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Medical Whistleblower Advocacy Network

Human Rights Defenders

“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.”

 Universal Declaration of Human Rights

Article 1

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Health Care Fraud

Fraud under the False Claims Act means that a contractor has knowingly presented a false claim for payment to the United States. The fraud can occur wherever federal or state monies are directly or indirectly used to purchase services or goods.

 

Medical Whistleblowers are typically healthcare professionals who are aware of hospitals, clinics, pharmacies, Nursing Homes, Hospices, long term care and other health care facilities that routinely overcharge or seek reimbursement from government programs for medical services not rendered, drugs not used, beds not slept in and ambulance rides not taken.

Since the 1990’s more fraud cases have been filed against against government medical health insurance programs – Medicare, Medicaid and Tri-Care (Military—formerly CHAMPUS) than against the defense industry.

Governmental Corruption - Transparency International

Types of Medical Fraud

Hospice care centers overbilling for patients stays and care.

Rehabilitation centers systematically inflating rehab bills.

Durable medical equipment fraud: kickbacks schemes in medical sales of items such as bedding and wheelchairs.

Nursing home overbilling of staff time and patient care.

Assisted living center fraud.

Medical coding: alteration of medical codes for different procedures and diagnosis.

Ambulance service fraud: billing for rides not authorized by Medicare.

"Phantom Billing" - Billing for tests not performed.

Performing inappropriate or unnecessary procedures.

Charging for equipment/supplies never ordered.

Billing Medicare/Medicaid for new equipment but providing the patient used equipment.

Billing Medicare/Medicaid for expensive equipment but providing the patient cheap equipment.

A drug or equipment supplier completing a Certificate of Medical Necessity (CMN) instead of the physician.

"Reflex testing" - Automatically running a test whenever the results of some other test fall within a certain range, even though the reflex test was not requested by a physician.

"Defective Testing" - When a test or part of a test was not performed because of technical trouble (ie: insufficient or destroyed sample, machine malfunction) but is billed for anyway.

"Code Jamming" - Laboratories inserting or "jamming" fake diagnosis codes to get Medicare/Medicaid coverage.

Offering free services or supplies in exchange for your Medicare or Medicaid number.

"Unbundling" - Using two or more Current Procedural Terminology ("CPT") billing codes instead of one inclusive code for a defined panel where rules and regulations require "bundling" of such claims. Submitting multiple bills, in order to obtain a higher reimbursement for tests and services that were performed within a specified time period and which should have been submitted as a single bill.

"Double Billing" — charging more than once for the same service, for example by billing using an individual code and again as part of an automated or bundled set of tests.

"Up Coding" - Inflating bills by using diagnosis billing codes that indicate the patient experienced medical complications and/or needed more expensive treatments. (eg., billing for complex services when only simple services were performed, billing for brand-named drugs when generic drugs were provided, listing treatment as having been for a more complicated diagnosis than was actually the case.)

"Phantom Employees" - Expensing employees or hours worked that do not exist.

"Improper Cost Reports" — Submitting false cost reports seeking higher Medicare reimbursements than permitted by actual facts.

Providing substandard nursing home care and seeking Medicare reimbursement.

Routinely waiving patient co-payments.

