2016

03-11-2016
Utah Ambulance Company Settles Case Involving False Claims

On March 11, 2016, Ogden City Corporation (Ogden), of Ogden, Utah, entered into a $363,159.38 settlement agreement with OIG. The settlement agreement resolves allegations that Ogden submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate (upcoding). OIG’s Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.

Oregon Physical Therapy Practice and Owner Settle Case Involving False Claims

On March 11, 2016, Dan Ibarra and Northwest Physical Therapy (collectively, NPT), Oregon, entered into a $200,000 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that NPT submitted claims to Medicare for payment for direct services rendered by unlicensed employees and also submitted claims for direct, one-on-one services when these services were rendered to multiple patients at the same time. Senior Counsel Nancy Brown represented OIG.

03-04-2016
North Dakota Ambulance Provider Settles Case Involving False Claims

On March 4, 2016, Altru Health System (Altru), of Grand Forks, North Dakota, entered into a $300,974 settlement agreement with OIG. The settlement agreement resolves allegations that Altru submitted claims to Medicare for: (1) emergency Advanced Life Support ambulance transportation that should have been billed at the lower emergency Basic Life Support rate; (2) duplicate billings; (3) ambulance transportation services that were reimbursable by private insurance; and (4) emergency ambulance transportation services provided to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG’s Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Michael Torrisi and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.

03-01-2016
Oregon Mental Health Facility Settles Case Involving Excluded Individual

On March 1, 2016, Cascadia Behavioral Health, Inc. (Cascadia), Oregon, entered into a $92,052.78 settlement agreement with OIG. The settlement agreement resolves allegations that Cascadia employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a residential counselor, provided items or services to Cascadia patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Eula Taylor.

02-26-2016
Connecticut Ambulance Company Settles Case Involving False Claims

On February 26, 2016, Campion Ambulance Service, Inc. (Campion), of Waterbury, Connecticut, entered into a $100,804.74 settlement agreement with OIG. The settlement agreement resolves allegations that Campion submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG’s Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.

02-09-2016
Illinois Billing and Ambulance Companies Settle Case Involving False Claims

On February 9, 2016, Andres Medical Billing, Ltd. (Andres), and Kurtz Ambulance Service (Kurtz), Illinois, entered into a $77,542.72 settlement agreement with OIG. The settlement agreement resolves allegations that Andres, acting as the third-party biller for Kurtz, submitted claims to Medicare for basic life support (emergency) that did not meet Medicare requirements for emergency transport services and should have been billed at the lower non-emergency transport rate. OIG’s Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, collaborated to achieve this settlement.

02-05-2016
Michigan Ambulance Company Settles Case Involving False Claims

On February 5, 2016, White Lake Ambulance Authority (White Lake), Michigan, entered into a $113,635.08 settlement agreement with OIG. The settlement agreement resolves allegations that White Lake submitted claims to Medicare for basic life support (emergency) and advanced life support (emergency) ambulance transportation claims that did not meet Medicare requirements for emergency transport services. OIG’s Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, collaborated to achieve this settlement.

Illinois Pharmacist and Owner of a Durable Medical Equipment Supply Company Agrees to Three-Year Exclusion

On February 5, 2016, an Illinois pharmacist and owner of a durable medical equipment supply company agreed to be excluded from participating in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the individual offered and paid kickbacks and bribes, directly or through an employee, to induce individuals representing hospitals and nursing homes to order health care items from his company for which payments were made under Medicare. Senior Counsel Henry Green represented OIG.

01-27-2016
Massachusetts Ambulance Company Settles Case Involving False Claims

On January 27, 2016, LifeLine Ambulance Service, LLC (LifeLine), of Woburn, Massachusetts, entered into a $74,414.66 settlement agreement with OIG. The settlement agreement resolves allegations that LifeLine submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG’s Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Associate Counsel Jennifer Leonardis and Senior Counsel Andrea Treese Berlin, collaborated to achieve this settlement.

01-07-2016
Illinois Cardiology Practices Settle Case Involving Excluded Individual

On January 7, 2016, CardioSpecialists Group, Ltd. (CSG), Illinois, entered into a $274,721.40 settlement agreement with OIG. The settlement agreement resolves allegations that CSG employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a medical biller, provided items or services to CSG patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Eula Taylor.

01-06-2016
University of Mississippi Medical Center Settles Case Involving a Patient Dumping Allegation

On January 6, 2016, The University of Mississippi Medical Center (UMMC), in Jackson, Mississippi, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that UMMC failed to accept the appropriate transfer of a 64-year-old women who needed specialized capabilities of UMMC’s hospital to stabilize her emergency medical condition. OIG’s investigation revealed that the operator at UMMC refused the request to transfer the patient because of a UMMC policy that it would not accept the transfer of Louisiana residents. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.

Floyd Medical Center in Georgia Settles Case Involving a Patient Dumping Allegation

On January 6, 2016, Floyd Medical Center (FMC), in Rome, Georgia, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that FMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to evaluate and treat a mentally ill patient who was transferred from another hospital to FMC for involuntary inpatient psychiatric care. OIG’s investigation revealed the following. The patient was aggressive and combative upon his arrival to FMC’s emergency department. Three security personnel, including an off-duty police officer working for FMC, attempted to restrain the patient while a nurse went to retrieve medication to calm him down. When the security personnel entered the room, the patient attempted to strike one of them. In response, a security officer hit the patient in the head and pushed him until he fell on the bed. The security officers then wrestled the patient to the ground and handcuffed him, causing injury to the patient. When the nurse returned, the security personnel informed her that the patient’s behavior was beyond what FMC could safely control. Without psychiatric evaluation or appropriate medical treatment, the emergency department physician medically cleared the patient and he was taken to jail. Despite having an on-call psychiatrist and capabilities to treat the patient, at no point was he evaluated or treated by a mental health professional. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.

