OIG Exclusion Screening

05-30-2017

On May 30, 2017, Heritage Robinson, LLC and Burnsides Community Health Center, Inc. (collectively, “Heritage”), entered into a $26,748.22 settlement agreement with OIG. The settlement agreement resolves allegations that Heritage 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 Heritage patients that were billed to Federal health care programs. Senior Counsel Nancy Brown represented OIG.

05-17-2017

On May 17, 2017, in connection with the resolution of his False Claims Act liability, Dr. Michael Esposito (Dr. Esposito), Albany, New York, agreed to be excluded again from participation in all Federal health care programs for a period of fifteen years under 42 U.S.C. § 1320a-7(b)(7). OIG’s investigation revealed that despite previously having been excluded from participation in all Federal health care programs on December 9, 2016, for a period of five years, he forged another physician’s signature on prescriptions, including opioids, in order to obtain medications for himself and another person. In the instant matter, Dr. Esposito presented claims for payment to Medicare for services that he furnished, ordered, and prescribed to Medicare beneficiaries while he was excluded. Senior Counsel David Traskey represented OIG

05-16-2017

After it self-disclosed conduct to OIG, UnityPoint at Home (UnityPoint), Iowa, agreed to pay $18,562.95 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UnityPoint employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

 

05-15-2017

On May 15, 2017, Dr. Haroutyoun Margossian (Dr. Margossian), a New York physician specializing in female urinary incontinence, agreed to be excluded from participation in all Federal health care programs for a period of seven years under 42 U.S.C. § 1320a-7(b)(7). OIG’s investigation revealed that Dr. Margossian knowingly presented or caused to be presented claims to Medicare and Medicaid relating to the treatment of patients suffering from urinary incontinence that he should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended Dr. Margossian failed to: (1) employ licensed individuals to perform the urodynamic and pelvic floor therapy (PFT) services; and (2) properly supervise the individuals performing the urodynamic and PFT services. Senior Counsel David Blank and Associate Counsel Jennifer Leonardis represented OIG.

05-11-2017

After it self-disclosed conduct to OIG, BrightView, LLC (BrightView), Ohio, agreed to pay $19,935.59 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that BrightView employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

04-18-2017

After it self-disclosed conduct to OIG, Pafford Medical Services, Inc. (Pafford), Arkansas, agreed to pay $390,587.18 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Pafford employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

03-16-2017

On March 16, 2017, OIG excluded Dr. Sean Orr (Dr. Orr), a Florida neurologist, for defaulting on his payment obligations under a Settlement Agreement (Agreement) with the Department of Justice (DOJ) and OIG. Dr. Orr previously entered into the Agreement for knowingly misdiagnosing certain patients with various neurological disorders, such as multiple sclerosis, which caused claims to be submitted to Federal health care programs for medically unnecessary items and services. The terms of the Agreement provided that Dr. Orr would make an initial upfront payment plus additional payments over a five-year period. On January 23, 2017, DOJ issued a Notice of Default to Dr. Orr. Senior Counsel Karen Glassman represented OIG.

03-13-2017

On March 13, 2017, Elizabeth Kressin, D.C. (Kressin), an Iowa chiropractor, agreed to be excluded from participation in Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7) for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Kressin caused claims to be submitted to Iowa Medicaid for chiropractic services performed on children, which were not provided as claimed and were for treatment of conditions for which payment is not allowed under applicable rules. Associate Counsel Jennifer Leonardis represented OIG.

03-08-2017

On March 8, 2017, Dr. Vinod Sharma, (Dr. Sharma) a Michigan physician and pain management specialist, agreed to be excluded from participation in Medicare and the State health care programs for a period of three years under 42 U.S.C. § 1320c-5 following a referral to OIG by Kepro, the Beneficiary and Family Centered Care Quality Improvement Organization (QIO). OIG’s investigation determined that Dr. Sharma substantially violated the obligation to provide services (1) of a quality that met professionally recognized standards of health care, and (2) that were supported by evidence of medical necessity and quality in such form and fashion and at such time as was reasonably required by the QIO in the exercise of its duties and responsibilities. Specifically, OIG alleged that Dr. Sharma failed to sufficiently document his response to the results of urine drug screenings and any discussions he had with patients regarding the urine drug screening results when these patients (1) tested positive for illicit drugs; (2) tested positive for controlled substances Dr. Sharma did not prescribe; (3) tested positive for noncontrolled substances Dr. Sharma did not prescribe; or (4) tested negative for controlled substances Dr. Sharma prescribed. Senior Counsel Kristen Schwendinger, Senior Counsel Geoffrey Hymans and Associate Counsel Srishti Sheffner represented OIG.