Office of Inspector General - False and Fraudulent Claims

http://oig.hhs.gov/fraud/enforcement/cmp/false_claims.asp

2011

11-17-2011
After it self-disclosed conduct to the OIG, Pitt County Memorial Hospital (PCMH), North Carolina, agreed to pay $68,479.04 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that PCMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-14-2011
After it self-disclosed conduct to the OIG, Providence Hospital, Alabama, agreed to pay $5,938.54 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Providence Hospital employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
11-02-2011
After it self-disclosed conduct to the OIG, Sonoma Healthcare Center (SHC), California, agreed to pay $106,650.11 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that SHC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-26-2011
After it self-disclosed conduct to the OIG, New York City Health and Hospital Corporation (HHC), New York, agreed to pay $442,909.35 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HHC employed eight individuals that it knew or should have known were excluded from participation in Federal health care programs.
10-26-2011
After it self-disclosed conduct to the OIG, Conestoga View Nursing, L.P. d/b/a Conestoga View, Pennsylvania, agreed to pay $264,879.84 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Conestoga View employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
10-06-2011
After it self-disclosed conduct to the OIG, Blue Hill Memorial Hospital (BHMH), Maine, agreed to pay $40,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that BHMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-20-2011
After it self-disclosed conduct to the OIG, Maine Coast Memorial Hospital (MCMH), Maine, agreed to pay $186,398.71 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MCMH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-15-2011
Jenq-Sheng Liu, Jenq-Sheng Liu, M.D., P.S.C. d/b/a Blue Grass Women's Clinic, and Su-Mei Liu, (defendants), Kentucky, agreed to pay $58,952.57 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that the defendants fraudulently billed Medicaid for six different Current Procedural Terminology codes. Su-Mei Liu agreed to a five-year period of exclusion from all Federal health care programs.
09-06-2011
After it self-disclosed conduct to the OIG, Cape Cod Hospital (CCH) a subsidiary of Cape Cod Healthcare, Inc., Massachusetts, agreed to pay $115,605.36 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that CCH employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
09-06-2011
After it self-disclosed conduct to the OIG, Visiting Nurse Association of Cape Cod (VNA) a subsidiary of Cape Cod Healthcare, Inc., Massachusetts, agreed to pay $278,169.84 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that VNA employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-30-2011
After it self-disclosed conduct to the OIG, St. Joseph Health Services of Rhode Island (St. Joseph), Rhode Island, agreed to pay $123,032 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that St. Joseph employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-23-2011
Savient Pharmaceuticals, Inc. (Savient), New Jersey, agreed to pay $100,000 to resolve Civil Monetary Penalties liability under the Medicaid Drug Rebate Program. Savient failed to submit pricing information and to pay a rebate to state Medicaid programs for covered drugs that the state Medicaid programs reimburse.
08-19-2011
After it self-disclosed conduct to the OIG, Hospice of the Finger Lakes (HFL), New York, agreed to pay $35,831.70 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that HFL employed an individual that it knew or should have known was excluded from participation in Federal health care programs.
08-09-2011
After it self-disclosed conduct to the OIG, Kmart Corporation (Kmart), Indiana, agreed to pay $945,021.19 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Kmart employed four individuals that it knew or should have known were excluded from participation in Federal health care programs.
08-09-2011
After it self-disclosed conduct to the OIG, North American Partners in Anesthesia (NAPA), New York, agreed to pay $506,231 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that five physicians formerly associated with NAPA had furnished services at a gastroenterologist's office that inaccurately reflected procedures as having been done on two separate days when they were actually done on a single day. The false statements resulted in higher charges and caused NAPA to submit false claims in connection with those services.
07-25-2011
After it self-disclosed conduct to the OIG, Trustees of Indiana University (IU), Indiana, agreed to pay $603,522 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that IU improperly claimed services provided by third and fourth year students in its professional optometry degree program under the physician fee schedule. The services could not be properly claimed under the physician fee schedule because the students were not in a graduate medical education program and the services were not provided in a teaching hospital or teaching setting.

Office of Inspector General - Kickback & Self Referral Fraud Cases

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.

