OIG Exclusion Screening

05-28-2019

On May 28, 2019, Ryan D. Pensyl, DMD (Dr. Pensyl), Cumberland, Maryland, entered into a $10,941.60 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Pensyl employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a dentist, provided items or services that were billed to Federal health care programs. OIG’s Office of Investigations and Office of Counsel to the Inspector General, represented by Senior Counsels Katie Fink and Jennifer Leonardis, collaborated to achieve this settlement.

04-25-2019

On April 25, 2019, Morganstern Urology (Morganstern), Atlanta, Georgia, entered into an $18,810.40 settlement agreement with OIG. The settlement agreement resolves allegations that Morganstern employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a physician, provided items or services to Morganstern’s patients that were billed to Federal health care programs.

04-12-2019

On April 12, 2019, Texas Health and Human Services Commission and Lufkin State Supported Living Center (Lufkin SSLC), entered into a $121,068.42 settlement agreement with OIG. The settlement agreement resolves allegations that Lufkin SSLC 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 Lufkin SSLC’s patients that were paid for by Federal health care programs. Senior Counsel Katie Fink represented OIG with the assistance of Program Analyst Mariel Filtz.

04-04-2019

On April 4, 2019, Aroostook Mental Health Services, Inc. (AMHS), Caribou, Maine, entered into a $17,750.12 settlement agreement with OIG. The settlement agreement resolves allegations that AMHS employed an individual who was excluded from participating in MaineCare, Maine’s Medicaid program. OIG’s investigation revealed that the excluded individual, a counselor, provided items or services to AMHS’s patients that were billed to MaineCare.

04-02-2019

After it self-disclosed conduct to OIG, Vanderbilt Stallworth Rehabilitation Hospital, L.P. (Vanderbilt), Tennessee, agreed to pay $25,912.53 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Vanderbilt employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

03-28-2019

On March 28, 2019, Sweeny Community Hospital d/b/a Lake Jackson Healthcare (LJH), Lake Jackson, Texas, entered into a $113,802.80 settlement agreement with OIG. The settlement agreement resolves allegations that LJH employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a vocational nurse, provided items or services to LJH’s patients that were billed to Federal health care programs.

03-26-2019

On March 26, 2019, in connection with the resolution of their False Claims Act liability, Acacia Mental Health Clinic, LLC (Acacia), Abraham Freund, and Isaac Freund, agreed to be excluded from participation in all Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). Acacia and Abraham Freund agreed to be excluded for a period of 20 years. Isaac Freund agreed to be excluded for a period of 5 years. At the time of the allegations, Wisconsin Medicaid reimbursed providers for urine drug screens performed with point-of-care cups under Current Procedure Terminology (CPT) Code 80104 at the rate of approximately $20 per test, regardless of the number of drug classes tested. OIG alleged that: (1) at Abraham Freund’s direction, Acacia submitted claims to Wisconsin Medicaid under CPT Code 80101 with a separate unit for each drug class, although CPT Code 80101 was appropriate only for more sophisticated tests performed using laboratory equipment that Acacia did not possess; (2) at Abraham Freund’s direction, Acacia also misrepresented to Wisconsin regulators that it possessed the laboratory equipment necessary to perform tests covered by CPT Code 80101 to conceal its false billings; (3) Acacia and Abraham Freund knew that, by submitting claims for urine drug screens performed at Acacia under CPT Code 80101, they were misrepresenting the types of tests performed to Wisconsin Medicaid; and (4) by submitting these allegedly false claims to Medicaid, Acacia and Abraham Freund improperly increased the reimbursement received from Wisconsin Medicaid by hundreds of dollars per test. OIG further alleged that Acacia and Abraham Freund submitted or caused the submission of false telemedicine services claims to Wisconsin Medicaid because it was improper to submit claims for telemedicine services provided to patients by psychiatrists located outside of the United States and that, at Abraham Freund’s direction and with Isaac Freund’s involvement, Acacia performed medically unnecessary and duplicative urine drug screens for its Medicaid patients. Senior Counsel Keshia Thompson represented OIG.

03-21-2019

On March 21, 2019, Berea Alzheimer’s Care Center (BACC), Berea, Ohio, entered into a $75,998.54 settlement agreement with OIG. The settlement agreement resolves allegations that BACC employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a medical records coordinator, provided items or services to BACC’s patients that were billed to Federal health care programs.

03-08-2019

On March 8, 2019, Sweet Town, LLC d/b/a Cleveland Manor Nursing and Rehabilitation (Cleveland Manor), Cleveland, Oklahoma, entered into a $171,047 settlement agreement with OIG. The settlement agreement resolves allegations that Cleveland Manor employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, an office manager, provided items or services to Cleveland Manor’s patients that were billed to Federal health care programs.

03-01-2019

On March 1, 2019, MHC, Inc. d/b/a Maplewood Health Care Center (Maplewood), Jackson, Tennessee, entered into an $81,419.42 settlement agreement with OIG. The settlement agreement resolves allegations that Maplewood 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 Maplewood’s patients that were billed to Federal health care programs. Senior Counsel Kenneth Kraft represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.

02-25-2019

On February 25, 2019, Aroostook Mental Health Services, Inc. (AMHS), Caribou, Maine, entered into a $17,750.12 settlement agreement with OIG. The settlement agreement resolves allegations that AMHS employed an individual who was excluded from participating in MaineCare, Maine’s Medicaid program. OIG’s investigation revealed that the excluded individual, a counselor, provided items or services to AMHS’s patients that were billed to MaineCare.

01-25-2019

After it self-disclosed conduct to OIG, IHC Health Services, Inc. d/b/a Intermountain Medical Center (IMC), Utah, agreed to pay $68,204.85 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that IMC employed an individual that it knew or should have known was excluded from participation in Federal health care programs. OIG further alleged that two additional excluded individuals provided items or services to IMC’s patients that were billed to Federal health care programs.

01-08-2019

After it self-disclosed conduct to OIG, PHI Air Medical, L.L.C. (PHI Air), Arizona), agreed to pay $13,259.99 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that PHI Air employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

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.

After it self-disclosed conduct to OIG, Valley’s Best Hospice (VBH), California, agreed to pay $27,420.23 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that VBH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.