rhode Island, agreed to pay $93,703.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MAS employed an individual, on a per diem basis on behalf of healthcare providers, that it knew or should have known was excluded from participation in Federal health care programs.
10-06-2017
After it self-disclosed conduct to OIG, OSF Healthcare System, d/b/a OSF Home Care Services (OSF), Illinois, agreed to pay $188,620.79 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OSF submitted claims to Medicare and Medicaid for skilled nursing services provided by a nurse whose license was suspended and therefore was ineligible to provide such nursing services.
09-28-2017
After it self-disclosed conduct to OIG, Humana Inc. (Humana), headquartered in Kentucky, agreed to pay $411,600 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Humana knowingly made or used false records or statements material to false or fraudulent claims for payment for items and services furnished under a Federal health care program. Specifically, OIG alleged that Humana knowingly made "meaningful use" attestations as part of its participation in the Centers for Medicare & Medicaid Services Electronic Health Records Incentive Program.
09-06-2017
After it self-disclosed conduct to OIG, Adventist Health System Sunbelt Healthcare Corporation d/b/a AHS Information Services (AHS), Florida, agreed to pay $101,435.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AHS 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, Adventist Health System Sunbelt Healthcare Corporation d/b/a Rx Plus Pharmacy (Rx Plus), Florida, agreed to pay $15,437.12 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rx Plus employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-01-2017
After it self-disclosed conduct to OIG, Leroy R. Polite, D.M.D., P.A., d/b/a Economy Dentures and Economy Dentistry (Economy Dentures), Florida, agreed to pay $279,135 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Economy Dentures employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-24-2017
After it self-disclosed conduct to OIG, Apex Dermatology and Skin Surgery Center, LLC (Apex), Ohio, agreed to pay $125,070.71 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Apex employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-14-2017
After it self-disclosed conduct to OIG, OSF Healthcare System, d/b/a OSF St. Francis Hospital & Medical Group (OSF), Michigan, agreed to pay $1,143,152.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OSF submitted claims for physical therapy services provided by personnel who were not eligible to bill Federal health care programs for those services.
08-01-2017
After it self-disclosed conduct to OIG, Nurse Practitioner Health Services, LLC (NPHS), Ohio, agreed to pay $22,846.38 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NPHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-27-2017
After it self-disclosed conduct to OIG, UMC Physicians, formerly known as UMC Physician Network Services (UMCP), Texas, agreed to pay $3,364,079 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UMCP improperly filed claims with Federal health care programs for: (1) evaluation and management services; and (2) Doppler and Ultrasound testing services that were upcoded, not rendered, or otherwise not supported by the record.
07-11-2017
After it self-disclosed conduct to OIG, Volunteer Medical Services Corps of Lansdale (VMSCL), Pennsylvania, agreed to pay $26,795.70 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that VMSCL staffed its ambulance transport services with an individual who had not maintained registrations of his Emergency Medical Technician certification with the appropriate state authority and then submitted claims and received payment from Federal health care programs for those transport services.
07-06-2017
After it self-disclosed conduct to OIG, Arvada, Colorado Fire Protection District (AFPD), Colorado, agreed to pay $30,494.36 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AFPD staffed its ambulance transport services with two individuals whose paramedic certifications were expired and then submitted claims and received payment from Federal health care programs for these improperly staffed ambulance transport services.
06-23-2017
After it self-disclosed conduct to OIG, Calvert Physical Therapy and Sports Fitness Center (Calvert), Maryland, agreed to pay $368,740.59 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that: (1) Calvert submitted claims to Medicare, Medicaid and TRICARE for therapeutic services that required direct one-to-one patient contact when the physical therapist was treating more than one patient at the same time: and (2) submitted claims to Medicare for patient re-evaluations when the physical therapist was recertifying Medicare patients' existing plans of care. OIG further alleged that Calvert improperly submitted claims to Medicare, Medicaid, and TRICARE for physical therapy services that failed to meet documentation requirements for time spent with patients and modalities used to treat patients.
06-16-2017
After it self-disclosed conduct to OIG, Laboratory Corporation of America (LabCorp), agreed to pay $45,466.13 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LabCorp, at a lab in Florida, employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-13-2017
After it self-disclosed conduct to OIG, Children's National Medical Center (CNMC), Washington, D.C., agreed to pay $615,263.42 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CNMC knowingly presented to Federal health care programs claims for services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, CNMC submitted claims for outpatient pediatric primary care services that it knew or should have known were furnished by medical students without required supervision.
06-12-2017
After they self-disclosed conduct to OIG, Central Maine Medical Center and Central Maine Health Care Corporation (collectively, "CMMC"), and Comprehensive Pharmacy Services, Inc. (CPS), Maine, agreed to pay $196,929 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CMMC, who had a contract with CPS to staff and manage its hospital pharmacies, employed an individual that CMMC and CPS knew or should have known was excluded from participation in MaineCare and that no MaineCare program payments could be made for items or services furnished by the individual.
06-02-2017
After it self-disclosed conduct to OIG, Tobii Dynavox, LLC (Tobii), Pennsylvania, agreed to pay $163,952.01 for allegedly violating the Civil Monetary Penalties Law provisions applicable to beneficiary inducements and kickbacks. OIG alleged that Tobii improperly induced Medicare and TRICARE beneficiaries to buy Tobii's products by waiving cost-sharing amounts without conducting an individualized determination of financial need.
05-16-2017
After it self-disclosed conduct to OIG, UnityPoint at Home (UnityPoint), Iowa, agreed to pay $18,562.95 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UnityPoint employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-11-2017
After it self-disclosed conduct to OIG, BrightView, LLC (BrightView), Ohio, agreed to pay $19,935.59 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BrightView employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-10-2017
After it self-disclosed conduct to OIG, Abingdon Convalescent Ambulance Service, Inc. (Abingdon), Pennsylvania, agreed to pay $20,087.98 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Abingdon submitted claims to Federal health care programs for ambulance transportation services provided an employee as if that employee had the EMT-Intermediate certification when, in fact, the employee had the EMT-Basic certification.
04-28-2017
After it self-disclosed conduct to OIG, Madison Parish Hospital Service District d/b/a Madison Parish Hospital (MPH), Louisiana, agreed to pay $1,800,000 for allegedly violating the Civil Monetary Penalties Law, including provisions applicable to physician self-referrals and kickbacks. OIG alleged that MPH: (1) improperly submitted claims to Medicare related to certain inpatient admissions; (2) received remuneration in the form of inpatient Computed Tomography equipment and services provided below fair market value (FMV) from an independent diagnostic testing facility (IDTF) and paid remuneration to the IDTF in the form of below FMV medical office space and support services; and (3) improperly reported illegal remuneration from hospital vendors paid to a former CEO on MPH cost reports then used by the Medicare and Medicaid program to calculate reimbursement rates to MPH, resulting in overpayments.
04-24-2017
After it self-disclosed conduct to OIG, Ambulance Service of Fulton County, Inc. (Fulton), New York, agreed to pay $150,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fulton submitted claims to Federal health care programs for ambulance transportation services provided to beneficiaries which were improper because Fulton did not obtain the required beneficiary signatures.
04-21-2017
After it self-disclosed conduct to OIG, Samaritan Pacific Health Services, Inc. (Samaritan Pacific), Oregon, agreed to pay $263,700 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Samaritan Pacific paid remuneration to a medical practice in the form of office space use without a written lease or payment of rent.
After it self-disclosed conduct to OIG, Samaritan North Lincoln Hospital (Samaritan North), Oregon, agreed to pay $60,300 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Samaritan North paid remuneration to a medical practice in the form of office space use without a written lease or payment of rent.
04-20-2017
After they self-disclosed conduct to OIG, David Yoon, M.D., David Yoon, MD PA, and Primary Care Physicians, Inc. (collectively, "Dr. Yoon"), Florida, agreed to pay $379,085 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Yoon submitted false claims to Medicare for: (1) services rendered by providers who were not enrolled in the Medicare program; and (2) services rendered by non-physician providers as "incident to" when the "incident to" requirements under Medicare were not met.
04-18-2017
After it self-disclosed conduct to OIG, Pafford Medical Services, Inc. (Pafford), Arkansas, agreed to pay $390,587.18 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pafford 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, Custom Clinic, PA d/b/a Smart Clinic (Smart Clinic), Minnesota, agreed to pay $24,696.18 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Smart Clinic submitted Chronic Care Management services under Current Procedural Terminology (CPT) Code 99490 that were not provided or that were not provided as required by CPT Code 99490.
After it self-disclosed conduct to OIG, Allergy Partners, P.A. (Allergy Partners), North Carolina, agreed to pay $14,638.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Allergy Partners submitted claims to Medicare for allergen immunotherapy injections provided without the requisite physician supervision.
04-06-2017
After it self-disclosed conduct to OIG, the Board of Trustees of the University of Illinois (University of Illinois), Illinois, agreed to pay $39,405.05 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the University of Illinois improperly billed neurosurgical procedures in the name of a physician who was not the appropriate physician to bill for the services.
03-21-2017
After it self-disclosed conduct to OIG, North Central Health Care Facilities (North Central), Wisconsin, agreed to pay $50,612.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that North Central employed an individual for the provision of items or services for which payment may be made under a Federal health care program. OIG alleged that North Central knew or should have known that the individual was not a licensed nurse, as she represented in certain employment related documentation, and that no Federal health care program payments could be made for items or services furnished by the unlicensed individual.
03-17-2017
After it self-disclosed conduct to OIG, Crittenton Hospital Medical Center (CHMC) and Crittenton Cancer Center (CCC), Michigan, agreed to pay $3,274,153.90 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that CHMC and CCC (1) paid more than fair market value compensation for prohibited financial arrangements with a physician and entities owned by that physician and (2) had compensation arrangements with the physician and entities owned by that physician that were at times not set forth in writing and, when a writing existed, did not act in accordance with the terms set forth therein. OIG further alleged that the remuneration described above created an inappropriate financial relationship and that CHMC and CCC presented claims for designated health services that resulted from the prohibited referrals.
After it self-disclosed conduct to OIG, Child and Family Services of New Hampshire (CFS), New Hampshire, agreed to pay $177,000 for allegedly violating the Civil Monetary Penalties Law. CFS administers a Healthy Families Home Visit (HFHV) program for low income, Medicaid eligible, pregnant women, to ensure coordinated social services pre and post birth. OIG alleged that CFS caused claims to be submitted to Medicaid for HFHV services that it knew or should have known were not provided as claimed by one of its case workers.
03-13-2017
After it self-disclosed conduct to OIG, Highland Medical, P.C. (Highland), New York, agreed to pay $403,151 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Highland submitted claims to Federal health care programs for Evaluation and Management Services purportedly provided by an employed physician, which were not rendered.
03-03-2017
After it self-disclosed conduct to OIG, Carroll Manor Nursing and Rehabilitation Center (Caroll Manor), Washington, D.C., agreed to pay $1,962,227.92 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Caroll Manor submitted claims to Medicare for therapy that lacked a physician certification for the plan of care and/or proper documentation for the number of therapy minutes billed.
02-28-2017
After it self-disclosed conduct to OIG, Quest Diagnostics, Incorporated (Quest), New Jersey, agreed to pay $1,151,053.07 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that: (1) phlebotomists employed by Quest performed services at multiple locations in Texas, Maryland, Ohio and New Jersey that were outside the scope of their employment; (2) Quest failed to meet documentation requirements supporting its donation of valuable electronic health records software or information technology and services through donation agreements with individuals or entities from which Quest received referrals of clinical laboratory business; and (3) Quest failed to collect timely second-year payments from physician clients as required in electronic health record donation agreements.
02-16-2017
After it self-disclosed conduct to OIG, Athena Orchard View LLC d/b/a Orchard View Manor (Orchard View), Rhode Island, agreed to pay $61,576.22 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Orchard View employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-08-2017
After it self-disclosed conduct to OIG, Metro Health Corporation and its subsidiary, Metropolitan Hospital d/b/a Metro Health Hospital (Metro Health), Michigan, agreed to pay $2,305,743.39 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Metro Health entered into professional services agreements with two independent contractor physician groups for the provision of neurosurgical and general surgery services and paid the physician groups in excess of fair market value.
After it self-disclosed conduct to OIG, OhioHealth Corporation (OhioHealth), Ohio, agreed to pay $231,277.60 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OhioHealth employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.
02-06-2017
After it self-disclosed conduct to OIG, Health Services, Inc. (Health Services), Alabama, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Health Services employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
02-01-2017
After it self-disclosed conduct to OIG, Ridgeview Institute, Inc. (Ridgeview), Georgia, agreed to pay $29,113.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Ridgeview employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-30-2017
After it self-disclosed conduct to OIG, Ocean Dental of Arkansas, PC (ODA), Arkansas, agreed to pay $17,346 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ODA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-24-2017
After it self-disclosed conduct to OIG, Quest Diagnostics, Incorporated (Quest), agreed to pay $315,093.35 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Quest, at one of its laboratories in New Jersey, paid remuneration in the form of greater than fair market value rent for space, which was related to a medical practice that referred patients to Quest.
01-23-2017
After it self-disclosed conduct to OIG, Staten Island University Hospital (SIUH), New York, agreed to pay $1,132,489.61 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SIUH knowingly submitted claims to Medicare for walk-in and home-drawn lab services that were performed at one of SIUH's outpatient lab facilities that it knew or should have know were false because they lacked sufficient documentation in one or more of the following areas: (1) the claims at issue lacked a signature or adequate medical documentation supporting the physician's intent to have the lab test performed, (2) the claims at issue lacked a date of request for lab services to be performed, or (3) the claims at issue for home-drawn lab services lacked a physician's order directing collection of the specimen in a patient's home.