2011

11-29-2011
After it self-disclosed conduct to the OIG, City Hospital, Inc., The Charles Town General Hospital d/b/a Jefferson Memorial Hospital, and West Virginia University Hospitals-East, Inc. (collectively respondents), West Virginia, agreed to pay $949,595 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that the respondents entered into several arrangements with physicians or physician groups for which the hospitals failed to collect office rental payments. The conduct included: (1) payments of costs and expenses pursuant to recruitment agreements in excess of the actual additional incremental costs; (2) payment of student loans without a written recruitment agreement; and (3) payment of costs and expenses pursuant to unwritten extensions of recruitment agreements.
10-04-2011
After it self-disclosed conduct to the OIG, County of Monterey d/b/a Natividad Medical Center (NMC), California, agreed to pay $174,508.46 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that NMC entered into a professional medical services agreement with a physician group for certain call coverage and clinic services. The compensation terms of the agreement offered incentives for the physician group to refer their private practice and medically indigent adult patients to NMC.
10-03-2011
After it self-disclosed conduct to the OIG, Westfields Hospital, Wisconsin, agreed to pay $204,150 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Westfields Hospital provided space, services, and supplies to certain physician group practices without entering into a formal written contract and without collecting payment.
9-08-2011
After it self-disclosed conduct to the OIG, Whidbey Island Hospital District (WIHD), Washington, agreed to pay $858,571 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that WIHD had over 100 violations surrounding various physician contracts and arrangements. Some of the violations included: (1) a number of hospitalist contracts had expired and new contracts had not been signed; (2) there were no written agreements in place for a number of medical staff leadership and call coverage arrangements; and (3) a variety of improper lease arrangements, personal service arrangements, malpractice subsidies, and a housing allowance and an equipment loan with one physician.
07-13-2011
After it self-disclosed conduct to the OIG, Good Samaritan Hospital Medical Center (GSHMC), New York, agreed to pay $55,018.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that GSHMC entered into an improper financial relationship with a physician professional corporation. The contract did not specify the terms of the intended agreement and the physician profession corporation received accelerated payments from GSHMC that did not comply with contractually agreed to payments. The payments were not consistent with fair market value.
07-13-2011
After it self-disclosed conduct to the OIG, St. Catherine of Siena Medical Center (St. Catherine), New York, agreed to pay $2,596,014 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that St. Catherine contracted with a physician owned professional services company. The company received remuneration that was not consistent with fair market value and received payments for services that were not performed under the contract.
05-11-2011
After it self-disclosed conduct to the OIG, Pacifica Hospital of the Valley (Pacifica), California, agreed to pay $764,250 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that Pacifica paid indirect improper remuneration to a physician in the form of payments to a marketing firm for marketing services that were never rendered under joint marketing agreements. The remuneration created a financial relationship between Pacifica and the physician that caused Pacifica to present claims for health services that resulted from prohibited referrals in violation of the Stark law.
03-24-2011
After it self-disclosed conduct to the OIG, Fairview Northland Regional Health Care (FNRHC), Minnesota, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that FNRHC entered into an unwritten lease agreement with a physician practice.