02-16-2017

After it self-disclosed conduct to OIG, Athena Orchard View LLC d/b/a Orchard View Manor (Orchard View), Rhode Island, agreed to pay $61,576.22 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Orchard View employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

02-08-2017

After it self-disclosed conduct to OIG, OhioHealth Corporation (OhioHealth), Ohio, agreed to pay $231,277.60 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that OhioHealth employed three individuals that it knew or should have known were excluded from participation in Federal health care programs.

02-06-2017

After it self-disclosed conduct to OIG, Health Sciences, Inc. (Health Sciences), Alabama, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Health Sciences employed two individuals that it knew or should have known were excluded from participation in Federal health care programs.

02-01-2017

After it self-disclosed conduct to OIG, Ridgeview Institute, Inc. (Ridgeview), Georgia, agreed to pay $29,113.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Ridgeview employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

01-30-2017

After it self-disclosed conduct to OIG, Ocean Dental of Arkansas, PC (ODA), Arkansas, agreed to pay $17,346 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that ODA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

01-13-2017

On January 13, 2017, in connection with the resolution of his False Claims Act liability, Dr. Sotero Ureta, Lake City, Michigan, agreed to be excluded from participation in all Federal health care programs for a period of three years under 42 U.S.C. § 1320a-7(b)(7). OIG’s investigation revealed that Dr. Ureta caused the submission of false claims to Medicare and Medicaid for physical therapy, electrodiagnostic testing, and/or home health care services that he referred in exchange for illegal remuneration or kickbacks. Senior Counsel David Traskey represented OI

01-11-2017


Roben Brookhim, an unlicensed Dentist in New Jersey, agreed to pay $1,134,000 for allegedly violating the Civil Monetary Penalties Law and agreed to be excluded from participation in Federal health care programs for a period of fifty years under 42 U.S.C. § 1320a-7a and 42 U.S.C. § 1320a-7(b)(7). OIG alleged that Brookhim owned, controlled, and managed Associated Dental NP, LLC (ADNP), a New Jersey dental practice with multiple locations, in violation of his exclusion from Federal health care program participation in August 2000. OIG further alleged that as part of his fraud scheme, Brookhim assumed the identity of a licensed New Jersey dentist (Dentist A), to provide services to ADNP patients. Brookhim assumed Dentist A’s identity because Brookhim’s license to practice dentistry was suspended in 1999 and revoked in 2004. OIG contends that Brookhim presented claims for services to various New Jersey Medicaid Managed Care Organizations identifying Dentist A as having providing services; in fact, Dentist A never rendered services to ADNP patients. Brookhim continued to pose as Dentist A and submit claims in his name — even after Dentist A died. Senior Counsels David Blank and Michael Torrisi represented OIG with the assistance of Paralegal Specialist Mariel Filtz. News Release

01-06-2017

On January 6, 2017, Deseret Health Group and Jon Robertson (Robertson), Bountiful, Utah, agreed to be excluded from participation in all Federal health care programs for a period of thirty years under 42 U.S.C. §§ 1320a-7(b)(7) and 1320a-7(b)(6)(B). OIG alleged that Deseret Health Group and Robertson: (a) failed to provide adequate care planning and assessments of residents; (b) failed to provide medications, treatments, laboratory tests, physical therapy, and other services as ordered and/or prescribed by residents’ physicians; (c) failed to properly use and/or administer psychotropic drugs; (d) failed to follow appropriate pressure ulcer and infection control protocols for some residents; (e) failed to follow appropriate fall protocols for some residents; (f) failed to properly administer medications to some of the residents to avoid medication errors; (g) failed to provide a safe living environment for residents; and (h) failed to answer some residents’ call lights promptly. Senior Counsel Felicia Heimer represented OIG.