01-13-2017
After it self-disclosed conduct to OIG, Planned Parenthood Great Plains and Comprehensive Health of Planned Parenthood Great Plains (collectively, "PGP"), Kansas, agreed to pay $18,808.92 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PGP submitted claims to Medicaid where the services were (1) provided by advanced registered nurse practitioners (ARNPs) but were billed improperly under a supervisory physician's name and national provider identifier, and (2) provided by ARNPs who were not properly enrolled or credentialed under the Medicaid program and were billed improperly under a supervisory physician's name and national provider identifier.
01-06-2017
After it self-disclosed conduct to OIG, St. Joseph Hospital, Breese, of the Hospital Sisters of the Third Order of St. Francis (SJHB), Illinois, agreed to pay $421,692.35 for allegedly violating the Civil Monetary Penalties. OIG alleged that SJHB knowingly presented to Federal health care programs claims for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that two independent contractor physicians affiliated with SJHB improperly permitted clinical staff to use: (1) signature stamps on physician order forms; (2) pre-signed physician orders; and (3) physician orders signed by clinical staff on their behalf with their knowledge.

2016

12-28-2016
After it self-disclosed conduct to OIG, New LifeCare Hospitals of Northern Nevada, LLC d/b/a Tahoe Pacific Hospitals (New Life Care), Nevada, agreed to pay $57,425.51 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that New LifeCare 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, KaleidAScope, Inc. (KaleidAScope), Pennsylvania, agreed to pay $18,468.30 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that KaleidAScope submitted claims for individual/intake therapy sessions that were billed as four units of service in fifteen-minute increments, instead of one unit of service.
After it self-disclosed conduct to OIG, Wexner Heritage Village (Wexner), Ohio, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Wexner employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-23-2016
After it self-disclosed conduct to OIG, Dr. Henry Tripp, Oldtown Immediate Care, P.A d/b/a Old Town Immediate and Family Care, and Ameri-Care Family Practice, P.A. (collectively, Dr. Tripp), North Carolina, agreed to pay $133,880.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Tripp submitted claims to Medicare for nurse practitioner services as if Dr. Tripp personally performed the services. These claims should have been submitted to Medicare using the nurse practitioner's National Provider Identifier at the nurse practitioner rate.
12-22-2016
After it self-disclosed conduct to OIG, Alternative Consulting Enterprises, Inc. (ACE), Pennsylvania, agreed to pay $126,102.38 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ACE employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-21-2016
After it self-disclosed conduct to OIG, the City of Grand Junction, Colorado (Grand Junction), agreed to pay $25,288.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Grand Junction staffed its ambulance transport services with two individuals whose Emergency Medical Technician (EMT) Basic or EMT Paramedic certifications were expired. Grand Junction then submitted claims and received payment from Federal health care programs for these improperly staff ambulance transport services.
11-30-2016
After it self-disclosed conduct to OIG, Antelope Valley Hospital (AVH), California, agreed to pay $190,087.90 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AVH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-21-2016
After it self-disclosed conduct to OIG, San Luis Obispo Count (San Luis), California, agreed to pay $56,583.68 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that San Luis excused clients from their drug and alcohol group counseling sessions prior to the scheduled end of the sessions, but billed the Medicaid program as if the sessions had been completed.
11-18-2016
After it self-disclosed conduct to OIG, Dignity Health (Dignity), agreed to pay $368,364.69 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to beneficiary inducements, physician self-referrals and kickbacks. OIG alleged that at one of Dignity's facilities in California, Dignity offered and paid the following remuneration in connection with an arrangement to induce referrals from physician specialists at a community physician practice: (a) medical equipment provided without charge and without a written agreement; (b) payments made to the physician practice for teaching physician supervision services that were not provided as claimed; (c) payments to a physician for services that were not provided as claimed; (d) payment for medical waste disposal services provided to the physician practice by a third party; (e) free medical supplies provided to the physician practice; (f) free taxi vouchers provided to patients of the physician practice; (g) food, drinks and baby shower gifts provided to patients of the physician practice; and (h) payments to two physicians for liaison marketing services that were not provided.
11-17-2016
After it self-disclosed conduct to OIG, Scheurer Hospital, Michigan, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Scheurer Hospital paid remuneration to a physician in the form of lodging costs.
11-10-2016
After it self-disclosed conduct to OIG, Ridgewood Medical Health, PLLC (Ridgewood), New York, agreed to pay $29,744 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Ridgewood submitted claims to Medicare for services provided by physician assistants at the rate payable for physician services instead of at the lower rate payable for physician assistant services.
10-26-2016
After it self-disclosed conduct to OIG, Our Lady of Lourdes (Lourdes), Washington, agreed to pay $55,575.00 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Lourdes paid remuneration to various members of its medical staff including physicians in the form of gift cards to local restaurants.
10-19-2016
After it self-disclosed conduct to OIG, Miller EMS, LLC (Miller), Oklahoma, agreed to pay $64,921.67 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Miller submitted claims to Federal health care programs for ambulance transportation services provided by an Emergency Medical Technician (EMT) as if she was properly licensed as an EMT, when, in fact she was not properly licensed. OIG alleged that Miller did not meet the staffing requirements and, therefore, the services were not provided as claimed and the claims were false or fraudulent.
10-18-2016
After it self-disclosed conduct to OIG, Memorial Hermann Health System (MHHS), Texas, agreed to pay $5,652,628.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MHHS improperly submitted claims to Federal health care programs for certain outpatient services that automatically appended modifiers 59 or 91 to Current Procedural Terminology codes.
10-11-2016
After they self-disclosed conduct to OIG, Muscogee (Creek) Nation Department of Health, acting on behalf of its subsidiary Creek Nation Hospital and Clinics d/b/a Creek Nation EMS (collectively, "Creek"), Oklahoma, agreed to pay $171,767.52 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Creek submitted claims to Federal health care programs for services provided by an unlicensed emergency medical technician.
After it self-disclosed conduct to OIG, Affinity Health System, a wholly owned subsidiary of Ministry Health Care (Affinity), Wisconsin, agreed to pay $50,000.00 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Affinity, as the parent company of two hospitals, entered into an improper financial relationship with a medical group practice involving an arrangement for the two hospitals to provide ultrasound equipment, space, and staff to the medical group practice for less than fair market value.
09-30-2016
After it self-disclosed conduct to OIG, Orthopedic Center of Vero Beach, P.A. (OCVB), Florida, agreed to pay $46,904.95 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OCVB billed for services provided by a physician using previously recorded consultation notes written by other physicians as his initial admitting history and physician examination and failing to generate his own patient encounter notes.
09-28-2016
After it self-disclosed conduct to OIG, Drug Abuse Comprehensive Coordinating Office, Inc. (DACCO), Florida, agreed to pay $32,189.76 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DACCO employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-27-2016
After it self-disclosed conduct to OIG, Pediatric Plus Home Healthcare Services, LLC (Pediatric Plus), Indiana, agreed to pay $68,353.34 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pediatric Plus employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-26-2016
After it self-disclosed conduct to OIG, Costco Wholesale Corporation (Costco), agreed to pay $340,157.25 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Costco's pharmacy manager at its pharmacy located in Waltham, Massachusetts improperly altered prescription drug claims to Medicare Part D and the Massachusetts Medicaid program that resulted in high reimbursement from these programs than was appropriate.
09-21-2016
After they self-disclosed conduct to OIG, Consulate Health Care and Vero Beach Facility Operations, LLC d/b/a Consulate Health Care of Vero Beach (collectively, "Consulate Vero Beach"), Florida, agreed to pay $30,978.42 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Consulate Vero Beach employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-19-2016
After they self-disclosed conduct to OIG, American Professional Associates, LLC and Atlanta Oncology Associates, LLC (collectively, "APA/AOA"), Georgia, agreed to pay $125,905.45 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that APA/AOA submitted claims for radiation oncology and related services without direct physician supervision by a radiation oncologist or similarly qualified person, and/or without timely review by a radiation oncologist.
After they self-disclosed conduct to OIG, Vantage Oncology, LLC, Radiation Oncology Services of America, Inc., and ROSA of Georgia, LLC (collectively, "Vantage"), Georgia, agreed to pay $91,172.91 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Vantage submitted claims for radiation oncology and related services without direct physician supervision by a radiation oncologist or similarly qualified person, and/or without timely review by a radiation oncologist
09-16-2016
After it self-disclosed conduct to OIG, Metroplex Adventist Hospital, Inc. d/b/a Metroplex Hospital (Metroplex), Texas, agreed to pay $115,279.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Metroplex paid remuneration to a physician in the form of: (1) waived late fees for unpaid rent, and (2) office space leasing agreements, which improperly calculated the square footage actually used by the physician, and which did not include any payments for certain shared space.
09-14-2016
After it self-disclosed conduct to OIG, Achievement Center, Inc. (AC), Pennsylvania, agreed to pay $16,523.55 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AC submitted false claims to Medicaid for behavioral specialist services purported to be provided by a Behavioral Specialist Consultant employed by AC, but that were not in fact rendered or were not supported by documentation. OI contends that the Behavioral Specialist Consultant (1) provided insufficient documentation in the progress notes and/or patient charts to justify the time billed, (2) provided recorded/time-stamped signatures that did not match billed times, (3) included non-reimbursable services in the progress notes, and (4) completed/signed progress notes for other individuals while providing services to an identified client.
09-08-2016
After it self-disclosed conduct to OIG, Stony Brook University Hospital (Stony Brook), New York, agreed to pay $3,219,483.45 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Stony Brook failed to timely obtain re-certification statements for inpatient psychiatric services furnished to Medicare Part A beneficiaries with stays of more than 11 days, which resulted in more reimbursement from Medicare than would otherwise have been paid. OIG also contends that Stony Brook failed to properly code daily activities in its New York Medicaid-qualified Continuing Day Treatment Program, which resulted in improper Medicare Part B reimbursement for non-covered services to dual-eligible beneficiaries.
09-07-2016
After it self-disclosed conduct to OIG, CareGivers America Home Health Services, LLC (CareGivers), Pennsylvania, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that CareGivers paid remuneration to an independent contractor for their recommendation of CareGivers' home health services to physicians.
09-01-2016
After it self-disclosed conduct to OIG, Med Solutions, LLC (Med Solutions), New Jersey, agreed to pay $429,683.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Med Solutions double billed Medicare Part B for vials of Remicade, a physician-administered injectable medication used to treat autoimmune diseases. Med Solutions was permitted to administer partial vials of Remicade to avoid product waste, but was not permitted to bill for the same vial more than once.
After they self-disclosed conduct to OIG, Jason A. Joy, DC (Joy) and Joy Chiropractic, PA d/b/a Joy Family and Sports Chiropractic (JFSC), Kansas, agreed to pay $12,494.27 for allegedly violating the Civil Monetary Penalties Law. OIG contends that Joy and JFSC knowingly presented to Medicare Part B claims for items or services that they knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG alleged that Joy provided chiropractic care in the State of Kansas when he was not actively licensed as a chiropractor in the State because he failed to timely renew his chiropractic license.
08-17-2016
After it self-disclosed conduct to OIG, Rutherford County, North Carolina, Department of Emergency Medical Services (Rutherford), North Carolina, agreed to pay $652,671.53 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rutherford presented claims to Medicare and TRICARE for non-emergency transportation services that Rutherford knew or should have known were not provided as claimed and were false and fraudulent because they did not have valid Physician Certification Statement (PCS) forms as required. Specifically, OIG contended that the documentation for such transports either did not include a PCS form certifying the transport or contained PCS forms with: (1) falsified dates, cut and pasted signatures, and/or forged signatures by Rutherford's former Quality Assurance Specialist; (2) signatures dated after the transport date; or (3) photocopied or inaccurate signatures from providers.
After it self-disclosed conduct to OIG, Richland Memorial Hospital, Inc. (Richland), Illinois, agreed to pay $29,932.86 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Richland employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-12-2016
After it self-disclosed conduct to OIG, Buffalo Heart Group (BHG), New York, agreed to pay $13,084.73 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BHG employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-05-2016
After they self-disclosed conduct to OIG, Beth Israel Deaconess Hospital-Needham and Medical Care of Boston Management, Inc. d/b/a Affiliated Physicians Group (collectively, "BIDMC"), Massachusetts, agreed to pay $154,506.84 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BIDMC employed an individual that BIDMC knew or should have known was excluded from participation in Federal health care programs.
08-03-2016
After it self-disclosed conduct to OIG, Compliance Advantage, LLC (CAL), Kentucky, agreed to pay $32,249.15 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CAL employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-02-2016
After they self-disclosed conduct to OIG, UMass Memorial Health Care, Inc.; UMass Memorial Medical Center, Inc.; and the Clinton Hospital Association (collectively, "UMass"), Massachusetts, agreed to pay $30,299.27 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UMass employed an individual that UMass knew or should have known was excluded from participation in Federal health care programs.
07-29-2016
After they self-disclosed conduct to OIG, Cheshire Medical Center (CMC) and Dartmouth-Hitchcock Clinic (DHC), New Hampshire, agreed to pay $1,424,271 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CMC and DHC submitted claims to Medicare for Level I Evaluation and Management services for its Coumadin Clinic patients that were not performed as billed and/or were not medically necessary.
07-27-2016
After it self-disclosed conduct to OIG, Fort Worth Manor Nursing Center (Fort Worth Manor), Texas, agreed to pay $113,820.91 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fort Worth Manor employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-26-2016
After it self-disclosed conduct to OIG, Greene Memorial Hospital (GMH) and Fort Hamilton Hospital (FHH), Ohio, agreed to pay $748,968.33 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that GMH and FHH submitted claims to Federal health care programs for radiation oncology and related services when the services were provided without direct supervision by a radiation oncologist or similarly qualified person.