2010

12-03-2010
After it self-disclosed conduct to the OIG, Wayne County Hospital (WCH), Kentucky, agreed to pay $110,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that WCH: 1) paid remuneration to a physician by failing to charge processing fees for payroll services rendered to his practice; 2) paid remuneration to a physician and failed to demand or collect payroll processing fees and payments due for personnel and practice management support services rendered to her practice; and 3) paid remuneration to two physicians by failing to demand repayment of wages and benefits paid to the physicians and their staff and failed to charge processing fees for payroll services rendered to the practice.
11-09-2010
After it self-disclosed conduct to the OIG that it discovered had occurred at another hospital with which it had merged, St. Elizabeth Medical Center, Kentucky, agreed to pay $1,216,511 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that St. Elizabeth entered into an improper billing arrangement for "provider-based services" involving a rural outreach program that had occurred at another hospital prior to its acquisition by St. Elizabeth. In addition, the OIG alleged that the acquired hospital entered into several improper financial relationships with a referring physician that violated the Stark Law and the Anti-Kickback Statute.
10-21-2010
Steven J. Lancaster, M.D., Florida, agreed to pay $101,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Dr. Lancaster solicited kickbacks from a medical device manufacture. Dr. Lancaster sought to leverage his product usage and ability to influence purchasing decisions in exchange for a consulting agreement with a guaranteed payment. In addition, he sought to obtain a personal service agreement.
09-03-2010
After it self-disclosed conduct to the OIG, South Coast Medical Center (SCMC), California, agreed to pay $72,637.77 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that SCMC entered into multiple lease and personal services arrangements with doctors that raised compliance issues under the Stark Law and Anti-Kickback Statute.
07-21-2010
After it self-disclosed conduct to the OIG, Mercy Medical Center, Inc. (MMC), Maryland, agreed to pay $195,013.50 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that MMC entered into physician service arrangements, lease arrangements, physician on-call arrangements and billing and collection agreements that raised potential issues under the Stark Law and the Anti-Kickback Statute.
07-08-2010
United Shockwave Services, United Urology Centers, and United Prostate Centers (collectively, United), Illinois, agreed to pay $7,359,500 and entered into a five year CIA for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that United and certain physician-investors used their ability to control patient referrals to obtain contract business from various hospitals. Specifically, United threatened hospitals that it would refer patients to competing hospitals if the respective hospital did not agree to a contract with United, or promised hospitals that did contract with United additional referrals. The relationships between United's physician-investors and the hospitals raised Stark concerns regarding the financial relationships between United's physician-investors and the hospitals to which they made referrals. Also, United sold more shares to physicians who produced more referrals or other business for the company. United had processes for having physicians divest if they did not use United's services sufficiently and offered huge returns on investment with virtually no business risk.
06-17-2010
After it self-disclosed conduct to the OIG, St. John's Regional Medical Center (SJRMC), Missouri, agreed to pay $274,815 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that SJRMC entered into an improper financial relationship with a physician. SJRMC allowed the physician to be regularly delinquent in rent under a written lease agreement and paid the physician for services without a written contract in place.
06-07-2010
After it self-disclosed conduct to the OIG, Christus Spohn Hospital Corpus Christi- Memorial (Memorial), Texas, agreed to pay $4,130,536 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks. The OIG alleged that: (1) Memorial paid indirect remuneration to family medicine and emergency medicine faculty physicians in the form of (a) salary and benefit reimbursements to the faculty physicians' employer that were more than fair market value for the time the physicians spent fulfilling their contractual duties to Memorial and (b) billing and collections services associated with the faculty physicians' practices to an educational foundation and successor entity; (2) Memorial paid remuneration to certain family medicine faculty physicians in the form of charging rent below fair market value for office space on the fifth and sixth floors of Memorial's hospital; and (3) Memorial paid remuneration to two entities providing services proscribed by the Ethical and Religious Directives for Catholic Health Care Services in the form of the entities' staffing, equipment, and billing for the facility fees associated with the proscribed services and paying those fees to the involved entities.
06-03-2010
Cochlear Americas, Colorado, agreed to pay $880,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Cochlear Americas paid various forms of illegal remuneration to physicians who prescribed the use of their manufactured implant system for Medicare and Medicaid patients.
05-11-2010
After it self-disclosed conduct to the OIG, Surgical Specialty Center of Baton Rouge, LLC (provider), Louisiana, agreed to pay $51,300 for allegedly violating the Civil Monetary Penalties Law provisions applicable to the Stark Law. The OIG alleged that the provider entered into several types of financial arrangements with referring physicians without the requisite written agreements in place as required by the Stark Law.
05-03-2010
After it self-disclosed conduct to the OIG, Colorado West HealthCare System d/b/a Community Hospital and its subsidiary, Doctor's Clinic Building, Inc. (Colorado West), Colorado, agreed to pay $420,175 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that Colorado West entered into six categories of contractual arrangements (i.e., medical director arrangements, emergency room services, office leases, on-call physician arrangements, continuing medical education services, and diagnostic test interpretations) that violated the Stark Law and, in some instances, implicated the Anti-Kickback Statute in connection with physicians' referrals of Medicare beneficiaries to Colorado West.
04-20-2010
After it self-disclosed conduct to the OIG, St. Elizabeth Hospital and Mercy Medical Center of Oshkosh, Inc. (hospitals), Wisconsin, both part of the Affinity Health System, agreed to pay $54,124 for allegedly violating the Civil Monetary Penalties Law provisions applicable to the Stark Law. The OIG alleged that the hospitals disclosed payments to three independent psychiatrists who provided behavioral health services at the hospitals' emergency rooms. Specifically, the on-call coverage arrangements between the psychiatrists and hospitals failed to comply with Stark Law requirements.
03-31-2010
After it self-disclosed conduct to the OIG, St. James Healthcare (SJH), Montana, agreed to pay $275,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to the Stark Law. The OIG alleged that SJH entered into a space lease, an employee lease, and a medical services arrangement with an entity partly owned by SJH that failed to meet Stark Law requirements because they were not set forth in writing and signed.
03-01-2010
After it self-disclosed conduct to the OIG, Liberty HealthCare Systems, Inc. (Liberty), New Jersey, agreed to pay $225,000 to resolve its liability for allegedly violating the Civil Monetary Penalties Law provisions applicable to the Stark Law. The OIG alleged that Liberty made an improper bonus payment to an employee physician based, in part, on the volume and value of referrals made by the physician.
02-16-2010
Harvey Montijo, M.D., Florida, agreed to pay $650,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Dr. Montijo solicited and received remuneration in the form of consulting payments from two medical device manufactures in exchange for using their orthopedic hip and knee products.
02-08-2010
Garden State Imaging (GSI), New Jersey, agreed to pay $83,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that GSI entered into a verbal agreement with two owners of a medical center. Under the terms of the verbal agreement, GSI agreed to provide mobile diagnostic imaging and related services to the medical center's patients and to split with the medical center 50% of the net proceeds that were generated.
01-22-2010
After it self-disclosed conduct to the OIG, St. Mary Medical Center - Long Beach (St. Mary), California, agreed to pay $494,374 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that St. Mary paid remuneration to a medical group and its owner in the form of administrative services from a St. Mary's employee and paid remuneration through leased space and a medical director agreement.
01-06-2010
After it self-disclosed conduct to the OIG, Inland Imaging, LLC (Inland), Washington, agreed to pay $155,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to the Stark Law. The OIG alleged that Inland provided certain outpatient radiology services to Medicare beneficiaries based on orders written by physicians who were immediate family members of three individuals who held indirect ownership interests in Inland.

