In 2009, there were over $2 million in fines levied against businesses for employing individuals sanctioned by the Federal Dept of Health & Human Services (HHS) via the Inspector General office (OIG).
Catagory: False and Fraudulent Claims
| False and Fraudulent Claims Archive |
In each CMP, OR CIVIL MONETARY PENALTIES LAW, case resolved through a settlement agreement, the settling party has contested the OIG’s allegations and denied any liability. No CMP, OR CIVIL MONETARY PENALTIES LAW, judgment or finding of liability has been made against the settling party.
2010
01-13-2010
After they self-disclosed conduct to the OIG, Bel Pre Leasing Co, LLC, Liberty Leasing Co, LLC, Marlboro Leasing Co, LLC, Fayette Leasing Co, LLC, RMNH EMP, LLC, CHSI EMP, LLC, Communicare of Columbus, Inc., Prime Care Four, LLC, Regency Leasing Co, LLC, and Resident Care Consulting, LLC, Ohio, agreed to pay $135,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the entities employed two individuals that they knew or should have known were excluded from participation in Federal health care programs.
2009
12-16-2009
After it self-disclosed conduct to the OIG, The Neurological Institute, P.A., f/k/a Neurology Consultants of the Carolinas, P.A. (Institute), North Carolina, agreed to pay $181,851 for allegedly violating the Civil Monetary Penalty Law. The OIG alleged that the Institute improperly submitted claims to Medicare and Medicaid for (1) a physician’s services (or an item or service incident to a physician’s service) when the individual who furnished the service was not a physician; (2) services provided by a physician, when the services were not actually provided by that physician; and (3) services provided based on codes that the Institute knew or should have known would result in greater payments to the Institute than the codes applicable to the services actually provided.
11-30-2009
After it self-disclosed conduct to the OIG, Fundamental Administrative Services, LLC, THI of Kansas at Indian Creek, LLC, and Mulberry Manor, LLC, Maryland, agreed to pay $15,313.80 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that each employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-10-2009
After it self-disclosed conduct to the OIG, Heartland Surgical Specialty Hospital (Heartland), Kansas, agreed to pay $33,187 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Heartland employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-31-2009
After it self-disclosed conduct to the OIG, Winslow House, LLC (Winslow), Iowa, agreed to pay $9,500.51 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Winslow employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-22-2009
After it self-disclosed conduct to the OIG, University Pediatricians, Michigan, agreed to pay $91,782.50 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that a former physician employee of University Pediatricians failed to follow policies and procedures for claims submitted to Medicare and Medicaid for services provided by Pediatric Gastroenterology Fellows under her supervision. Specifically, the physician employee occasionally instructed Fellows to use pre-printed forms indicating that she accompanied the Fellows during patient visits. The physician employee used these forms at times when she was present during patient visits, as well as at times when she was not present.
10-16-2009
After it self-disclosed conduct to the OIG, Coram, Inc., New York, agreed to pay $72,500 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Coram, Inc. employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-15-2009
After it self-disclosed conduct to the OIG, ABCM Corporation, Iowa, agreed to pay $40,137 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ABCM Corporation employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-15-2009
After it self-disclosed conduct to the OIG, Margaretville Memorial Hospital and Margaretville Nursing Home, Inc., New York, agreed to pay $80,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Margaretville inappropriately billed Medicare Part D and State health care plans for drugs provided by Margaretville Hospital to Margaretville Nursing Home residents when the residents were covered by Medicare Part A.
09-08-2009
After it self-disclosed conduct to the OIG, Pocahontas Manor Care Center (PMCC), Iowa, agreed to pay $106,862 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PMCC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-11-2009
After it self-disclosed conduct to the OIG, Medicalodge of Butler (Medicalodge), Missouri, agreed to pay $67,715.26 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Medicalodge employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-12-2009
After it self-disclosed conduct to the OIG, Saint Vincent Medical Education and Research Institute, Inc. d/b/a Saint Vincent Medical Group (SVMG), Pennsylvania, agreed to pay $23,436.12 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SVMG employed an individual that SVMG knew or should have known was excluded from participation in Federal health care programs.
07-17-2009
After it self-disclosed conduct to the OIG, SJH Cardiac Catheterization (SJH), New York, agreed to pay $15,133 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SJH employed an individual that SJH knew or should have known was excluded from participation in Federal health care programs.
