2016

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, 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 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.

http://oig.hhs.gov/fraud/enforcement/cmp/psds.asp

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