2009

12-10-2009
After it self-disclosed conduct to the OIG, Piedmont Hospital, Inc., Georgia, agreed to pay $126,322 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that Piedmont's financial relationships with 22 physicians failed to meet Stark law and Anti-Kickback statute requirements. The majority of the arrangements involved payment for services performed without a fully-executed written contract, one arrangement involved a physician who was paid at rates differing from the contract rate, and other arrangements involved payment for services that were not set forth in a contract.
12-02-2009
After it self-disclosed conduct to the OIG, Oswego Hospital, New York, agreed to pay $2,134,037 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that Oswego's financial relationships with more than 20 physicians failed to meet Stark law requirements. Most of the violations involved the hospital's failure to comply with Stark law requirements for recruitment arrangements, office leases, professional service arrangements, and the provision of discounted employee benefit plan premiums to non-employed physicians.
11-04-2009
After it self-disclosed conduct to the OIG, Allied Health Care Corporation (Allied), Florida, agreed to pay $132,500 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that two physicians that were shareholders in Allied made referrals to two home health agencies which were wholly owned subsidiaries of Allied.
10-20-2009
Robert Diaz, M.D. (Diaz), Florida, agreed to pay $65,000 and to be excluded from participating in Federal health care programs for three years for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Diaz solicited and received remuneration in the form of consulting payments from a medical device manufacturer in exchange for using their orthopedic hip and knee products.
10-16-2009
After it self-disclosed conduct to the OIG, Medina General Hospital (MGH), Ohio, agreed to pay $240,298 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that MGH's financial relationships with a family practice physician, occupational health services physicians, and a cardiologist failed to meet Stark Law requirements. Specifically, the financial relationships were during periods when there were no written service agreements or payments were not made consistent with the contracts.
After it self-disclosed conduct to the OIG, Vascular Specialty Services, Inc. (VSSI), Maryland, agreed to pay $34,182 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that VSSI's financial relationship with four vascular surgeons failed to meet Stark law requirements. Specifically, VSSI added lab referral revenues into a bonus pool that was paid to the vascular surgeons.
09-25-2009
Michael Bakst, the former Executive Director of Community Memorial Hospital (CMH) of Ventura, California, agreed to pay $64,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Bakst caused the submission of claims to Medicare in violation of the physician self-referral (Stark) law. During the relevant time period Bakst was also identified as CMH's Compliance Officer.
09-17-2009
After it self-disclosed conduct to the OIG, Liberty HealthCare System, Inc. (Liberty), New Jersey, agreed to pay $417,675 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that one of Liberty's hospitals failed to reflect an increase in compensation and hours of service in a written pediatric coverage agreement with a physician practice that provided pediatric coverage services to MHMC.
08-11-2009
After it self-disclosed conduct to the OIG, Cushing Memorial Hospital (CMH), Kansas, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that CMH's financial relationship with a cardiologist failed to meet Stark Law requirements. Specifically, the cardiologist was engaged to provide medical director services to CMH's cardiac rehabilitation unit. However, the written agreement was not signed. In addition, CMH's office space lease with the cardiologist did not meet the applicable lease exception.
08-03-2009
After it self-disclosed conduct to the OIG, Central Kansas Medical Center (CKMC), Kansas, agreed to pay $50,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that CKMC entered into two lease arrangements, with a referring-physician-owned partnership, that failed to comply fully with the Stark law's requirements for such financial arrangements.
07-31-2009
After self-disclosing to the OIG, Kahuku Hospital, Hawaii, agreed to pay $75,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that Kahuku Hospital entered into services agreements with emergency room physicians where payments were made in excess of the amount provided for in the agreement and entered into other arrangements with emergency room physicians that were not in writing.
07-10-2009
After it self-disclosed conduct to the OIG, Inova Health Care Services d/b/a Inova Fairfax Hospital (Inova), Virginia, agreed to pay $528,158 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that Inova paid remuneration to Arrhythmia Associates (AA) in the form of services provided by certain physician assistants (PA) within the office of AA. Specifically, Inova provided PA services to AA without written contracts in place and failed to bill and collect for those PA services.
06-26-2009
After it self-disclosed conduct to the OIG, Memorial Hospital of Union County (MHUC), Ohio, agreed to pay $31,202 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that MHUC provided excess non-monetary compensation to physicians and the immediate family member of a physician who referred patients to MHUC.
02-09-2009
After it self-disclosed conduct to the OIG, Jewish Hospital and St. Mary's Healthcare (JHSMH), Kentucky, agreed to pay $130,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that JHSMH entered into an arrangement with a physician for a Medical Director position that included the physician being paid compensation in excess of his Medical Director agreement and receiving free nurse services for his private practice without any contractual entitlement to such services.
01-27-2009
After it self-disclosed conduct to the OIG, San Jacinto Methodist Hospital (SJMH), Texas, agreed to pay $21,025.62 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that SJMH entered into an arrangement with a physician for a Medical Director position that included the physician occupying hospital space for private use and utilizing hospital personnel for clerical assistance related to the physician's private practice patient visits without any contractual entitlement to do so.