07-21-2016
After it self-disclosed conduct to OIG, Mayo Clinic Health System - Franciscan Medical Center, Inc. (Mayo Clinic), Wisconsin, agreed to pay $219,357.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mayo Clinic: (1) submitted claims to Federal health care programs for psychotherapy services allegedly provided by a psychiatrist using blended Current Procedural Terminology (CPT) Code 90805 or 90807, where the services were not billable, or where only Evaluation and Management service CPT Code 99212 or 99213 should have been billed; and (2) submitted claims to Federal health care programs for psychotherapy services allegedly provided by a psychiatrist, and billed each claim using CPT Code 90833, 90836, or 90838, where the services were not billable, or where only CPT Code 99212 or 99213 should have been billed.
07-15-2016
After they self-disclosed conduct to OIG, Buckner Elam Medical (BEM) and Setal Rana, M.D. (Dr. Rana), Texas, agreed to pay $435,481.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BEM and Dr. Rana employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
07-14-2016
After it self-disclosed conduct to OIG, O'Connor Hospital, California, agreed to pay $207,698 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that O'Connor Hospital employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-12-2016
After it self-disclosed conduct to OIG, Carolina Kidney Associates, P.A. (CKA), North Carolina, agreed to pay $11,805.48 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CKA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-11-2016
After it self-disclosed conduct to OIG, Doctors' Anesthesia Associates, Inc. (DAA), West Virginia, agreed to pay $519,058.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DAA submitted claims to Medicare and Medicaid for reimbursement for services personally performed by an anesthesiologist when, in fact, the services had been performed at least in part by licensed and certified registered nurse anesthetists who were not properly credentialed under the Medicare and Medicaid program.
07-07-2016
After it self-disclosed conduct to OIG, Medical Resources Group (MRG), Michigan, agreed to pay $362,515.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that MRG improperly paid remuneration to a surgical center and its owners through a side letter to a professional service agreement, signed by an employee of MRG without express authorization.
After it self-disclosed conduct to OIG, Palisades Health Care Partners, Inc. d/b/a ASAP Services Corporation (ASAP Services), District of Columbia, agreed to pay $66,647.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ASAP Services employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-06-2016
After it self-disclosed conduct to OIG, Gateway Healthcare, Inc. (Gateway), Rhode Island, agreed to pay $400,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Gateway employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.
After they self-disclosed conduct to OIG, New York Physicians LLP (NYP) and Lewis P. Schneider, M.D. (Dr. Schneider), New York, agreed to pay $57,839.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NYP and Dr. Schneider knowingly presented or caused to be presented to Medicare Part B beneficiaries and extra "office fee" ranging from $50 to $2,000 per patient for the convenience of performing colonoscopies and/or endoscopies in-office instead of at a hospital in violation of an assignment agreement.
After it self-disclosed conduct to OIG, Natera, Inc. (Natera), California, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Natera employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-24-2016
After it self-disclosed conduct to OIG, Five Star Quality Care-CA LLC d/b/a Lancaster Healthcare Center (Lancaster), California, agreed to pay $8,601,795 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Lancaster submitted claims for skilled nursing services without proper certifications and recertifications for services, establishment and content of therapy plans, and/or maintenance of clinical records. OIG also alleged that Lancaster paid remuneration to a physician for referrals pursuant to a medical director agreement.
After it self-disclosed conduct to OIG, Planned Parenthood Health System, Inc. (Planned Parenthood), incorporated in North Carolina, agreed to pay $1,572,752.80 for potentially violating the Civil Monetary Penalties Law. Planned Parenthood submitted claims to Medicaid programs in North Carolina, South Carolina, Virginia and West Virginia that included the following billing errors: (1) services billed under a provider number different than the medical professional who provided the service and (2) billed for services of non-physician practitioners who were not properly enrolled in their state Medicaid program.
After it self-disclosed conduct to OIG, Moses H. Cone Memorial Hospital Operating Corporation d/b/a Cone Health System (CHS), North Carolina, agreed to pay $475,220.66 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHS 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, Boston University Eye Associates, Inc. (BUEA), Massachusetts, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that BUEA provided improper remuneration in the form of holiday gifts, consisting primarily of candy and other small food items, to physicians and physician practices who were referral sources.
06-23-2016
After it self-disclosed conduct to OIG, Community Care Physicians, P.C. (CCP), New York, agreed to pay $60,972.04 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CCP employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
06-20-2016
After it self-disclosed conduct to OIG, Medical Plaza Family and Geriatric Physician, P.A. (Medical Plaza), North Carolina, agreed to pay $109,975.24 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Medical Plaza submitted claims to Medicare for payment under two physicians' National Provider Identification numbers for incident-to services provided to patients at Medical Plaza when the services had been provided by Medical Plaza's nurse practitioners.
06-17-2016
After it self-disclosed conduct to OIG, Radiology Alliance, PC (Radiology Alliance), Tennessee, agreed to pay $355,461.34 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Radiology Alliance submitted claims to Federal health care programs that were false or fraudulent in the following ways: (1) services were performed by two radiology practitioner assistants that were supervised by Radiology Alliance's physicians as if they were personally provided by the physicians; (2) in certain instances Radiology Alliance billed for nursing practitioner and physician assistant services using the supervising physician's billing number at the supervising physician's billing rate; and (2) billed for the insertion of peripherally inserted central catheter lines by hospital nurses and radiology technicians that were supervised by Radiology Alliance's physicians as if those services were directly provided by the physicians.
After it self-disclosed conduct to OIG, UHS of Fairmount, Inc. d/b/a Fairmount Behavioral Health System (Fairmount), Pennsylvania, agreed to pay $58,339.74 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fairmount employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-09-2016
After it self-disclosed conduct to OIG, St. Vincent Medical Group, Inc. (St. Vincent), Indiana, agreed to pay $523,135.76 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. Vincent submitted claims to Federal health care programs for evaluation and management services where the services where upcoded or where the supporting documentation did not support any billable services.
After it self-disclosed conduct to OIG, CNY Women's Healthcare, P.C. (CNY), New York, agreed to pay $123,122.44 65 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CNY submitted claims to Federal health care programs for services provided by a physician that lacked documentation or lacked sufficient documentation.
05-24-2016
After it self-disclosed conduct to OIG, Prime Pharmacy Solutions, LLC (PPS), Louisiana, agreed to pay $613,671.22 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PPS submitted claims for compound drug prescriptions to Federal health care programs that overstated the amount of ingredients actually dispensed, or included more than an amount prescribed by the physician.
After it self-disclosed conduct to OIG, ZMS1 LLC, d/b/a The Medicine Shoppe Pharmacy, in Kissimmee, Florida (ZMS), agreed to pay $35,313.05 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ZMS submitted claims to Federal health care programs for compound drug prescriptions when it knew or should have known the claims overstated the amount of the active ingredient Lipoderm actually dispensed.
05-19-2016
After it self-disclosed conduct to OIG, Regional Medical Laboratory, Inc. (RML), Oklahoma, agreed to pay $1,095,279.69 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that RML paid remuneration to a medical group in the form of a profit-splitting arrangement related to on-site clinical reference laboratory services for non-governmental business which induced the referral of business for which the government was the payer.
After it self-disclosed conduct to OIG, UHS of Westwood Pembroke, Inc. d/b/a Pembroke Hospital (Pembroke Hospital), Massachusetts, agreed to pay $807,856.65 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pembroke Hospital employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Fort Duncan Medical Center, L.P. d/b/a Fort Duncan Regional Medical Center (FDRMC), Texas, agreed to pay $545,995.62 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that FDRMC 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, BHC Streamwood Hospital, Inc. d/b/a Streamwood Behavioral Health System (SBHS), Illinois, agreed to pay $285,683.03 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SBHS 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, UHS of Dover, LLC d/b/a Dover Behavioral Health System (DBHS), Delaware, agreed to pay $197,320.85 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DBHS 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, UHS of Texoma, Inc. d/b/a Texoma Medical Center (TMC), Texas, agreed to pay $127,001.69 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that TMC 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, TBD Acquisition, LLC d/b/a Brook Hospital-Dupont (BHD), Kentucky, agreed to pay $119,033.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BHD 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, La Amistad Residential Treatment Center, LLC d/b/a Central Florida Behavioral Hospital (CFBH), Florida, agreed to pay $26,744.55 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CFBH 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, UHS of Parkwood, Inc. d/b/a Parkwood Behavioral Health System (PBHS), Mississippi, agreed to pay $13,092.48 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PBHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-18-2016
After it self-disclosed conduct to OIG, Health Recovery Services, Inc. (HRS), Ohio, agreed to pay $213,564.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HRS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-06-2016
After it self-disclosed conduct to OIG, Anesthesia and Pain Management Services of Pueblo, LLC and APM Billings, LLC (collectively, "APM"), Colorado, agreed to pay $207,923 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that APM forged physician signatures on Colorado Medical Assistance Program Sterilization Consent Forms and submitted these forms to Colorado Medicaid in order to receive reimbursement for anesthesia services provided during tubal ligation. OIG also alleged that APM improperly submitted claims for reimbursement for services provided by Certified Registered Nurse Anesthetists whose Medicare credentialing forms were forged.
After it self-disclosed conduct to OIG, Where The Heart Is (WTHI), Tennessee, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that WTHI employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-05-2016
After it self-disclosed conduct to OIG, Sheridan Community Hospital (Sheridan), Michigan, agreed to pay $124,800 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Sheridan received improper remuneration from a physician practice and provided improper remuneration to physicians/physician practices and that this conduct violated physician self-referral and kickback prohibitions.
After it self-disclosed conduct to OIG, 125 Alma Boulevard Operations LLC d/b/a Island Health and Rehabilitation Center (IHRC), Florida, agreed to pay $30,924.11 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that IHRC 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, AHS Oklahoma Physician Group, LLC d/b/a Utica Park Clinic (UPC), Oklahoma, agreed to pay $13,467.01 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UPC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-12-2016
After it self-disclosed conduct OIG, Diversicare Healthcare Services, Inc. (Diversicare), headquartered in Delaware, agreed to pay $514,424 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Diversicare employed four individuals that it knew or should have known were excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Marias Care Center (Marias), Montana, agreed to pay $85,952.72 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Marias employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-05-2016
After it self-disclosed conduct to OIG, Union County General Hospital (Union County), New Mexico, agreed to pay $45,458.10 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Union County presented false or fraudulent claims to Medicare for services purportedly provided or supervised by a physician when he was not present at Union County and his presence was required.
03-22-2016
After it self-disclosed conduct to OIG, Senior Care Centers and Midland SCC, LLC d/b/a Senior Care Midland (collectively, Senior Care), Texas, agreed to pay $162,171.36 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Senior Care employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-18-2016
After it self-disclosed conduct to OIG, St. John Hospital and Medical Center (St. John), Michigan, agreed to pay $79,167 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that St. John paid remuneration in excess of fair market value to an independent contractor physician oncology group with which it entered into a professional services agreement. OIG alleged that St. John improperly compensated the oncology group based on work relative value units (wRVU) that the oncology group did not personally perform.
03-15-2016
After it self-disclosed conduct to OIG, Samuel U. Rogers Health Center (SURHC), Missouri, agreed to pay $196,013.37 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that SURHC submitted claims to Missouri Medicaid for imaging services without pre-authorization, as required under Missouri Medicaid, and resubmitted claims for services that had been denied with a CPT code not reflective of the services rendered, resulting in improper payment.
03-14-2016
After it self-disclosed conduct to OIG, Lahey Health System, Inc. on behalf of its current subsidiaries and affiliates Lahey Clinic Hospital, Inc. (LCH), Northeast Senior Health Corporation, and Visiting Nurse Association of Middlesex-East, Inc. (collectively, Lahey), Massachusetts, agreed to pay $1,923,993 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Lahey received remuneration from home health agencies in the form of free administrative services related to discharge planning provided by the home health agencies staff serving as liaisons for their respective home health agency employers. Specifically, OIG contends that, without any written contract, some of the functions performed by the home health agency employees were functions that ordinarily would have been performed by LCH discharge planners or other LCH staff, and those services constituted improper remuneration. After it self-disclosed conduct to OIG, Northeast Kingdom Human Services, Inc. (NKHS), Vermont, agreed to pay $50,712.27 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NKHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-26-2016
After it self-disclosed conduct to OIG, Consulate Health Care (Consulate), Florida, agreed to pay $359,388.10 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Consulate employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Consulate Health Care and Perry Village Facility Operations, LLC d/b/a The Manor at Perry Village (collectively, Perry Village), Florida, agreed to pay $29,324.36 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Perry Village 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, Good Samaritan Society HCBS-Choice, LLC d/b/a Choice Home Health Care (CHHC), Texas, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-22-2016
After it self-disclosed conduct to OIG, Decatur County Memorial Hospital (Decatur), Indiana, agreed to pay $3,757,615.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Decatur improperly submitted claims for home health care where the underlying patient files contained the following deficiencies: (1) venipuncture identified as the only skilled service furnished for purposes of justifying Medicare home health eligibility; (2) missing or incomplete documentation; (3) certifications and orders unsigned or undated by physicians; (4) lack of documentation to support the patient's skilled need or homebound status; and (5) documentation indicating that the requisite physician face-to-face encounter was not timely performed, or the absence of any face-to-face encounter documentation.
After it self-disclosed conduct to OIG, Cedars-Sinai Medical Center (Cedars), California, agreed to pay $872,925 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Cedars submitted claims to Federal health care programs for outpatient and inpatient professional services on behalf of a physician that were not provided as claimed or for which there was insufficient documentation to support the level of professional services claimed.
After it self-disclosed conduct to OIG, Hamilton Medical Group, Inc. (Hamilton), Louisiana, agreed to pay $259,746.37 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Hamilton submitted claims to Medicare and Medicaid for upcoded patient bills to reflect higher levels of services than were actually warranted.
02-05-2016
After it self-disclosed conduct to OIG, Napa County Health & Human Services Agency (Napa), California, agreed to pay $35,064.19 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Napa submitted claims to the Medicaid program, through the California Department of Health Service, for services provided by an employee of Napa's Public Health Division that were not provided as claimed.