2015

12-29-2015
Moses H. Cone Memorial Hospital in North Carolina Settles Case Involving a Patient Dumping Allegation

On December 29, 2015, Moses H. Cone Memorial Hospital (MCMH), in Greensboro, North Carolina, entered into a $35,000 settlement agreement with OIG. The settlement agreement resolves allegations that MCMH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an adequate medical screening examination and stabilizing treatment for an 86-year-old female who presented to MCMH’s emergency department after falling at home. OIG’s investigation revealed that although an emergency room doctor evaluated her knee pain and performed other imaging tests, he did not fully evaluate her reported severe pain and inability to ambulate. OIG alleged she was discharged with a displaced fracture of her hip. Senior Counsel Sandra Sands represented OIG.

12-23-2015
Vermont Municipality Settles Case Involving False Claims

On December 23, 2015, the City of Barre, Vermont (Barre), entered into a $127,669.90 settlement agreement with OIG. The settlement agreement resolves allegation that Barre submitted claims for basic life support (emergency) and advanced life support (emergency) ambulance transportation claims that did not meet Medicare requirements for emergency transport services and should have been billed at the lower non-emergency rate. OIG’s Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsel Nicole Caucci, collaborated to achieve this settlement.

12-21-2015
Mississippi Ambulance Company Settles Case Involving False Claims

On December 21, 2015, South Central Regional Medical Center (SCRMC), of Laurel, Mississippi, entered into a $318,885.62 settlement agreement with OIG. The settlement agreement resolves allegations the SCRMC submitted claims for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences that should have been billed at the lower non-emergency rate. OIG’s Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.

Santa Rosa Memorial Hospital in California Settles Case Involving a Patient Dumping Allegation

On December 21, 2015, Santa Rosa Memorial Hospital (SRMH), in Santa Rosa, California, entered into a $50,000 settlement agreement with OIG. The settlement agreement resolves allegations that SRMH violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate medical screening examination and stabilizing treatment to a patient found on SRMH’s property. OIG’s investigation revealed the following. The patient was seen the previous day in SRMH’s emergency department for alcohol withdrawal and neck pain. The physician prescribed a medication for alcohol withdrawal and discharged the patient with instructions for alcohol withdrawal and alcohol abuse. The next morning, the patient was seen by multiple members of the hospital staff, including security, lying on the ground near the perimeter of SRMH’s parking lot, possibly in need of medical assistance. Despite being notified several times that the patient may be in need of medical assistance, SRMH failed to respond. Eventually, a staff member who was jogging saw the patient on the ground and called 911. When EMS arrived, the patient had died shortly before EMS’s arrival. An autopsy report revealed the cause of death to be acute bacterial pneumonia of the left lung. Under EMTALA, hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.

Lake City Medical Center in Florida Settles Case Involving a Patient Dumping Allegation

On December 21, 2015, Lake City Medical Center (LCMC), in Lake City, Florida, entered into a $25,000 settlement agreement with OIG. The settlement agreement resolves allegations that LCMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate medical screening examination and stabilizing treatment for a 42-year-old female. OIG’s investigation revealed the following. The patient arrived at LCMC’s emergency department complaining of headaches, right arm pain and diarrhea the previous day. She was seen by a physician’s assistant and then asked to wait in the waiting room. While there, she vomited and continued to complain of right arm pain. The physician’s assistant concluded that she did not need immediate medical attention and asked the patient to leave the emergency department. When the patient resisted and her family complained, the emergency department personnel called the police to escort her out of the emergency department. After unsuccessful attempts by police and paramedics to get the patient into a car, her family requested the emergency department call an ambulance so she could be taken to another hospital. When the ambulance arrived, the patient was unresponsive and taken to another hospital where she was placed on a ventilator in the Intensive Care Unit and later diagnosed with bacterial meningitis. Under EMTALA, a small hospital can be fined up to $25,000 per violation. Senior Counsel Sandra Sands represented OIG.

Pennsylvania Chiropractor Agrees to 25-Year Exclusion

On December 21, 2015, in connection with the resolution of False Claims Act liability, a Pennsylvania chiropractor agreed to be excluded from participating in Federal health care programs for a period of twenty-five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that the chiropractor knowingly submitted or caused to be submitted false or fraudulent claims to Medicare for services rendered as a de facto executive and administrator of a chiropractic center notwithstanding the fact that he was excluded from participating in Federal health care programs. Senior Counsel Katherine Matos and Associate Counsel Kaitlyn Dunn represented OIG.

12-11-2015
St. Francis Hospital – Downtown in South Carolina Settles Case Involving Patient Dumping Allegations

On December 11, 2015, St. Francis Hospital – Downtown (St. Francis), in Greenville, South Carolina, entered into a $100,000 settlement agreement with OIG. The settlement agreement resolves allegations that St. Francis violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to fully evaluate and treat two gunshot victims. OIG’s investigation revealed that the first patient presented to St. Francis after being robbed and shot in the left leg within close range and the second patient after being shot in the abdomen at a club. OIG contends that although St. Francis had the capacity and capability to provide treatment to both gunshot victims, St. Francis transferred the patients to another hospital. OIG further contends that the benefits of the transfers did not outweigh the risks and unnecessarily placed the health of both gunshot victims at further risk. Under EMTALA hospitals can be fined up to $50,000 per violation. Senior Counsel Sandra Sands represented OIG.

http://oig.hhs.gov/fraud/enforcement/cmp/cmp-ae.asp#ae03302016

 

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