OIG Exclusion Screening

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.

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.

08-28-2018

After it self-disclosed conduct to OIG, Adventist Health System Sunbelt Healthcare Corporation (Adventist), Florida, agreed to pay $21,219.17 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Adventist employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

08-24-2018

On August 24, 2018, St. Mary’s Health System (St. Mary’s), Lewiston, Maine, entered into a $68,497.32 settlement agreement with OIG. The settlement agreement resolves allegations that St. Mary’s employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a call center patient scheduler, provided items and services to St. Mary’s patients that were billed to Federal health care programs.

08-21-2018

On August 21, 2018, OIG excluded La Fuente Ocular Prosthetics, LLC (La Fuente), an Oklahoma City, Oklahoma, prosthetic supplier, for defaulting on payment obligations under a settlement agreement with OIG wherein OIG alleged that La Fuente submitted false or fraudulent claims to Medicare and created false records material to a false claim. La Fuente’s exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates La Fuente’s participation in Federal Health care programs. Senior Counsel Geoffrey Hymans represented OIG.

08-20-2018

On August 20, 2018, First Initiative, LLC, a behavioral health services provider in Las Vegas, Nevada, and Shameika Amin, its owner (collectively, “First Initiative”), agreed to be excluded for a period of fifty years under 42 U.S.C. § 1320a-7(b)(7). OIG’s investigation revealed that First Initiative knowingly submitted or caused to be submitted claims to the Nevada Medicaid program for: (1) individual therapy services using CPT Codes 90834 and 90837 when group therapy services had been provided; (2) individual psychotherapy services utilizing biofeedback training using CPT Code 90876 when no biofeedback training had been provided; and (3) behavioral health services that were billed under the names and national provider identifiers of providers who had not provided the services. Senior Counsel Michael Torrisi and Associate Counsel Srishti Sheffner represented OIG.

08-08-2018

On August 8, 2018, CHJ Diagnostic, Inc., an independent diagnostic testing facility in Orange, California, and Andranik Tovmasyan, its owner (collectively, “CHJ”), agreed to be excluded for a period of five years under 42 U.S.C. § 1320a-7(b)(7). OIG’s investigation revealed that CHJ submitted claims for nerve conduction studies that are considered screening exams and not covered by Medicare. OIG’s Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Kenneth Kraft, collaborated to achieve this resolution.

08-02-2018

On August 2, 2018, Ireland Health Care Center, Inc. d/b/a Singleton Health Care Center (SHCC), Cleveland, Ohio, entered into a $45,735.42 settlement agreement with OIG. The settlement agreement resolves allegations that SHCC 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 SHCC’s patients that were billed to Federal health care programs. Senior Counsel Nancy Brown, with the assistance of Paralegal Specialist Eula Taylor, represented OIG.