After it self-disclosed conduct to OIG, Specialized Physical Therapy, P.C. (SPT), Oklahoma, agreed to pay $22,635.77 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that two SPT employees submitted false and fraudulent physical therapy claims on SPT's behalf to Medicare. OIG contended that the claims submitted on behalf of SPT were false and fraudulent because (1) the services were billed as one-on-one patient/therapist encounters where group therapy services were provided; (2) the services did not accurately reflect the amount of time spent administering therapy for time based CPT codes; (3) the services were provided by a physical therapy assistant who was not properly supervised; and/or (4) some services were provided by unlicensed and unqualified individuals.
After it self-disclosed conduct to OIG, Scott & White Memorial Hospital (S&W;), Texas, agreed to pay $19,146.08 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that S&W; employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-27-2016
After it self-disclosed conduct to OIG, Liberty Medical Center (Liberty), Montana, agreed to pay $60,649.29 for allegedly violating the civil Monetary Penalties Law. OIG alleged that Liberty submitted claims to Medicare for erroneously billed Hospital Based Ambulatory Care services that were performed by Liberty's clinic as though they were provided in the hospital section of Liberty.
01-21-2016
After it self-disclosed conduct to OIG, Berkeley HeartLab, Inc. (Berkeley) and Celebra Corp. (Celebra), California, agreed to pay $750,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Berkeley and Celebra submitted claims to Medicare for clinical laboratory services performed on blood specimens previously submitted by the ordering physician or other health care professional that lacked indicia of medical necessity.
After they self-disclosed conduct to OIG, Delaware Valley Community Health, Inc. (DVCH) and Fairmount Primary Care Center (FPCC), Pennsylvania, agreed to pay $27,061.58 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DVCH and FPCC employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
01-11-2016
After it self-disclosed conduct to OIG, Claxton-Hepburn Medical Center (CHMC), New York, agreed to pay $23,483.39 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-07-2016
After it self-disclosed conduct to OIG, Somerset Cardiology Group, P.C. (Somerset), New Jersey, agreed to pay $422,741.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Somerset knowingly presented claims to Medicare for items or services that it knew or should have known were not provided as claims and were false and fraudulent. Specifically, OIG contended that Somerset cloned patient progress notes, as well as improperly coded and submitted for payment to Medicare E&M; services that used current procedural terminology codes to reflect a higher level of service than the cardiologists actually preformed resulting in higher payments by Medicare to which Somerset was not entitled.
After they self-disclosed conduct to OIG, Trilogy Health Services, LLC (Trilogy) and PCA-Corrections, LLC (PCA), Kentucky, agreed to pay $80,526 for allegedly violating the Civil Monetary Penalties Law provisions applicable to beneficiary inducements and kickbacks. OIG alleged that Trilogy and PCA improperly induced Medicare beneficiaries to fill their drug prescriptions at PCA locations by waiving Medicare Part D prescription drug copayment amounts without conducting an individualized determination of financial need for residents at 50 skilled nursing and assisted living facilities owned and/or serviced by Trilogy or PCA.
01-06-2016
After it self-disclosed conduct to OIG, Precision Toxicology, LLC (Precision), California, agreed to pay $30,137.69 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Precision employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2015

12-30-2015
After it self-disclosed conduct to OIG, The Passavant Memorial Area Hospital Association (Passavant), Illinois, agreed to pay $275,000.22 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Passavant paid remuneration to a clinic in the form of compensation purportedly for the services of two physicians where delivery of the services could not be confirmed with documentation or otherwise.
12-23-2015
After it self-disclosed conduct to OIG, Bradshaw Medical Clinic, PC (Bradshaw), Tennessee, agreed to pay $24,637.76 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bradshaw submitted claims to Federal health care programs for: (1) services provided "incident-to" a physician's services when the services were not provided "incident-to" a physician's services; (2) services not provided as claimed; (3) non-reimbursable services; and (4) services where the Patient Encounter Form was missing and resulted in the correctness of payment not being verifiable.
After it self-disclosed conduct to OIG, Kindred Transitional Care and Rehab-Wyomissing (Kindred), Pennsylvania, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kindred employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-22-2015
After it self-disclosed conduct to OIG, Towson University Speech Language & Hearing Center (Towson), Maryland, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Towson submitted claims for audiology services with a National Provider Identification (NPI) number that did not correctly identify the provider that rendered those audiology services. OIG further alleged that for these services to be paid by Medicare, the audiologist must have been credentialed by Medicare as a provider and that audiologist's NPI number must accompany the claim.
After it self-disclosed conduct to OIG, Our Lady of Lourdes Hospital at Pasco (Lourdes), Texas, agreed to pay $460,173.45 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Lourdes paid remuneration to eight physicians in the form of arrangements for medical office building space and certain support services and supplies.
12-21-2015
After it self-disclosed conduct to OIG, Renown Health (Renown), Nevada, agreed to pay $598,213.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Renown failed to execute a written lease with a physician tenant and had provided for actual use of office space and provision of personnel beyond what the parties initially discussed and agreed. OIG further alleged that Renown paid remuneration to the physician in the form of office space and the services of medical assistant, patient access representative, a clinic dietician and a registered nurse.
After it self-disclosed conduct to OIG, Mercy Health Services, Inc. (Mercy), Maryland, agreed to pay $253,899 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Mercy paid remuneration to a spine center in the form of the services of a physician's assistant. OIG further alleged that the physician's assistant provided on-call services to the spine center without a written agreement in place and without any compensation paid to Mercy.
After it self-disclosed conduct to OIG, Caro Community Hospital (Caro), Michigan, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Caro paid remuneration to two physicians in the form of professional liability insurance premium payments to induce both physicians to continue seeing patients at Caro's hospital facility.
After it self-disclosed conduct to OIG, Dayem Health Services, LLC and its owner, Dr. Michael Dayem (collectively, Dayem), Ohio, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dayem employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-18-2015
After it self-disclosed conduct to OIG, Webster MA SNF, LLC d/b/a Webster Manor Rehabilitation and Health Care Center (Webster), Massachusetts, agreed to pay $18,454.44 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Webster employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-16-2015
After it self-disclosed conduct to OIG, Sports & Orthopedic Rehabilitation, P.L.L.C. d/b/a STAR Spine and Sport (STAR), Colorado, agreed to pay $19,095.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that STAR submitted claims to Medicare for items or services that were preferred by a physician's assistant for "incident-to" services using a STAR physician's provider identification number during times when the physician was not supervising the physician's assistant in accordance with Medicare guidelines.
12-09-2015
After it self-disclosed conduct to OIG, Indianapolis Osteopathic Hospital, Inc. d/b/a Westview Hospital Physicians (Westview), Indiana, agreed to pay $61,755 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Westview submitted claims to Medicare, Medicaid, and TRICARE for evaluation and management services allegedly performed by a physician, where the medical record documentation for the services failed to support the level of services billed and/or lacked physician credentials and signatures.
12-08-2015
After it self-disclosed conduct to OIG, Webster Manor Long Term Care Facility, Inc. (Webster Manor), Massachusetts, agreed to pay $92,881.76 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Webster Manor 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, Kroger Co. (Kroger), Ohio, agreed to pay $21,523,047 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kroger: 1) employed 14 excluded individuals who were excluded from participation in Federal health care programs; and 2) filled prescriptions, for which payment was made under a Federal health care program, that were written by 84 excluded prescribers.
12-02-2015
After it self-disclosed conduct to OIG, The Lowell General Hospital (Lowell), Massachusetts, agreed to pay $225,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Lowell paid remuneration to a physician in the form of monthly payments under a written agreement to serve as a medical director of a specialty facility. Although the facility never came into existence, OIG alleged that, nevertheless, Lowell continued to make the monthly payments to the physician under the agreement.
11-23-2015
After it self-disclosed conduct to OIG, Northampton Manor, Inc. d/b/a Northampton Manor Health Care Center, Magnolia Management, Inc., Perini Services, Inc., and the Perini Family Trust (collectively, Northampton), Maryland, agreed to pay $183,450.97 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Northampton employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-12-2015
After it self-disclosed conduct to OIG, Signature Medical Group, Inc. (Signature), Missouri, agreed to pay $158,297.72 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Signature submitted claims to Medicare for pelvic floor electrical stimulation services rendered by a physician that failed to meet applicable coding and documentation requirements.
10-30-2015
After it self-disclosed conduct to OIG, Providence Hospital (Providence), Washington, D.C., agreed to pay $50,665.20 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Providence 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, Van Rue, Inc. d/b/a Vancrest Health Care Center (Vancrest), Ohio, agreed to pay $35,117.64 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Vancrest employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-22-2015
After it self-disclosed conduct to OIG, Community Health United Home Care, LLC (CHUHC), Alabama, agreed to pay $9,800,707 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHUHC submitted claims to Medicare for two of its locations without certifications of terminal illness, face-to-face encounters, and/or physician narratives as required by regulations.
After it self-disclosed conduct to OIG, Cardiology Associates of Fredericksburg, Ltd. (CAF), Virginia, agreed to pay $49,578.63 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CAF employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-08-2015
After it self-disclosed conduct to OIG, Baptist Hospitals of Southeast Texas (BHSE), Texas, agreed to pay $116,946.72 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BHSE 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, East Tennessee Children's Hospital Association, Inc. (ETCHA), Tennessee, agreed to pay $221,920.61 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ETCHA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-07-2015
After it self-disclosed conduct to OIG, Jupiter Imaging Associates (JIA), Florida, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that JIA, through one of its employed physicians, paid remuneration to the top 100 referring physicians of JIA in the form of holiday gift cards. OIG alleged that the physician used reports of referring physicians to determine the corresponding value of holiday gifts based on the volume of referrals.
10-01-2015
After it self-disclosed conduct to OIG, COMHAR, Inc. (COMHAR), Pennsylvania, agreed to pay $24,128.07 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that COMHAR employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-22-2015
After it self-disclosed conduct to OIG, Community Hospice, LLC (Community), Mississippi, agreed to pay $87,792.87 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Community employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-17-2015
After it self-disclosed conduct to OIG, Brier Creek Integrated Pain & Spine, PLLC (Brier Creek), North Carolina, agreed to pay $222,348.81 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Brier Creek employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-14-2015
After it self-disclosed conduct to OIG, Spectrum Health Primary Care Partners d/b/a Spectrum Health Medical group (Spectrum), Michigan, agreed to pay $292,225.64 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, Sanderling Renal Services-USA, LLC and SRS Ely, LLC d/b/a Sanderling Dialysis of Ely (Sanderling), Tennessee, agreed to pay $39,337.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Sanderling employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-10-2015
After it self-disclosed conduct to OIG, Humphreys Community Care Center, LLC d/b/a Humphreys County Nursing Center (Humphreys), Mississippi, agreed to pay $200,136.77 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Humphreys employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-02-2015
After it self-disclosed conduct to OIG, PHC Las Cruces, Inc. d/b/a Memorial Medical Center of Las Cruces (Las Cruces), New Mexico, agreed to pay $1,107,698 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Las Cruces paid remuneration to a physician in the form of payments for medical director services not performed. OIG contends that such remuneration created prohibited financial relationships and Las Cruces presented claims for designated health services that resulted from prohibited referrals. OIG also alleged that Las Cruces improperly billed certain Intensive Outpatient Psychiatric program claims that were not medically necessary and/or lacked sufficient documentation.
08-31-2015
After it self-disclosed conduct to OIG, Memorial Health Services and Saddleback Memorial Medical Center (collectively, "Saddleback"), California, agreed to pay $1,143,750 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Saddleback paid remuneration to a surgical practice in the form of payment for purported services that were not adequately documented or were beyond the scope of their medical director agreements, including services provided at third-party facilities. OIG contends that such remuneration created prohibited financial relationships and Saddleback presented claims for designated health services that resulted from prohibited referrals.
After it self-disclosed conduct to OIG, Community Medical Associates, Inc. (CMA), Kentucky, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that CMA received remuneration from a hospital in the form of an arrangement for medical office space and certain support services utilized by one of CMA's employees.
After it self-disclosed conduct to OIG, Inlet Physical Medicine (Inlet), Georgia, agreed to pay $11,905.89 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Inlet employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-27-2015
After it self-disclosed conduct to OIG, Laser Spine Institute, LLC and its subsidiaries (collectively, "Laser Spine"), Florida, agreed to pay $145,127.45 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged Laser Spine paid remuneration to Medicare and TRICARE beneficiaries in the form of hotel and travel assistance to induce referrals to Laser Spine.
07-31-2015
After it self-disclosed conduct to OIG, Northeast Medical Consultants, P.C. d/b/a Interventional Spine Medicine (Interventional Spine), New Hampshire, agreed to pay $185,767 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Interventional Spine submitted claims to Medicare for trigger point injections and joint/bursa injections when prolotherapy (which is not covered by Medicare) was being performed.
07-30-2015
After it self-disclosed conduct to OIG, The Health and Hospital Corporation of Marion County d/b/a Eskenazi Health (Eskenazi), Indiana, agreed to pay $5,840,322.54 for allegedly violating the Civil Monetary Penalties Law including provisions applicable to physician self-referrals and kickbacks. OIG alleged that Eskenazi: 1) submitted claims to Medicare and Medicaid that were false or fraudulent because Eskenazi maintained a relationship with behavioral health services providers that did not meet applicable provider-based requirements, and 2) paid remuneration to a behavioral health services provider in the form of rent that exceeded fair market value.
07-14-2015
After it self-disclosed conduct to OIG, Theratech, Inc. (Theratech), Tennessee, agreed to pay $6,646,911.72 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Theratech submitted claims to Medicare for transcutaneous electrical nerve stimulators and related supplies without a detailed written physician order, and without adequate clinical documentation from the patient's medical record to support medical necessity and coverage.