2008

12-03-2008
After it self-disclosed conduct to the OIG, The King's Daughters' Hospital and Health Services (Hospital), Indiana, agreed to pay $391,500 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that the Hospital had compensation arrangements with employed physicians that failed to comply fully with the Stark Law's restrictions on productivity bonuses. Specifically the physicians were compensated for services that were not personally performed by them.
11-26-2008
After self-disclosing conduct to the OIG, Bioscrip, Inc. and Bioscrip Pharmacy, Inc. (Bioscrip), agreed to pay $795,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and prohibited physician self-referrals. The OIG alleged that Bioscrip stationed a pharmacist, from its West Hollywood, California pharmacy, at two physician practices and that, while on-site at the physician practices, the pharmacist provided services for the pharmacy with the practices as well as services that benefitted the physician practices (without a lease), including services that otherwise would have been provided to patients by the physician practices. Patients of the physician practices, including those counseled by the on-site Bioscrip pharmacist, were referred to and filled prescriptions paid for by the Medicare Part D program at a Bioscrip pharmacy.
11-04-2008
Abbott Northwestern Hospital, Minnesota, agreed to pay $350,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals. The OIG alleged that Abbott made physician salary guarantee payments to three Sports and Orthopedic Specialists without entering into written physician recruitment agreements with the recruited physicians.
10-01-2008
Valerie Tolley d/b/a Health Care Medical (HCM), Mississippi, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that HCM made payments and attempted to make payments of kickbacks in exchange for direct and indirect patient referrals.
08-11-2008
After it self-disclosed conduct to the OIG, Ivinson Hospital, Wyoming, agreed to pay $635,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Ivinson paid prohibited remuneration to physicians in the form of free rent, equipment and furnishings, leases at less-than-fair-market value, reimbursement for medical-director services in excess of fair-market value, and reimbursement in excess of the requirements of an income-guarantee agreement.
08-04-2008
Bernhardt Laboratories, Inc. (BLI), Michael J. Bernhardt, M.D., and Michael J. Bernhardt, M.D.P.A., Florida, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law b y submitting claims in violation of the Stark Law. The OIG alleged that Michael Bernhardt, M.D. referred patients to BLI for clinical laboratory services. The referrals to BLI violated the Stark Law in that BLI was owned by Michael Bernhardt's brother.

