Civil Monetary Penalties and Affirmative Exclusions

The Office of Inspector General (OIG) has the authority to seek civil monetary penalties (CMPs), assessments, and exclusion against an individual or entity based on a wide variety of prohibited conduct. In each CMP case resolved through a settlement agreement, the settling party has contested the OIG's allegations and denied any liability. No CMP judgment or finding of liability has been made against the settling party.

OIG Enforcement Cases

The cases listed below represent recently-closed cases initiated by the OIG's Office of Counsel to the Inspector General. To view additional cases, including those resolved through the provider self-disclosure protocol, click on the specific categories to the right.

07-20-2020

Texas Company and Owner Agree to Voluntary Exclusion On July 20, 2020, in connection with the resolution of their False Claims Act liability, Jason Bourque (Bourque) and Allen Research Corporation (Allen Research), Frisco, Texas, each agreed to be excluded under 42 U.S.C. 1320a-7(b)(7) for 10 years. The investigation revealed and OIG alleged that Bourque and Allen Research: recruited physicians to be part of a purported "research study" for transdermal pain cream; directed certain recruited physicians who participated in the purported "research study" to send prescriptions for pain creams to a pharmacy in Allen, Texas; together with the pharmacy, had an agreement pursuant to which the pharmacy agreed to pay Bourque and Allen Research a percentage of its insurance reimbursements, which included amounts paid by TRICARE, for pain cream prescriptions Bourque and Allen Research arranged to be filled by the pharmacy; and then paid certain physicians who had written the prescriptions a percentage of the amount received from the pharmacy. OIG alleged that the arrangement among Bourque, Allen Research, the pharmacy, and the physicians violated the Anti-Kickback Statute. Senior Counsel Karen Glassman represented OIG. 07-14-2020

New York Federally Qualified Health Center Settles Case Involving False Grant Claims and Misrepresentations On July 14, 2020, Brooklyn Plaza Medical Center (BPMC), a federally qualified health center in Brooklyn, New York, entered into a $100,000 settlement agreement and a 5-year recipient compliance agreement with OIG. The settlement agreement resolves allegations that BPMC made false specified claims in the form of drawdowns from the HHS Payment Management System for Health Resources and Services Administration grant funds that were not supported by adequate documentation, timesheets, and a financial management and control system that ensured that HHS grant funds were used solely for authorized purposes in accordance with federal statutes, regulations, and the terms and conditions of BPMC's federal awards. The OIG further alleged that on various occasions during the same timeframe, BPMC falsely represented to HHS in funding applications that it had in place: (1) safeguards to prohibit employees from using their positions for personal gain; and (2) a financial management and control system that ensured that HHS grant funds were used solely for authorized purposes in accordance with federal statutes, regulations, and the terms and conditions of BPMC's federal awards. OIG's Office of Investigations and Office of Counsel to the Inspector General, represented by Senior Counsels Michael Torrisi and David Traskey, collaborated to achieve this settlement. 07-10-2020

Texas Skilled Nursing Facility Settles Case Involving Excluded Individual On July 10, 2020, RJ Meridian Care Alta Vista, LLC d/b/a Meridian Care Monte Vista (Meridian Care), San Antonio, Texas, entered into a $143,630.83 settlement agreement with OIG. The settlement agreement resolves allegations that Meridian Care employed an individual who was excluded from participating in any Federal health care program. OIG's investigation revealed that the excluded individual, an admission director, provided items or services that were billed to Federal health care programs. 06-29-2020

Florida Practice Settles Case Involving False Claims On June 29, 2020, Florida Pain and Rehabilitation Center (FPRC), Lake City, Florida entered into a $94,658.76 settlement agreement with OIG. The settlement agreement resolves allegations that FPRC submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution. Florida Laboratory Settles Case Involving False Claims On June 29, 2020, River Crossing Labs, LLC (RCL), Tampa, Florida, entered into a $68,253.44 settlement agreement with OIG. The settlement agreement resolves allegations that RCL submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution. 06-05-2020

Florida Laboratory Settles Case Involving False Claims On June 5, 2020, Complete Biosolutions, Inc. (CBI), Hialeah, Florida, entered into a $126,793.56 settlement agreement with OIG. The settlement agreement resolves allegations that CBI submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution. 05-27-2020

Florida Practice Settles Case Involving False Claims On May 27, 2020, Stages of Life Medical Institute, Inc. (SLMI), Longwood, Florida, entered into a $54,746.52 settlement agreement with OIG. The settlement agreement resolves allegations that SLMI submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Gregory Becker with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution. 05-21-2020

Texas Pharmaceutical Company Settles Case Involving Drug Price Reporting On May 21, 2020, Method Pharmaceuticals, LLC (Method), Fort Worth, Texas, entered into a $45,000 settlement agreement with OIG. The settlement agreement resolves allegations that Method failed to submit timely certified monthly and quarterly Average Manufacturer's Price (AMP) data to the Centers for Medicare and Medicaid Services (CMS) for certain months and quarters in 2015, 2016, 2017, and 2018. The Medicaid Drug Rebate Program requires manufacturers to enter into and have in effect a national rebate agreement with the Secretary of Health and Human Services in order for Medicaid payments to be available for the manufacturer's covered outpatient drugs. Companies with such rebate agreements are required to submit certain drug pricing information to CMS, including quarterly and monthly AMP data. Senior Counsel Mary Riordan represented OIG with the assistance of Program Analyst Mariel Filtz. 05-14-2020

South Carolina Ambulance Company Settles Case Involving False Claims On May 14, 2020, Vital Care EMS, Inc. (Vital Care), an ambulance provider servicing Sumter, Columbia, and Greenville, South Carolina, entered into a $2,213,516.71 settlement agreement with OIG. The settlement agreement resolves allegations that Vital Care presented claims to Medicare Part B for ambulance transportation to and from skilled nursing facilities (SNFs) where such transportation was 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 Srishti Sheffner and Geoffrey Hymans with the assistance of Paralegal Specialist Jennifer Hilton, collaborated to achieve this resolution. 05-08-2020

Illinois Diagnostic Service Provider and Owner Settle Case Involving False Claims On May 8, 2020, Hussain Ghalib and U.S. Diagnostics, Inc. (collectively, "US Diagnostics"), Chicago, Illinois, entered into a $147,302.35 settlement agreement with OIG. The settlement agreement resolves allegations that US Diagnostics submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 93965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which US Diagnostics submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. OIG further alleges that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary. Senior Counsels Geoffrey Hymans and Joan Matlack, with the assistance of Program Analyst Mariel Filtz, represented OIG.

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