After it self-disclosed conduct to OIG, Vantage Oncology, LLC, Radiation Oncology Services of America, Inc., ROSA of South Alabama, LLC, and ROSA of Eastern Shore, LLC (collectively, Vantage), Alabama, agreed to pay $9,561,998.58 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Vantage submitted claims for radiation oncology and related services without direct physician supervision by a radiation oncologist or similarly qualified person, and/or without timely review by a radiation oncologist.
After it self-disclosed conduct to OIG, Monroeville Radiation - Oncology, P.C., South Alabama Radiation Oncology, P.C., Eastern Shore Radiation Oncology, P.C., William Hixson, M.D. and Gulf Coast Cancer Center - Gulf Shores, P.C. (collectively, Gulf Coast), Alabama, agreed to pay $2,557,824.27 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Gulf Coast submitted claims for radiation oncology and related services without direct physician supervision by a radiation oncologist or similarly qualified person, and/or without timely review by a radiation oncologist.
07-08-2015
After it self-disclosed conduct to OIG, PeaceHealth, Washington, agreed to pay $23,407.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PeaceHealth employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-29-2015
After it self-disclosed conduct to OIG, Safe Haven Health Care, LLC (Safe Haven), Idaho, agreed to pay $262,249.44 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Safe Haven employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-09-2015
After it self-disclosed conduct to OIG, Miguel A. Gutierrez, M.D. and Miguel A. Gutierrez, M.D. & Associates, P.A. (Gutierrez), Texas, agreed to pay $596,986.77 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Gutierrez submitted claims to Federal health care programs for manual therapy when computerized therapy was being performed.
06-04-2015
After it self-disclosed conduct to OIG, Triangle Spine and Back Care Center of Raleigh (Triangle), North Carolina, agreed to pay $21,166.66 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Triangle submitted claims to Federal health care programs for items or services that it knew or should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended that Triangle submitted claims on behalf of and for services performed by a former physician, who worked for the practice for approximately six weeks, which contained inaccurate Current Procedural Terminology codes and inadequate documentation.
06-02-2015
After it self-disclosed conduct to OIG, Premier Urology Associates, L.L.C. (Premier), New Jersey, agreed to pay $266,882.13 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Premier submitted false or fraudulent claims to Federal health care programs as follows: (1) claims identified a physician as the rendering provider where the services were provided by a physician assistant and failed to meet "incident to" physician supervision requirements; (2) claims were submitted for evaluation and management (E&M;) services using Modifier 25, on the same day as other services were billed, where medical record documentation did not support the separate E&M; service charge; and (3) claims were supported by a physician for services that were already covered by global surgical package claims submitted by Premier.
05-15-2015
After it self-disclosed conduct to OIG, The Arc of Westchester (the Arc), New York, agreed to pay $16,920.81 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the Arc knowingly presented to Medicaid claim for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that the Arc submitted claims for prevocational services using rate codes 4464 and 4465 where supporting documentation was destroyed and replaced with improperly altered documentation.
05-14-2015
After it self-disclosed conduct to OIG, St. Vincent Medical Group, Inc. (St. Vincent), Indiana, agreed to pay $111,057.05 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. Vincent submitted claims to Medicare and Medicaid for items or services that it knew or should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended that St. Vincent submitted claims for evaluation and management services performed by a physician that did not meet applicable coding and documentation requirements.
After it self-disclosed conduct to OIG, Wael Asi, M.D., P.A., d/b/a Respiratory and Sleep Disorder Specialists (RSDS), Texas, agreed to pay $152,821.07 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that RSDS knowingly presented claims to Medicare for items or services that RSDS knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that RSDS submitted claims for services provided at a non-participating facility using RSDS's National Provider Identifier as though the services had been performed at a participating facility.
05-13-2015
After it self-disclosed conduct to OIG, Maryland Cardiology Associates, P.C. (MCA), Maryland, agreed to pay $134,506.47 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MCA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-06-2015
After he self-disclosed conduct to OIG, Arastoo Yazdani, M.D., Maryland, agreed to pay $42,334.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Dr. Yazdani employed an individual that he knew or should have known was excluded from participation in Federal health care programs.
04-27-2015
After it self-disclosed conduct to OIG, Golden Triangle Living Centers, Inc. (GTLC), Texas, agreed to pay $163,740.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that GTLC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-07-2015
After it self-disclosed conduct to OIG, Consulate Health Care at the Heart of Caring for its subsidiary Envoy of Richmond, LLC d/b/a Envoy of Westover Hills (Envoy), Virginia, agreed to pay $11,037.35 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Envoy employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-31-2015
After it self-disclosed conduct to OIG, Trinity Mission & Rehab of Farmville, LLC (Trinity Mission), Virginia, agreed to pay $399,573.85 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Trinity Mission employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-30-2015
After it self-disclosed conduct to OIG, Ripon Medical Center (Ripon), Wisconsin, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Ripon paid remuneration to certain physician-owners of physician practices through two lease arrangements. OIG contends that such remuneration created prohibited financial relationships and Ripon presented claims for designated health services during that resulted from prohibited referrals.
03-18-2015
After it self-disclosed conduct to OIG, Gwinnett Hospital System, Inc. d/b/a Glancy Rehabilitation Center (Glancy), Georgia, agreed to pay $750,815.90 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Glancy submitted claims for inpatient rehabilitation services that did not meet preadmission screening requirements in the following ways: (1) two of the four Clinical Evaluators employed by Glancy had lapsed credentials, and thus, were not licensed or certified clinicians during that time; and (2) the physiatrist had not documented his review and concurrence with the findings and results of the preadmission screenings conducted by the Clinical Evaluators.
After it self-disclosed conduct to OIG, Seton Family of Hospitals d/b/a Seton Shoal Creek Hospital (Seton), Texas, agreed to pay $2,474,008.76 for allegedly violating the Civil Monetary Penalties Law (CMPL) and provisions of the CMPL applicable to kickbacks. OIG alleged Seton paid remuneration to Medicare beneficiaries in the form of waiving collection of beneficiary coinsurance and deductible amounts. OIG further alleged that Seton presented claims to Medicare for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that Seton submitted claims for partial hospitalization program (PHP) services that did not meet Medicare requirements in that: (1) claims were submitted where patients had been admitted without a proper certification by the physician that the patient would require inpatient psychiatric hospitalization if not admitted to the PHP program requiring at least 20 hours of therapeutic services through the PHP on a weekly basis;( 2) claims were submitted where the physician treating the patient failed to recertify the patient's ongoing need for PHP services; and (3) claims were submitted where PHP patients did not have individualized treatment plans, prescribed and signed by a physician, which identified treatment goals, described coordination of services, were structured to meet the particular needs of the patient, included a multidisciplinary team approach to care, and documented ongoing efforts to restore the patient to a higher level of function that would permit discharge from the PHP or reflected the continued need for the intensity of the active PHP therapy to maintain the individual's condition and functional level to prevent relapse or hospitalization.
03-16-2015
After it self-disclosed conduct to OIG, Advance Home Health Care Services, Inc. (Advance HHC), Texas, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Advance HHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-25-2015
After it self-disclosed conduct to OIG, Grafton School, Inc. (Grafton), Virginia, agreed to pay $324,055.11 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Grafton employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
02-06-2015
After it self-disclosed conduct to OIG, Bourne Management Systems, Inc. and Bourne Manor Nursing, LLC (Bourne), Massachusetts, agreed to pay $123,893 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bourne employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-04-2015
After it self-disclosed conduct to OIG, Valley Presbyterian Hospital (Valley Presbyterian), California, agreed to pay $121,316.55 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Valley Presbyterian employed an individual that it knew or should have known was excluded from participation in the California Medicaid program.
01-21-2015
After it self-disclosed conduct to OIG, Hospice Care of America, Inc. d/b/a Hospice Care of California (HCC), California, agreed to pay $146,774.94 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HCC submitted claims to Medicare for hospice services that: (1) were not supported by face-to-face encounter documentation; and (2) were provided to one beneficiary as routine home care hospice services when the documentation did not support Medicare hospice eligibility requirements.
01-07-2015
After it self-disclosed conduct to OIG, Healthcare Authority for Medical West (Medical West), Alabama, agreed to pay $431,041.28 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Medical West employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2014

12-29-2014
After it self-disclosed conduct to OIG, Northampton Internal Medicine Associates, PC (NIMA), Massachusetts, agreed to pay $289,492.02 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that NIMA: (1) purchased the following devices from foreign sources, Synvisc, Orthovisc and Euflexxa; (2) provided these devices to Federal healthcare program patients; and (3) billed Federal healthcare programs for these devices or for their biochemical equivalents sold in the United States.
12-23-2014
After it self-disclosed conduct to OIG, Grace Home Health, Inc. (Grace), Texas, agreed to pay $2,035,262 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Grace improperly submitted claims to Medicare for episodes of home health services that failed to meet Medicare's plan of care and/or certification requirements for home health services. OIG further alleged that Grace submitted claims to Medicare for episodes of home health services that failed to meet Medicare's face-to-face encounter and/or encounter documentation requirements.
12-22-2014
After it self-disclosed conduct to OIG, Mercer Osteopathic, Ltd. (Mercer), Ohio, agreed to pay $49,598.10 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mercer improperly billed Medicare for patient visits under a physician's National Provider Identifier when the services had been rendered by a nurse practitioner and did not comply with Medicare's "incident to" requirements.
After it self-disclosed conduct to OIG, Physicians Immunodiagnostic Laboratory, Inc. (PIL), California, agreed to pay $1,386,816 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PIL employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-19-2014
After it self-disclosed conduct to OIG, Salinas Valley Memorial Hospital System (Salinas), California, agreed to pay $354,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Salinas paid remuneration to a health care company owned and operated by two physicians on staff at Salinas. OIG further alleged that the remuneration paid took the form of payments under an arrangement for Salinas to pay the health care company to rent a laser when the laser was not needed by Salinas because a second laser had been purchased by Salinas for its own use. OIG contended that Salinas failed to discontinue the arrangement after purchasing its own laser because continued payments to the health care company took into account the value of the company owners' referrals.
12-18-2014
After it self-disclosed conduct to OIG, Standish Community Hospital, Inc. d/b/a St. Mary's of Michigan Standish Hospital (SMMSH), Michigan, agreed to pay $64,854.41 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that SMMSH paid remuneration in the form of below-fair market value rates for the use of two hospital employees.
After it self-disclosed conduct to OIG, St. Agnes Healthcare, Inc. d/b/a St. Agnes Hospital (St. Agnes), Maryland, agreed to pay $1,414,248 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that St. Agnes paid remuneration to a cardiology practice in the form of equipment, supplies, staff and space needed to provide certain nuclear diagnostic cardiology testing services. OIG alleged that the cardiology practice paid St. Agnes less than fair market value for these services.
12-17-2014
After it self-disclosed conduct to OIG, Presbyterian Healthcare Services (PHS), New Mexico, agreed to pay $31,810.31 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-16-2014
After it disclosed conduct to OIG, Memorial Medical Center of West Michigan (Memorial), Michigan, agreed to pay $218,517.54 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Memorial paid remuneration to a physician in the form of below-fair market value rental rates for use of a medical office building.
12-12-2014
After it self-disclosed conduct to OIG, Cary HealthCare, LLC (Cary), Georgia, agreed to pay $62,058.70 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Cary employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-09-2014
After it self-disclosed conduct to OIG, Good Samaritan Hospital Association d/b/a Heart of America Medical Center (HAMC) agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HAMC submitted claims to Medicare for durable medical equipment allegedly prescribed to patients where the medical record documentation that supported the claims had been falsified by a former employee.
12-01-2014
After it self-disclosed conduct to OIG, West Shore Health Center (WSHC), Rhode Island, agreed to pay $18,736.68 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that WSHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-18-2014
After they self-disclosed conduct to OIG, Douglas Charles Albers (Albers) and MedTrak Services, LLC (MedTrak), Kansas, agreed to pay $40,682.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MedTrak employed Albers while MedTrak and Albers knew or should have known he was excluded from participation in Federal health care programs.
After it self-disclosed conduct to OIG, Mountain Land Rehabilitation (Mountain Land), Idaho, agreed to pay $37,206.75 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mountain Land employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-17-2014
After it self-disclosed conduct to OIG, Berkshire Medical Center, Inc. (Berkshire), Massachusetts, agreed to pay $14,490.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Berkshire employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-30-2014
After it self-disclosed conduct to OIG, Mid-Atlantic of Delmar, LLC (Mid-Atlantic), Delaware, agreed to pay $92,344.60 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mid-Atlantic employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-16-2014
After it self-disclosed conduct to OIG, The County of Wilson Emergency Medical Services (Wilson), North Carolina, agreed to pay $124,688.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Wilson 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, IHC Health Services, Inc. d/b/a McKay-Dee Hospital Center (McKay-Dee), Utah, agreed to pay $13,633.52 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that McKay-Dee employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-03-2014
After they self-disclosed conduct to OIG, DLP Maria Parham Medical Center, LLC (DLP Maria Parham) and Henderson/Vance Healthcare, Inc. (HVH), North Carolina, agreed to pay $141,459.59 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that DLP Maria Parham and HVH paid remuneration to a physician in the form of free useable office space not identified in or accounted for in their existing written lease agreement or in any written amendment to the lease agreement.
10-01-2014
After it self-disclosed conduct to OIG, Reliable Respiratory, Inc. (Reliable), Massachusetts, agreed to pay $23,065.89 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the Reliable employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-19-2014
After it self-disclosed conduct to OIG, the University of California, Los Angeles (UCLA), California, agreed to pay $470,422.85 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the UCLA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-15-2014
After it self-disclosed conduct to OIG, San Miguel Hospital Corporation d/b/a Alta Vista Regional Hospital (Alta Vista), New Mexico, agreed to pay $989,955 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Alta Vista submitted claims for physical therapy services that were performed by unqualified individuals.