Office of Inspector General - Medical Fraud

          
08-23-2011
Savient Pharmaceuticals, Inc. (Savient), New Jersey, agreed to pay $100,000 to resolve Civil Monetary Penalties liability under the Medicaid Drug Rebate Program. Savient failed to submit pricing information and to pay a rebate to state Medicaid programs for covered drugs that the state Medicaid programs reimburse.

05-15-2007
Lee R. Rocamora, M.D., North Carolina, agreed to pay $106,600 to resolve his liability for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the practitioner requested payments from Medicare beneficiaries in violation of his assignment agreement. Specifically, the practitioner allegedly asked his patients to enter into a membership agreement for his patient care program, under which the patients paid an annual fee. In exchange for the fee, the membership agreement specified that the practitioner would provide members with: (1) an annual comprehensive physical examination; (2) same day or next day appointments; (3) support personnel dedicated exclusively to members; (4) 24 hours a day and 7 days a week physician availability; (5) prescription facilitation; (6) coordination of referrals and expedited referrals, if medically necessary; and (7) other service amenities as determined by the practitioner.
07-28-2003
A physician from Minneapolis, Minnesota, agreed to pay $53,400 to resolve his liability under the CMP provision applicable to violations of a provider's assignment agreement. By accepting assignment for all covered services, a participating provider agrees that he or she will not collect from a Medicare beneficiary more than the applicable deductible and coinsurance for covered services. The OIG alleged that the physician created a program whereby the physician's patients were asked to sign a yearly contract and pay a yearly fee for services that the physician characterized as "not covered" by Medicare. The OIG further alleged that because at least some of the services described in the contract were actually covered and reimbursable by Medicare, each contract presented to the Medicare patients constituted a request for payment other than the coinsurance and applicable deductible for covered services in violation of the terms of the physician's assignment agreement. In addition to payment of the settlement amount, the physician agreed not to request similar payments from beneficiaries in the future.

11-07-2007
America's Health Choice, Inc. (AHC), Florida, agreed to pay $100,000 to resolve its liability under the OIG's CMP provision applicable to any Medicare Advantage organization that misrepresents or falsifies information to the Secretary of HHS (Secretary). The OIG alleged that AHC submitted documents to the Secretary on at least three occasions that misrepresented the academic credentials of an AHC employee and submitted at least seven effectuation notices to the Center for Health Care Dispute Resolution (CHDR) in which dates of submission had been falsified to appear in compliance with CHDR's request for claims data.

12-31-2001
Molina Medical Centers, a California Medicaid managed care plan, agreed to pay $600,000 to resolve its liability under the OIG's CMP provision applicable to any Medicaid managed care organization that misrepresents or falsifies information to an individual. The OIG alleged that the managed care plan sent misleading letters to its Medicaid enrollees in an effort to persuade the enrollees to continue to choose it as their Medicaid managed care plan. The OIG alleged that the letters appeared to be written and signed by the enrollees' primary care physicians even though they were actually written and signed by employees of the managed care plan.



“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”

― Leo Buscaglia

Medical Whistleblower Advocacy Network

MEDICAL WHISTLEBLOWER ADVOCACY NETWORK

P.O. 42700 

Washington, DC 20015

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"Never impose on others what you would not choose for yourself."  Confucius

"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."

Theodore Roosevelt- Excerpt from the speech "Citizenship In A Republic", delivered at the Sorbonne, in Paris, France on 23 April, 1910