OIG Exclusion Screening

01-04-2019


On January 4, 2019, Baptist Village of Owasso (BVO), Owasso, Oklahoma, entered into a $96,020.92 settlement agreement with OIG. The settlement agreement resolves allegations that BVO employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, an admission specialist, provided items or services to BVO’s patients that were billed to Federal health care programs.

12-01-2018

On December 1, 2018, in connection with the resolution of their False Claims Act liability, Families United Services, Inc. (FUS), and Pamela McKenzie, Georgia, each agreed to be excluded from participation in all Federal health care programs for periods of five years under 42 U.S.C. § 1320a-7(b)(7). OIG alleged that FUS and Pamela McKenzie submitted claims to Georgia Medicaid for behavioral health services that were not provided. Senior Counsel Katie Fink represented OIG.

11-27-2018

On November 27, 2018, Spurwink Services (Spurwink), Portland, Maine, entered into a $61,461.00 settlement agreement with OIG. The settlement agreement resolves allegations that Spurwink employed an individual who was excluded from participating in MaineCare, Maine’s Medicaid program. OIG’s investigation revealed that the excluded individual, a residential treatment specialist, provided items or services to Spurwink’s patients that were billed to MaineCare.

11-13-2018

On November 13, 2018, OIG excluded Medicus Laboratories, LLC (Medicus), a Dallas, Texas, laboratory, for defaulting on payment obligations under a settlement agreement with OIG wherein OIG alleged that Medicus submitted false or fraudulent claims to Medicare. Medicus’ exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates Medicus’ participation in Federal health care programs. Senior Counsel Geoffrey Hymans represented OIG.

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.

11-07-2018

On November 7, 2018, the University of Chicago Medical Center (UCMC), Chicago, Illinois, entered into a $253,671.20 settlement agreement with OIG. The settlement agreement resolves allegations that UCMC, through a staffing agency, employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a registered nurse, provided items or services to UCMC’s patients that were billed to Federal health care programs.

11-01-2018

On November 1, 2018, Wayside Farm, Inc. (Wayside), Peninsula, Ohio, entered into a $293,842.58 settlement agreement with OIG. The settlement agreement resolves allegations that Wayside employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a state tested nurse aide, provided items or services to Wayside’s patients that were billed to Federal health care programs.

10-30-2018

On October 30, 2018, Resource Center for Independent Living, Inc. (RCIL), Osage City, Kansas, entered into a $232,610 settlement agreement with OIG. The settlement agreement resolves allegations that RCIL employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a direct service worker, provided items and services to RCIL patients that were billed to Kansas Medicaid. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.

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.

10-11-2018

On October 11, 2018, Tymekka Greenough (Greenough), the in-house medical biller for First Initiative, LLC (First Initiative), a Nevada behavioral health services provider, agreed to be excluded for a period of 25 years under 42 U.S.C. § 1320a-7(b)(7). OIG’s investigation revealed that Greenough knowingly submitted or caused to be submitted claims to the Nevada Medicaid Program on behalf of First Initiative that were false or fraudulent or were not provided as claimed, including: (1) individual psychotherapy services using CPT Codes 90832, 90834, and 90837; (2) individual psychotherapy services utilizing biofeedback training using CPT Code 90876; (3) case management services using CPT Code T1016; and (4) skills training and development services using CPT Code H2014. Senior Counsels Srishti Sheffner and Michael Torrisi represented OIG.

10-05-2018


On October 5, 2018, Healthways Worldwide Inc. d/b/a Healthways Pharmacy and Surgical (Healthways), Brooklyn, New York, entered into a $204,426.64 settlement agreement with OIG. The settlement agreement resolves allegations that Healthways employed an individual who was excluded from participating in any Federal health care programs. OIG’s investigation revealed that the excluded pharmacist provided items or services to Healthways patients that were billed to Federal health care programs. Senior Counsel Jennifer Leonardis represented OIG.

On October 5, 2018, Whispering Knoll, Pine Bluff, Arkansas, entered into a $35,195.95 settlement agreement with OIG. The settlement agreement resolves allegations that Whispering Knoll employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a licensed practical nurse, provided items or services to Whispering Knoll’s patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.

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

On September 27, 2018, Newark Community Health Centers, Inc. (NCHC), New Jersey, entered into a $98,750.36 settlement agreement with OIG. The settlement agreement resolves allegations that NCHC employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a physician working in quality assurance and risk management, provided items and services to NCHC that were billed to Federal health care programs. Associate Counsel Srishti Sheffner represented OIG.

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.

09-14-2018

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.

On September 14, 2018, Anthony D. Vertino, Psy.D. (Vertino), Illinois, agreed to be excluded from participation in all Federal health care programs for a period of twenty years under 42 U.S.C. § 1320a-7(b)(7). OIG’s investigation revealed that Vertino submitted claims for psychological services that were not provided as claimed or were false or fraudulent because the claims were for dates of service when patients were hospitalized or when Vertino was travelling out of state. Senior Counsel Joan Matlack represented OIG.

On September 14, 2018, Cindy Scott, R.N., A.P.R.N. (Scott), Tennessee, agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. §§ 1320a-7(b)(6)(B) and 1320a-7(b)(7). OIG alleged Scott submitted or caused the submission of false claims for controlled substance prescriptions that were medically unnecessary, substantially in excess of the needs of her patients, and below the professionally recognized standards of care. Specifically, OIG alleged Scott prescribed monthly prescriptions to individual patients exceeding a daily dosage of five hundred (500) morphine milligram equivalents (MME), which included inappropriate combinations of long and short acting opioids often combined with high amounts of a benzodiazepine and/or carisoprodol. OIG also alleged Scott prescribed controlled substances and combinations of controlled substances and other medication without appropriately documenting: (1) a clear objective finding of a chronic pain source to justify the ongoing and increasing prescribing; (2) attempts to identify the etiology of reported pain; (3) a thorough history or adequately inquiring into potential substance abuse history; or (4) a written treatment plan with regard to the use of the prescriptions. Senior Counsels Andrea Treese Berlin, Katie Fink, and Joan Matlack represented OIG.

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.