After it self-disclosed conduct to OIG, Arrowhead Cardiology Medical Group, Inc., Steven Fitzmorris, M.D., and Sunil Nowrangi, M.D. (collectively Arrowhead), California, agreed to pay $485,217 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Arrowhead billed Medicare for CPT code 93042 (Rhythm ECG, 1-2 leads; interpretation and report only) in excess of one per patient per day where there was no documented change in the patient's condition to warrant an additional service.
09-09-2014
After it self-disclosed conduct to OIG, Rescue, Inc. (Rescue), Vermont, agreed to pay $152,593 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rescue 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, Amedisys, Inc. (Amedisys), South Carolina, agreed to pay $2,069,936.26 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Amedisys submitted claims for home health services that were not supported by proper medical documentation due to forgery.
09-02-2014
After it self-disclosed conduct to OIG, Norwalk Hospital Association (Norwalk), Connecticut, agreed to pay $330,967.29 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Norwalk employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-24-2014
After it self-disclosed conduct to OIG, the City of Baytown, Texas, agreed to pay $29,431.43 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the City of Baytown employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-22-2014
After it self-disclosed conduct to OIG, Rolling Hills H.C., Inc. and Fountain Lake Health and Rehab, Inc. (Rolling Hills and Fountain Lake), Arkansas, agreed to pay $117,748.32 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Rolling Hills and Fountain Lake employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
08-12-2014
After it self-disclosed conduct to OIG, Deerfield Valley Rescue, Inc. (Deerfield), Vermont, agreed to pay $71,503.06 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Deerfield 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, Five Star Crossing LLC d/b/a The Form at the Crossing and Five Star Quality Care, Inc. (Fiver Star), Indiana, agreed to pay $121,855.01 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fiver Star submitted claims to Medicare for physical therapy services that were improperly documented by a physical therapist formerly employed by Fiver Star. OIG further alleged that the improper documentation included photocopied signed and unsigned physician certifications of plans of care that were whited-out, edited, and sometimes faxed back to physician for signature; and documentation that did not meet certain progress report requirements.
08-05-2014
After it self-disclosed conduct to OIG, Oregon Health & Science University (OHSU), Oregon, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OHSU 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, Diagnostic Laboratories and Radiology (DLR), California, agreed to pay $1,983,907.51 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DLR employed four individuals that it knew or should have known were excluded from participation in Federal health care programs.
07-31-2014
After it self-disclosed conduct to OIG, Integrated First Response - Great Lakes, LLC (IFR-GL), Michigan, agreed to pay $96,476.63 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that IFR-GL contracted with and employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-28-2014
After it self-disclosed conduct to OIG, Park West Surgical Center, LLC (Park West), Ohio, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Park West employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-17-2014
After it self-disclosed conduct to OIG, Willow Springs, LLC (Willow Springs), Nevada, agreed to pay $475,423.86 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Willow Springs employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-08-2014
After it self-disclosed conduct to OIG, DJK Home Healthcare, LLC d/b/a Children's Home Healthcare (CHH), Texas, agreed to pay $318,598.43 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHH 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, Central Maine Health Care Corporation and Central Maine Medical Center (CMMC), Maine, agreed to pay $164,841.90 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CMMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-26-2014
After it self-disclosed conduct to OIG, Americare Certified Special Services, Inc. (Americare), New York, agreed to pay $44,593.41 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Americare (1) submitted claims to Medicare for home health care services provided by an RN that were not rendered; and (2) submitted claims to Medicare for items or services provided by individuals who did not receive home health aide training or who lacked the requisite home health aide certificate.
06-24-2014
After it self-disclosed conduct to OIG, Hospicare and Palliative Care Services of Tompkins County, Inc. (HPC), New York, agreed to pay $10,726.68 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HCP employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-20-2014
After it self-disclosed conduct to OIG, Hospice by the Sea, Inc. (HBTS), Florida, agreed to pay $428,935.46 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HBTS 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, Bennington Rescue Squad, Inc. (Bennington), Vermont, agreed to pay $94,441.35 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bennington employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-13-2014
After it self-disclosed conduct to OIG, Redlands Community Hospital (Redlands), California, agreed to pay $155,563.44 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Redlands employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-05-2014
After it self-disclosed conduct to OIG, Valeo Behavioral Health Care, Inc. (Valeo), Kansas, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Valeo submitted claims to Federal health care programs containing Evaluation & Management codes 99202 through 99205, which were for higher levels of services than those services actually provided.
05-28-2014
After it self-disclosed conduct to OIG, Remington Family Dental, PLLC, Hardin Family Dental, PLLC, and Rubicon Dental Associates, PLLC (collectively, Remington), Montana, agreed to pay $24,579.93 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Remington employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-15-2014
After it self-disclosed conduct to OIG, Carteret Medical Group, LLC (Carteret), North Carolina, agreed to pay $29,493.21 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Carteret 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, Kindred Nursing Centers West, LLC (Kindred), Colorado, agreed to pay $62,964.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kindred 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, Brighton Operations, LLC (Brighton Operations), Colorado, agreed to pay $49,430.22 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Bright Operations 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, California Cancer Associates for Research and Excellence (CCARE), California, agreed to pay $17,346.84 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CCARE billed Medicare for Evaluation and Management visits that were already covered within a grant funded by a pharmaceutical company and should have not been billed separately to Medicare.
05-09-2014
After it self-disclosed conduct to OIG Winterholler Dentistry, P.C. and Morrison Family Dentistry, P.C. d/b/a Winterholler Dentistry (collectively, Winterholler), Montana, agreed to pay $54,621.54 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Winterholler employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-06-2014
After it self-disclosed conduct to OIG, Uhrichsville Health Care Center, Inc. d/b/a Beacon Pointe Rehabilitation Center (Beacon Pointe), Ohio, agreed to pay $110,270.40 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Beacon Pointe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-24-2014
After it self-disclosed conduct to OIG, Kmart Corporation (Kmart), doing business in New York, agreed to pay $497,110.97 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kmart 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, Immediate Homecare, Inc. d/b/a Immediate Homecare and Hospice (Immediate), Pennsylvania, agreed to pay $78,160.59 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Immediate employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-07-2014
After it self-disclosed conduct to OIG, Harvard Vanguard Medical Associates, Inc. (HVMA), Massachusetts, agreed to pay $168,687 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that HVMA submitted claims to Medicare, Medicare's Atrius Health Pioneer Accountable Care Organization, and Massachusetts Medicaid using CPT codes 90805 and 90807 for services provided by a physician when the services rendered by the physician did not meet the coverage requirements for CPT codes 90805 and 90807.
03-24-2014
After it self-disclosed conduct to OIG, Ukiah Valley Medical Center (UVMC), California, agreed to pay $1,692,588 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. OIG alleged that UVMC paid improper remuneration to physicians who invested in a joint venture ambulatory surgical center with UVMC.
03-20-2014
After it self-disclosed conduct to OIG, Mission Medical Associates, Inc. (MMA), North Carolina, agreed to pay $141,809.74 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MMA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-12-2014
After it self-disclosed conduct to OIG, Amedisys, Inc. (Amedisys), West Virginia, agreed to pay $1,974,812.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Amedisys, on behalf of its wholly-owned subsidiaries West Virginia, LLC, d/b/a Amedisys Hospice of Parkersburg (Amedisys-Parkersburg) and Tender Loving Care Health Care Services of West Virginia, LLC d/b/a Amedisys Hospice (Amedisys-St. Clairsville), submitted claims for hospice services for which the certification documents did not meet Federal health care program requirements. OIG contends the contracted medical directors at Amedisys-Parkersburg and Amedisys-St. Clairsville pre-signed blank medical forms, including certificates of terminal illness and face-to-face visit forms, which were later completed by Amedisys staff members.
03-11-2014
After it self-disclosed conduct to OIG, Community Memorial Healthcenter (CMH), Virginia, agreed to pay $52,332.41 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-07-2014
After it self-disclosed conduct to OIG, Brentwood Healthcare, Ltd. (Brentwood), Texas, agreed to pay $243,266.31 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Brentwood 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, Little Flower Haven (LFH), Iowa, agreed to pay $61,054.64 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LFH 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, Centegra Health Systems and Centegra Primary Care, LLC (Centegra), Illinois, agreed to pay $398,053.31 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Centegra improperly submitted claims to Medicare and Medicaid for medical services performed by a physician based on CPT codes that resulted in greater payment than the code applicable to the services actually provided.
02-18-2014
After it self-disclosed conduct to OIG, KTLA Properties LP d/b/a Alamitos West Healthcare Center (Alamitos), California, agreed to pay $27,617.37 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Alamitos employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-18-2014
After it self-disclosed conduct to OIG, Heritage Healthcare of Macon, LLC (Heritage), Georgia, agreed to pay $88,113.93 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Heritage employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-14-2014
After it self-disclosed conduct to OIG, Interim HealthCare of the Eastern Carolinas, Inc. (Interim HealthCare), North Carolina, agreed to pay $79,694 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Interim HealthCare employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-27-2014
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.
01-13-2014
After it self-disclosed conduct to OIG, Spanish Fork Nursing and Rehabilitation Center (Spanish Fork), Utah, agreed to pay $10,000.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Spanish Fork employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-13-2014
After it self-disclosed conduct to OIG, Elim Care, Inc. (Elim), Minnesota, agreed to pay $11,477.34 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Elim employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
01-09-2014
After it self-disclosed conduct to OIG, Voices for Independence (Voices), Pennsylvania, agreed to pay $59,197.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Voices employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2013

12-23-2013
After it self-disclosed conduct to OIG, Northland Retirement Community, Inc. (Northland), Wisconsin, agreed to pay $12,775.16 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Northland 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, Havasu Regional Medical Center (Havasu), Arizona, agreed to pay $510,179.44 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Havasu paid remuneration to a doctor in the form of the allowed rental of usable space at a below-market rental rate and the inappropriate provision of employee services.
12-19-2013
After it self-disclosed conduct to OIG, Palm Drive Hospital (PDH), California, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law (CMPL) and provisions of the CMPL applicable to physician self-referrals and kickbacks. OIG alleged that PDH submitted claims for physician services provided by three providers to Medicare beneficiaries using the provider identification number of a physician who neither furnished the services nor personally supervised the services rendered. OIG further alleged that PDH knowingly charged facility fees and submitted claims for services provided at Palm Drive Medical Clinic (Clinic) when the Clinic failed to fully meet Medicare's regulations for Provider-Based Status, which resulted in improper billing of the claims disclosed. OIG also alleged that PDH paid remuneration to a physician in the form of payments for rent and other Clinic expenses. OIG further alleged that PDH paid remuneration to another physician in the form of payments under a service agreement and a recruitment agreement.
12-16-2013
After it self-disclosed conduct to OIG, Wyoming County Community Health System (WCCHS), New York, agreed to pay $15,000.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that WCCHS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-13-2013
After it self-disclosed conduct to OIG, Laboratory Corporation of America (LabCorp), Virginia, agreed to pay $21,051 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that LabCorp 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, Pioneer Health Services of Newton, LLC (Pioneer), Mississippi, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pioneer 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, 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.
12-11-2013
After it self-disclosed conduct to OIG, East River Medical Imaging, PC (East River), New York, agreed to pay $227,427.42 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that East River employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-05-2013
After it self-disclosed conduct to OIG, Fairview Health Services (Fairview), Minnesota, agreed to pay $37,823.57 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Fairview employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
12-03-2013
After it self-disclosed conduct to OIG, Atlantic Gastroenterology, P.A. (Atlantic), North Carolina, agreed to pay $120,073.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Atlantic submitted claims for evaluation and management services provided by a former physician employee under CPT codes 99231, 99232, and 99233, that were not provided as claimed and were billed at levels unsupported by the record documentation.
After it self-disclosed conduct to OIG, Kishwaukee Community Hospital (Kishwaukee), Illinois, agreed to pay $230,320 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that Kishwaukee paid remuneration to three medical group practices in the forms of a cash collections guarantee, start-up expenses, and loan forgiveness to subsidize the practices recruitment of a midwife, an advanced practice nurse practitioner, and a certified nurse practitioner.
11-15-2013
After it self-disclosed conduct to OIG, Helen Newberry Joy Hospital (HNJH), Michigan, agreed to pay $221,080.47 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. OIG alleged that HNJH entered into improper financial relationships with a doctor involving the lease of space, discounted internet service, professional liability and health insurance, arrangement for office supplies and pharmaceuticals, arrangement for back-up call coverage, physician supervision and attendance at certain medical leadership meetings, and failure to collect interest on an outstanding loan balance.
11-14-2013
After it self-disclosed conduct to OIG, 60 Geneva Health Care, Inc., 840 Sherman Healthcare, Inc., and BCFL Holdings (Geneva), Ohio, agreed to pay $115,856.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Geneva employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-29-2013
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.
10-18-2013
After it self-disclosed conduct to the OIG, Memphis Pathology Laboratory d/b/a American Esoteric Laboratories (AEL), Tennessee, agreed to pay $6,780.63 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that AEL employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-08-2013
After it self-disclosed conduct to the OIG, Conroe Healthcare (Conroe), Florida, agreed to pay $145,106.68 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Conroe 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, The Guidance Center (Guidance), Michigan, agreed to pay $742,398 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Guidance made false records or statements material to improper claims for payment for multiple developmental disability services provided simultaneously to Medicaid patients when only one service was eligible for payment.
10-02-2013
After it self-disclosed conduct to the OIG, Valley View Regional Hospital (VVRH), Oklahoma, agreed to pay $44,307.15 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that VVRH 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, United General Hospital - Public Hospital District 304 (UGH), Washington, agreed to pay $74,067 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that UGH paid remuneration to a physician in the form of excessive compensation for services performed at its facility.
