OIG Exclusion Screening

01-22-2020

After it self-disclosed conduct to OIG, Windsor Hospital Corporation d/b/a Mt. Ascutney Hospital and Health Center (Mt. Ascutney), Vermont, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mt. Ascutney employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

12-31-2019

On December 31, 2019, in connection with the resolution of their False Claims Act liability, Tree of Life Behavioral Health Services, Inc., Tree of Life Professional Behavioral Health Services, Inc., Tree of Life Professional Behavioral Health Systems (collectively, “Tree of Life”), Ada Vidal, and Victor Vidal, Philadelphia, Pennsylvania, agreed to be excluded under 42 U.S.C. 1320a-7(b)(7). Tree of Life agreed to be excluded for 25 years. Ada Vidal and Victor Vidal each agreed to be excluded for 20 years. The investigation revealed that Tree of Life, Ada Vidal, and Victor Vidal: (1) knowingly submitted or caused the submission of thousands of fraudulent Medicaid claims for outpatient mental health services for services never rendered or falsely inflated, services that were based on false patient progress notes and billing sheets and forged signatures of psychiatrists and therapists, and services provided by unqualified individuals; and (2) knowingly submitted or caused the submission of fraudulent outpatient mental health Medicaid claims that resulted from their payment of remuneration to a social worker for referrals of patients, including Medicaid patients. Senior Counsel Sarah Kessler represented OIG.

12-26-2019

On December 26, 2019, Lynne S. Brodell, DDS (Dr. Brodell), Cumberland, Maryland, entered into a $94,096.64 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Brodell 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.

12-20-2019

After it self-disclosed conduct to OIG, St. Charles Health System d/b/a St. Charles Bend (St. Charles), Oregon, agreed to pay $10,000 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. Charles employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

11-17-2019

On November 17, 2019, in connection with the resolution of their False Claims Act liability, Norman Harr (Harr) and Horisons Unlimited Health Care (Horisons), with multiple locations in and around Merced, California, agreed to be excluded. Harr agreed to be excluded under 42 U.S.C. § 1320a-7(b)(7) for a period of 15 years. Horisons agreed to be excluded under 42 U.S.C. §§ 1320a-7(b)(7) and (8) for a period of 20 years. OIG alleged that Harr and Horisons billed Federal health care programs for services they knew were not reimbursable, including billing for the following: (1) services provided by unlicensed and/or unqualified practitioners; (2) dental services not rendered; (3) reimbursable health care services when acupuncture, a non-reimbursable service, was actually provided; (4) visits with licensed doctors when patients actually received Ziploc baggies of Suboxone handed to them in the parking lots of McDonald’s or Rite Aid; (5) non-reimbursable experimental treatments using incorrect generic medical and dental codes; (6) unnecessary medical testing; (7) unnecessary orthodontia; (8) visits with a licensed social worker rather than for a routine office visit in order to increase reimbursement; and (9) mycotic toenail care when the patient actually received a toenail clipping, which would not have been covered. OIG also alleged that Harr and Horisons altered medical records, including making up diagnoses, in order to obtain reimbursement to which they were otherwise not entitled, and received cash payments from a lab in exchange for referring Federal health care program patients for testing. Senior Counsel Andrea Treese Berlin represented OIG.

11-08-2019

On November 8, 2019, Lakeshore Diagnostic Ultrasound Co. (Lakeshore), Essexville, Michigan, agreed to be excluded for a period of five years under 42 U.S.C. 1320a-7(b)(7). OIG’s investigation revealed that Lakeshore submitted claims for Current Procedural Terminology (CPT) code 96965 for the same dates of service on which it submitted claims for CPT code 93970 or 93971. OIG contends that Lakeshore’s submission of claims for CPT code 93965 were for a procedure that was already included as a component of the duplex ultrasound procedures for which Lakeshore submitted claims using CPT codes 93970 or 93971 for the same beneficiary on the same dates of service. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.

11-06-2019

On November 6, 2019, Amarillo Endoscopy Center (AEC), Amarillo, Texas, entered into a $121,550.12 settlement agreement with OIG. The settlement agreement resolves allegations that AEC employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a nursing assistant, provided items or services to AEC’s patients that were billed to Federal health care programs. Associate Counsel Dennis Pangindian represented OIG with the assistance of Paralegal Specialist Jennifer Hilton.

11-01-2019

On November 1, 2019, Eastern Area Specialty Transport, Inc., and David Haines, its owner (collectively, “EAST”), Leesburg, Ohio, agreed to be excluded for a period of five years under 42 U.S.C. 1320a-7(b)(7). OIG’s investigation revealed that EAST presented claims to Medicare Part B for ambulance transportation to and from skilled nursing facilities (SNFs) where such transportation was already covered by the SNF consolidated billing payment under Medicare Part A. OIG’s Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Geoffrey Hymans with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution.

10-11-2019

On October 11, 2019, West Texas Multicare Clinic, P.A. d/b/a Precision Chiropractic (Precision Chiropractic), Amarillo, Texas, entered into a $10,000 settlement agreement with OIG. The settlement agreement resolves allegations that Precision Chiropractic employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a billing specialist, provided items or services to Precision Chiropractic’s patients that were billed to Federal health care programs.

10-01-2019

On October 1, 2019, Miller’s Health System, Inc. d/b/a Miller’s Merry Manor (Miller’s), Portage, Indiana, entered into a $51,489.97 settlement agreement with OIG. The settlement agreement resolves allegations that Miller’s employed an individual who was excluded from participating in any Federal health care program. OIG’s investigation revealed that the excluded individual, a Director of Inservice Education, provided items or services to Miller’s patients that were billed to Federal health care programs.