06-29-2009
Clifford Koon, Jeffrey Cowan, and William Dorvall (respondents), Florida, former owners and officers of Matrix, Diabetics, Inc. (a durable medical equipment (DME) company), agreed to pay $260,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the respondents caused Matrix to pay telemarketing firms to make unsolicited telephone calls to Medicare beneficiaries to market DME on behalf of the company. The DME company in turn submitted claims for these items for Medicare reimbursement. Section 1834(a)(17) of the Social Security Act prohibits DME suppliers from making unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of a covered item, except in certain situations that were not present in this case. Section 1834(a)(17)(B) of the Act prohibits payment to a supplier who knowingly submits a claim generated pursuant to prohibited telemarketing calls.
06-17-2009
Alexander Zeuli and Physical Therapy Health Services (Respondents), Massachusetts, agreed to pay $18,532 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents improperly billed Medicare under certain CPT codes for physical therapy services when lower reimbursed codes and/or fewer units of these codes should have been billed.
06-02-2009
Ravenwood Nursing Home, Inc. (RNH), Maryland, agreed to pay $28,252.95 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that RNH employed an individual that RNH knew or should have known was excluded from participation in Federal health care programs.
05-29-2009
After it self-disclosed conduct to the OIG, National Medicare Recovery Services, Inc. (NMRS), California, agreed to pay $500,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NMRS presented or caused to be presented improper claims to Medicare for Part B wound care supplies.
05-27-2009
Claxton-Hepburn Medical Center (CHMC), New York, agreed to pay $168,597 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CHMC employed two individuals that CHMC knew or should have known were excluded from participation in Federal health care programs.
05-20-2009
Wayne Wittenberg, M.D. and his medical practice, Nature Coast Neurosurgery (Respondents), Florida, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the Respondents employed an individual that they knew or should have known was excluded from participation in Federal health care programs.
05-14-2009
After it self-disclosed conduct to the OIG, Colquitt Regional Medical Center (Colquitt), Georgia, agreed to pay $151,004.65 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Colquitt billed Medicare and Tricare for services provided by physician-assistants as if they were provided by the actual physicians.
04-21-2009
After it self-disclosed conduct to the OIG, National Medicare Recovery Services, Inc. (NMRS), California, agreed to pay $500,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that NMRS presented or caused to be presented claims for Medicare Part B wound care supplies that NMRS knew or should have known would result in greater payment to NMRS’s nursing home clients than the code applicable to the items actually provided.
04-02-2009
After it self-disclosed conduct to the OIG, Marquis Healthcare, Inc. (MHI), Ohio, agreed to pay $7,714.68 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MHI employed an individual that MHI knew or should have known was excluded from participation in Federal health care programs.
03-25-2009
After it self-disclosed conduct to the OIG, St. Mary Medical Center (SMMC), Pennsylvania, agreed to pay $172,617.10 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SMMC employed an individual that SMMC knew or should have known was excluded from participation in Federal health care programs.
03-16-2009
Ediberto Soto-Cora, M.D., Texas, agreed to pay $534,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Dr. Soto-Cora submitted false or fraudulent claims by using CPT codes that would generate a higher reimbursement than justified by the medical documentation or that he submitted claims without any supporting medical documentation.
03-13-2009
West Valley Imaging Limited Partnership and two physicians (West Valley), Nevada, agreed to pay $2 million and to enter into a 5-year integrity agreement for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that West Valley performed radiology tests and exams that were not ordered by Medicare beneficiaries’ treating physicians.
03-11-2009
After it self-disclosed conduct to the OIG, Walgreen Louisiana Co. (Walgreen), Louisiana, agreed to pay $1,053,774.82 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Walgreen employed an individual that Walgreen knew or should have known was excluded from participation in Federal health care programs.
03-03-2009
After it self-disclosed conduct to the OIG, ShopKo Stores, Inc. (ShopKo), Utah, agreed to pay $669,824.74 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ShopKo employed an individual that ShopKo knew or should have known was excluded from participation in Federal health care programs.
02-25-2009
After it self-disclosed conduct to the OIG, HealthWorks Rehab & Fitness, (HealthWorks), West Virginia, agreed to pay $8,132.16 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HealthWorks inappropriately billed Medicare for the performance of iontophoresis services, which is not a covered service under Medicare because it is deemed experimental.
01-06-09
Methodist Health Care-Memphis Hospitals (Methodist), Tennessee, agreed to pay $136,627 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Methodist employed an individual that Methodist knew or should have known was excluded from participation in Federal health care programs.
Source: Federal Dept of Health & Human Services, Office of Inspector General Feb 2010 . Main Office oig.hhs.gov
Carl Slicer, www.Besthire.com blog editor.
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