09-30-2013
After it self-disclosed conduct to the OIG, Atmore Community Hospital (Atmore), Alabama, agreed to pay $10,996.20 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Atmore employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-27-2013
After it self-disclosed conduct to the OIG, Ocala Specialty Surgery Center, LLC (Ocala), Florida, agreed to pay $21,523.44 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Ocala 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, 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.
After it self-disclosed conduct to the OIG, Mercy Medical Center, Inc. (Mercy), Maryland, agreed to pay $50,000 for allegedly violating the Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Mercy paid remuneration to a physician owned real estate company in the form of not collecting net profits from the real estate company due under an agreement between Mercy and the real estate company. Further, this agreement established Mercy's right to forty percent of the net profits the real estate company and Mercy obtained as joint owners of a property.
09-26-2013
After it self-disclosed conduct to the OIG, Vital Signs Staffing, LLC (Vital Signs), Utah, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law. The OIG Alleged that Vital Signs 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, St. Vincent's East (St. Vincent's), Alabama, agreed to pay $50,000 for allegedly violating the Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that St. Vincent's paid remuneration to a sports medicine practice in the form of payment for Durable Medical Equipment (DME). Specifically, the OIG alleged that St. Vincent's arranged to purchase DME prescribed by the sports medicine practice physician for their patients' inpatient stay directly from the sports medicine practice.
09-20-2013
After it self-disclosed conduct to the OIG, Osler HMA Medical Group, LLC (Osler), Florida, agreed to pay $13,836.99 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Osler employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-17-2013
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.
09-13-2013
After it self-disclosed conduct to the OIG, Molina Healthcare of Florida, Inc. (Molina), Florida, agreed to pay $257,111 for allegedly violating the Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Molina offered to increase the capitation rates paid to four physicians in exchange for the referral of their patients to Molina and did increase the capitation rates of two of the four physicians.
09-09-2013
After it self-disclosed conduct to the OIG, Miami Behavioral Health Center, Inc. (MBHC), Florida, agreed to pay $150,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MBHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-06-2013
After it self-disclosed conduct to the OIG, Hampton Behavioral Health Center (Hampton), New Jersey, agreed to pay $30,541.49 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Hampton employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-30-2013
After it self-disclosed conduct to the OIG, Cystic Fibrosis Services, Inc. (CFS), Maryland, agreed to pay $307,877.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CFS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-12-2013
After it self-disclosed conduct to the OIG, Saint Francis Hospital and Medical Center (Saint Francis), Connecticut, agreed to pay $78,931.62 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Saint Francis employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-07-2013
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.
08-07-2013
After it self-disclosed conduct to the OIG, Hospital Doctor Susoni, Inc., d/b/a Hospital Dr. Susoni (Susoni), Puerto Rico, agreed to pay $78,229.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Susoni employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-17-2013
After it self-disclosed conduct to the OIG, North Arkansas Regional Medical Center (NARMC), Arkansas, agreed to pay $395,591.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NARMC improperly billed separately for "incident to" services that were included in its Rural Health Center payment.
07-12-2013
After it self-disclosed conduct to the OIG, Saint Luke's Health System (SLPS), Missouri, agreed to pay $142,740 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SLPS improperly billed Medicare and Medicaid for interventional radiology services furnished by a radiology practitioner assistant (RPA) in SLPS's Radiology Department. Specifically, SLPS separately and improperly billed Medicare for services furnished by an RPA even though, under Medicare rules, payment for services furnished by an RPA in a hospital setting are bundled and paid to the hospital as part of its facility payment.
07-08-2013
After it self-disclosed conduct to the OIG, Sonora Regional Medical Center (SRMC) California, agreed to pay $597,193 for allegedly violating the Civil Monetary Penalties Law. SRMC contracted with a physician to provide professional services at SRMC's medical oncology outpatient center. The OIG alleged that SRMC submitted claims containing CPT codes 99204, 99205, 99214, and 99215, that it submitted for services provided by the physician that were upcoded and that the physician engaged in a pattern or practice of coding at a higher level that he knew or should have known would result in a greater payment than the code applicable to the services he was actually providing.
06-19-2013
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.
06-10-2013
After it self-disclosed conduct to the OIG, Mercy Clinic Oklahoma Communities, Inc. (Mercy Clinic), Oklahoma, agreed to pay $51,444.03 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mercy Clinic employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-24-2013
After it self-disclosed conduct to the OIG, Expeditive, LLC (Expeditive), New Jersey, agreed to pay $2,883.53 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Expeditive 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, SpecialtyCare Surgical Assist, LLC (SCSA), Florida, agreed to pay $247,024.19 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SCSA knowingly presented to Medicare, Medicaid, and TRICARE claims for items or services that SCSA knew or should have known were not provided as claimed and were false or fraudulent. Specifically, the OIG contends that SCSA billed the above programs for assistant-at-surgery services provided by certified surgical assistants and registered nurse first assistants, when these programs reimburse such services only if provided by physicians and/or physician assistants.
05-21-2013
After it self-disclosed conduct to the OIG, St. Peter's Hospital of the City of Albany (St. Peter's), New York, agreed to pay $16,538.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that St. Peter's 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, Shahid Mansoor, M.D. doing business as Mansoor Pediatrics (Mansoor), Louisiana, agreed to pay $51,315.90 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mansoor employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-10-2013
After it self-disclosed conduct to the OIG, Sutter Health Sacramento Sierra Region (SHSSR), California, agreed to pay $130,308.39 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SHSSR employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-03-2013
After it self-disclosed conduct to the OIG, Jackson Pediatric Associates, P.A. (JPA), Mississippi, agreed to pay $89,080.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that JPA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
04-03-2013
After it self-disclosed conduct to the OIG, RenalSouth Garden District (RSGD), Louisiana, agreed to pay $10,487.45 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that RSGD employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
03-05-2013
After it self-disclosed conduct to the OIG, Hospital Authority of Benn Hill County, Georgia d/b/a Dorminy Medical Center (Dorminy), Georgia, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Dorminy paid remuneration to a doctor in the form of free use of hospital space for a period of time.
03-04-2013
After it self-disclosed conduct to the OIG, Radiology Associates, P.C. (RA) and Oregon Imaging Centers, LLC (OIC), OR, agreed to pay $189,045.28 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that OIC inappropriately billed Medicare for certain diagnostic tests provided by radiology practitioner assistants employed by RA that required personal supervision by a physician, but instead were provided under direct supervision.
02-27-2013
After it self-disclosed conduct to the OIG, Glen Haven Home, Inc. (GH), Iowa, agreed to pay $34,575.35 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that GH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-08-2013
After it self-disclosed conduct to the OIG, Ability and Performance Home Care, LLC (Ability), Texas, agreed to pay $92,976.44 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Ability submitted claims to Medicare for home health care services provided to patients that included false or fraudulent documentation.
02-08-2013
After it self-disclosed conduct to the OIG, Steward Good Samaritan Medical Center, Inc. (Good Samaritan), Massachusetts, agreed to pay $15,104.13 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Good Samaritan employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-05-2013
After it self-disclosed conduct to the OIG, Swan Pointe Care Center (Swan Pointe), Ohio, agreed to pay $213,708.00 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Swan Pointe employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-17-2013
After it self-disclosed conduct to the OIG, RCHP-Florence, LLC d/b/a Shoals Hospital (Shoals), Alabama, agreed to pay $45,682.02 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Shoals employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
01-17-2013
After it self-disclosed conduct to the OIG, Paterson Community Health Center (Paterson), New Jersey, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Paterson submitted claims for items and services furnished by an unlicensed and unregistered physician.
01-16-2013
After it self-disclosed conduct to the OIG, Bartlett Regional Hospital (Bartlett), Arkansas, agreed to pay $1,434,664.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bartlett submitted claims using incorrect physician names and NPI numbers and submitted claims for non-physician provider services that were billed under a physician's name and NPI number.

2012

12-21-2012
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.
11-13-2012
After it self-disclosed conduct to the OIG, Community General Hospital (CGH), NY, agreed to pay $248,362.78 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CGH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-13-2012
After it self-disclosed conduct to the OIG, Community General Hospital (CGH), NY, agreed to pay $248,362.78 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CGH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-25-2012
After it self-disclosed conduct to the OIG, Colorado Retina Associates, P.C. and Douglas Holmes, M.D. (CRA and Dr. Holmes), Colorado, agreed to pay $71,867.58 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CRA and Dr. Holmes submitted to Federal healthcare programs claims for evaluation and management services that were not provided as claimed and were false or fraudulent.
10-07-2012
After it self-disclosed conduct to the OIG, ABQ Health Partners, LLC (ABQ), New Mexico, agreed to pay $1,096,112 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ABQ submitted claims to Federal health care programs for services performed by pharmacy clinicians during new and established patient visits based on E&M; codes that ABQ knew or should have known were not reimbursable.
After it self-disclosed conduct to the OIG, Home Healthcare Connection, Inc. (HHCI), Kansas, agreed to pay $81,102.06 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HHCI 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, Auburn Community Hospital (ACH), New York, agreed to pay $150,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ACH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
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.
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 self-disclosed conduct to the OIG, Duke University Health System, Inc., d/b/a Duke University Hospital (Duke), North Carolina, agreed to pay $6,395.54 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Duke employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-26-2012
After it self-disclosed conduct to the OIG, North Canton Medical Foundation (NCMF), Ohio, agreed to pay $1,018,877 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NCMF submitted claims to the Federal health care programs for podiatry services which were not supported by medical documentation.
After it self-disclosed conduct to the OIG, Salida Hospital District d/b/a Heart of the Rockies Regional Medical Center (HRRMC), Colorado, agreed to pay $120,580.25 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HRRMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-25-2012
After they self-disclosed conduct to the OIG, Discovery House LT, Inc., Discovery House UC, Inc., Discovery House TV, Inc., and Discovery House Utah, Inc. (collectively, Discovery House), Utah, agreed to pay $105,794.24 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Discovery House 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, Carlsbad Medical Center, LLC (CMC), New Mexico, agreed to pay $995,380 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that CMC paid remuneration to three orthopedists in the form of improper payments for on-call coverage, malpractice insurance, travel reimbursement, and overpayments under an income guarantee agreement.
09-19-2012
After it self-disclosed conduct to the OIG, East Boston Neighborhood Health Center (EBNHC), Massachusetts, agreed to pay $103,485.79 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that EBNHC 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, Down East Community Hospital (Down East), Maine, agreed to pay $417,440.78 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Down East employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-11-2012
After it self-disclosed conduct to the OIG, Sleep Services of America, Inc. and Do You Snore of Maryland, LLC (SSA and DYSM), Pennsylvania, agreed to pay $1,006,104.29 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that the problematic arrangements included leases with doctors, medical directorships, personal services contracts and loans to referral sources.
After it self-disclosed conduct to the OIG, New England Sinai Hospital, Inc. (NESH), Massachusetts, agreed to pay $1,149,396.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that NESH paid remuneration to two physicians in the form of: 1) free, or less than fair market value, space and staff; 2) payment for services not performed and services performed pursuant to expired agreements; and 3) paid remuneration to a physicians group in the form of payment for services not performed and services performed without a written agreement.
08-22-2012
After it self-disclosed conduct to the OIG, Mercy Hospitals East Communities (Mercy), Missouri, agreed to pay $138,452 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Mercy employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-22-2012
After it self-disclosed conduct to the OIG, House Psychiatric Clinic, Inc. and Matthew House, D.O. (collectively House), California, agreed to pay $34,849.89 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that House billed Federal health care programs for items or services that were not provided as claimed and were false or fraudulent. Specifically, House: 1) submitted claims for services provided by four unlicensed employees as if the services were provided by Dr. House; and 2) submitted claims for services provided by a Nurse Practitioner as if those services were provided by Dr. House.
08-15-2012
After it self-disclosed conduct to the OIG, Colorado Surgical Services, PC (CSS), Colorado, agreed to pay $13,616.57 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CSS employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-07-2012
After it self-disclosed conduct to the OIG, Supervalu, Inc., and its subsidiaries, FF Acquisitions, LLC, Foodarama, Inc., New Albertsons, Inc., SUPERVALU Pharmacies, Inc., and Shoppers Food Warehouse Corporation (collectively Supervalu), Minnesota, agreed to pay $184,464.03 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Supervalu submitted claims to Federal health care programs for a branded drug when it dispensed the authorized generic drug.
08-07-2012
After it self-disclosed conduct to the OIG, Mental Health Center of East Central Kansas (MHCECK), Kansas, agreed to pay $35,840 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MHCECK improperly billed the Kansas Medicaid program for psychological services provided by a psychological testing assistant (PTA). Specifically, the PTA, who was not licensed to provide or bill for psychological evaluations, was instructed by one of MHCECK's licensed clinical psychologists (clinician) to perform psychological testing and write test interpretations and evaluation reports without the clinician ever having interviewed or seen the patients. MHCECK billed the services to Medicaid under the clinician's provider number.
08-02-2012
After it self-disclosed conduct to the OIG, Albany Memorial Hospital (AMH), New York, agreed to pay $206,669.53 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that AMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-01-2012
After it self-disclosed conduct to the OIG, Laurence Rosenfield, M.D., P.A., and Spinal Diagnostics & Interventional Pain Medicine (SDIPM), Texas, agreed to pay $110,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Rosenfield and SDIPM, through a contracted company, improperly billed Federal health care programs for services provided by a physician that did not have a Medicare provider number. The services were billed using Dr. Rosenfield's provider number.
07-24-2012
After it self-disclosed conduct to the OIG, Billings Clinic (Billings), Montana, agreed to pay $284,098.55 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Billings employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-24-2012
After it self-disclosed conduct to the OIG, Dartmouth-Hitchcock, Vermont, agreed to pay $65,934.00 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dartmouth-Hitchcock submitted claims to Medicare and Medicaid for outpatient ambulatory clinic visits provided by a physician that were not supported by medical record documentation.
07-13-2012
After it self-disclosed conduct to the OIG, The Village of Wilkes (Wilkes), North Carolina, agreed to pay $207,440.19 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Wilkes employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-06-2012
After it self-disclosed conduct to the OIG, the Treatment and Learning Centers, Inc. (TLC), Maryland, agreed to pay $28,214.16 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that TLC knowingly presented claims for items or services that TLC knew or should have known were not provided as claimed and were false or fraudulent. The OIG alleged that TLC improperly submitted claims to Medicare for services rendered by two audiologists, using the Medicare enrollment information and National Provider Identifier of a third audiologist employed by TLC.
07-05-2012
After it self-disclosed conduct to the OIG, Seasons Hospice and Palliative Care of Southern Florida, Inc. (Seasons), Florida, agreed to pay $73,428.48 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Seasons 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, LipoScience, Inc., North Carolina, agreed to pay $151,785 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that LipoScience paid remuneration to employees and referring doctor's offices in the form of thousands of gift cards.
06-27-2012
After it self-disclosed conduct to the OIG, The Memorial Hospital at North Conway, New Hampshire (TMH) agreed to pay $20,479.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that TMH submitted upcoded claims to Medicare and Medicaid for Evaluation & Management services provided by one of TMH's physicians.
06-22-2012
After it self-disclosed conduct to the OIG, Good Samaritan Hospital Medical Center (Good Samaritan) and South Bay OB/GYN (South Bay), New York, agreed to pay $1,753,447.40 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Good Samaritan paid remuneration to South Bay physicians that were more than fair market value because they did not account for the value of the benefits of malpractice insurance premium payments made for the physicians.
After it self-disclosed to the OIG, Good Samaritan Hospital Medical Center (Good Samaritan), New York, agreed to pay $604,780.73 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Good Samaritan paid remuneration to a physician in the form of salary and benefits under a contract for leadership, teaching, and administrative services. The salary and benefits paid were above fair market value.
06-15-2012
After it self-disclosed conduct to the OIG, Robert Jacobson Pharmacy (RJP), New York, agreed to pay $164,842.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that RJP employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-07-2012
After it self-disclosed conduct to the OIG, University Eye Surgeons, P.C. (University), Tennessee, agreed to pay $19,429 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that University employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-31-2012
After it self-disclosed conduct to the OIG, HCM Management, Inc. (HCM), Iowa agreed to pay $200,812.31 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HCM 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, HCM Management, Inc. (HCM), Iowa, agreed to pay $200,812.31 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HCM employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.
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.
04-03-2012
After it self-disclosed conduct to the OIG, Transitional Services for New York, Inc. (TSNYI), New York, agreed to pay $141,275 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that TSNYI submitted to Medicare upcoded claims for reimbursement for outpatient psychotherapy and psychiatric services.
03-26-2012
After it self-disclosed conduct to the OIG, Southern Maine Medical Center (SMMC), Maine, agreed to pay $76,529.81 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SMMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
02-13-2012
After it self-disclosed conduct to the OIG, Reid Hospital & Health Care Services, Inc. (Reid), Indiana, agreed to pay $96,645.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Reid made and used false records to secure payment of false and fraudulent claims for items and services furnished under Medicare.
01-20-2012
After it self-disclosed conduct to the OIG, Senior Select Home Health Services (Senior Select), Texas, agreed to pay $41,125.51 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Senior Select knowingly presented claims for items or services that Senior Select knew or should have known were not provided as claimed and were false or fraudulent.
01-20-2012
After it self-disclosed conduct to the OIG, Advanced Physical Therapy, PLLC and Richard Brannin, PT (collectively respondents), West Virginia, agreed to pay $62,460 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that the respondents accepted patients for treatment who presented with a physician's written order for physical therapy from Richard Brannin's spouse. The respondents indirectly paid remuneration to Richard Brannin's spouse. As a result, the respondents presented claims to Medicare for physical therapy services that were furnished pursuant to prohibited referrals.
01-10-2012
After it self-disclosed conduct to the OIG, Superior Medical Supply, Inc. (SMSI), Tennessee, agreed to pay $20,649.81 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SMSI employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

2011

11-30-2011
After it self-disclosed conduct to the OIG, Evergreen Health Center, P.C. (Evergreen), Missouri, agreed to pay $83,012.58 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that one of Evergreen's independent contracting psychologists submitted claims for services not provided.
11-29-2011
After it self-disclosed conduct to the OIG, City Hospital, Inc., The Charles Town General Hospital d/b/a Jefferson Memorial Hospital, and West Virginia University Hospitals-East, Inc. (collectively respondents), West Virginia, agreed to pay $949,595 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that the respondents entered into several arrangements with physicians or physician groups for which the hospitals failed to collect office rental payments. The conduct included: (1) payments of costs and expenses pursuant to recruitment agreements in excess of the actual additional incremental costs; (2) payment of student loans without a written recruitment agreement; and (3) payment of costs and expenses pursuant to unwritten extensions of recruitment agreements.
11-22-2011
After it self-disclosed conduct to the OIG, Waukesha Memorial Hospital, Inc. and ProHealth Care Medical Associates, Inc. (collectively, Waukesha), Wisconsin, agreed to pay $38,375.37 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Waukesha employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-17-2011
After it self-disclosed conduct to the OIG, Pitt County Memorial Hospital (PCMH), North Carolina, agreed to pay $68,479.04 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PCMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-14-2011
After it self-disclosed conduct to the OIG, Providence Hospital, Alabama, agreed to pay $5,938.54 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Providence Hospital employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-02-2011
After it self-disclosed conduct to the OIG, Sonoma Healthcare Center (SHC), California, agreed to pay $106,650.11 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-26-2011
After it self-disclosed conduct to the OIG, New York City Health and Hospital Corporation (HHC), New York, agreed to pay $442,909.35 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HHC employed eight individuals that it knew or should have known were excluded from participation in Federal health care programs.
After it self-disclosed conduct to the OIG, Conestoga View Nursing, L.P. d/b/a Conestoga View, Pennsylvania, agreed to pay $264,879.84 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Conestoga View employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-06-2011
After it self-disclosed conduct to the OIG, Blue Hill Memorial Hospital (BHMH), Maine, agreed to pay $40,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BHMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-04-2011
After it self-disclosed conduct to the OIG, County of Monterey d/b/a Natividad Medical Center (NMC), California, agreed to pay $174,508.46 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that NMC entered into a professional medical services agreement with a physician group for certain call coverage and clinic services. The compensation terms of the agreement offered incentives for the physician group to refer their private practice and medically indigent adult patients to NMC.
10-03-2011
After it self-disclosed conduct to the OIG, Westfields Hospital, Wisconsin, agreed to pay $204,150 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Westfields Hospital provided space, services, and supplies to certain physician group practices without entering into a formal written contract and without collecting payment.
09-20-2011
After it self-disclosed conduct to the OIG, Maine Coast Memorial Hospital (MCMH), Maine, agreed to pay $186,398.71 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MCMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-08-2011
After it self-disclosed conduct to the OIG, Whidbey Island Hospital District (WIHD), Washington, agreed to pay $858,571 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that WIHD had over 100 violations surrounding various physician contracts and arrangements. Some of the violations included: (1) a number of hospitalist contracts had expired and new contracts had not been signed; (2) there were no written agreements in place for a number of medical staff leadership and call coverage arrangements; and (3) a variety of improper lease arrangements, personal service arrangements, malpractice subsidies, and a housing allowance and an equipment loan with one physician.
09-06-2011
After it self-disclosed conduct to the OIG, Cape Cod Hospital (CCH) a subsidiary of Cape Cod Healthcare, Inc., Massachusetts, agreed to pay $115,605.36 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CCH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-06-2011
After it self-disclosed conduct to the OIG, Visiting Nurse Association of Cape Cod (VNA) a subsidiary of Cape Cod Healthcare, Inc., Massachusetts, agreed to pay $278,169.84 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.
08-30-2011
After it self-disclosed conduct to the OIG, St. Joseph Health Services of Rhode Island (St. Joseph), Rhode Island, agreed to pay $123,032 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that St. Joseph employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-19-2011
After it self-disclosed conduct to the OIG, Hospice of the Finger Lakes (HFL), New York, agreed to pay $35,831.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HFL employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-09-2011
After it self-disclosed conduct to the OIG, Kmart Corporation (Kmart), Indiana, agreed to pay $945,021.19 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Kmart employed four individuals that it knew or should have known were excluded from participation in Federal health care programs.
08-09-2011
After it self-disclosed conduct to the OIG, North American Partners in Anesthesia (NAPA), New York, agreed to pay $506,231 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that five physicians formerly associated with NAPA had furnished services at a gastroenterologist's office that inaccurately reflected procedures as having been done on two separate days when they were actually done on a single day. The false statements resulted in higher charges and caused NAPA to submit false claims in connection with those services.
07-25-2011
After it self-disclosed conduct to the OIG, Trustees of Indiana University (IU), Indiana, agreed to pay $603,522 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that IU improperly claimed services provided by third and fourth year students in its professional optometry degree program under the physician fee schedule. The services could not be properly claimed under the physician fee schedule because the students were not in a graduate medical education program and the services were not provided in a teaching hospital or teaching setting.
07-22-2011
After it self-disclosed conduct to the OIG, Health Management Services, Inc. (HMS), Louisiana, agreed to pay $6,545.61 for allegedly violating the Civil Monetary Penalties Law. Specifically, HMS disclosed the alteration of continuous positive airway pressure downloads for patients by two individuals at HMS in order to obtain Federal health care program reimbursement.
07-22-2011
After it self-disclosed conduct to the OIG, Margaret R. Pardee Memorial Hospital (Pardee), North Carolina, agreed to pay $94,729 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Pardee employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
07-18-2011
After it self-disclosed conduct to the OIG, Premier Health Care Services (PHCS), Ohio, agreed to pay $39,039 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PHCS's wholly owned subsidiary, Lucas County Emergency Physicians (LCEP), submitted false claims to Medicare and Medicaid. Specifically, while employed by LCEP, a physician provided physician services at two hospitals where he improperly billed Medicare and Medicaid under the physician fee schedule for services which were performed by residents only.
After it self-disclosed conduct to the OIG, Mercy Health Partners (MHP), Ohio, agreed to pay $82,855 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that two of MHP's hospitals, St. Vincent Mercy Medical Center and St. Charles Mercy Hospital, submitted false claims to Medicare and Medicaid. Specifically, a physician improperly billed under the physician fee schedule for physician services which were performed by residents only.
07-13-2011
After it self-disclosed conduct to the OIG, Good Samaritan Hospital Medical Center (GSHMC), New York, agreed to pay $55,018.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that GSHMC entered into an improper financial relationship with a physician professional corporation. The contract did not specify the terms of the intended agreement and the physician profession corporation received accelerated payments from GSHMC that did not comply with contractually agreed to payments. The payments were not consistent with fair market value.
After it self-disclosed conduct to the OIG, St. Catherine of Siena Medical Center (St. Catherine), New York, agreed to pay $2,596,014 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that St. Catherine contracted with a physician owned professional services company. The company received remuneration that was not consistent with fair market value and received payments for services that were not performed under the contract.
06-22-2011
After it self-disclosed conduct to the OIG, University of Nevada School of Medicine (UNSOM), Nevada, agreed to pay $138,321.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that UNSOM submitted or caused to be submitted claims for physicians' services provided by two physicians to beneficiaries of Federal health care programs using the provider identification numbers of two physicians who did not furnish the services.
06-10-2011
After it self-disclosed conduct to the OIG, Valley Obstetrics and Gynecology (VOG), Washington, agreed to pay $72,439.62 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that VOG employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-10-2011
After it self-disclosed conduct to the OIG, WellStar Cobb Hospital (WCH), Georgia, agreed to pay $9,216.73 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that WCH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
06-06-2011
After it self-disclosed conduct to the OIG, University of North Texas Health Science Center at Fort Worth (UNTHSC), Texas, agreed to pay $859,500 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that UNTHSC submitted claims for physicians' services provided to beneficiaries of Federal health care programs using the provider identification numbers of 103 physicians who neither furnished the service nor personally supervised the services rendered.
05-13-2011
After it self-disclosed conduct to the OIG, Internal Medicine Associates (IMA), Indiana, agreed to pay $58,573.55 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that IMA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
05-11-2011
After it self-disclosed conduct to the OIG, Pacifica Hospital of the Valley (Pacifica), California, agreed to pay $764,250 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Pacifica paid indirect improper remuneration to a physician in the form of payments to a marketing firm for marketing services that were never rendered under joint marketing agreements. The remuneration created a financial relationship between Pacifica and the physician that caused Pacifica to present claims for health services that resulted from prohibited referrals in violation of the Stark law.
05-10-2011
After it self-disclosed conduct to the OIG, Colorado-Fayette Medical Center (CFMC), Texas, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CFMC presented claims for items or services that it knew or should have known were not provided as claimed and were false or fraudulent.
04-29-2011
Fort Smith Regional Healthcare Foundation (Foundation), Arkansas, agreed to pay $233,000 to resolve Sparks Health System's (Sparks) liability for allegedly violating the Civil Monetary Penalties Law. The Foundation was created from the sale of Sparks and bears liability for this settlement. Sparks self-disclosed conduct to the OIG and the OIG alleged that Sparks presented claims for items that it knew or should have know were false or fraudulent.
04-06-2011
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.
03-24-2011
After it self-disclosed conduct to the OIG, Fairview Northland Regional Health Care (FNRHC), Minnesota, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that FNRHC entered into an unwritten lease agreement with a physician practice.
03-22-2011
After it self-disclosed conduct to the OIG, Mary Imogene Bassett Hospital d-b-a Bassett Medical Center (Bassett), New York, agreed to pay $18,084 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bassett submitted claims to Medicare and Medicaid for a multiple view non-invasive physiologic vascular study and instead delivered a single view non-invasive physiologic vascular study.

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