Two companies heavily fined for employing excluded individuals

After it disclosed conduct to the OIG pursuant to its CIA, Quest Diagnostics, Incorporated (Quest), New Jersey, agreed to pay $152,560.51 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Quest employed four individuals that it knew or should have known were excluded from participation in Federal health care programs.

After it disclosed conduct to the OIG pursuant to its CIA, Amerigroup Corporation (Amerigroup), Virginia, agreed to pay $30,754.93 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Amerigroup contracted with three individuals that it knew or should have known were excluded from participation in Federal health care programs and paid for prescriptions written by a fourth individual that it knew or should have known were excluded from participation in Federal health care programs.

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OIG Excludes Georgia Pain Management Clinic for Material Breach

On November 5, 2015, OIG excluded C.F. Health Management, Inc. d/b/a/ Gainesville Pain Management (Gainesville), for a period of five years, based on a material breach of its Corporate Integrity Agreement (CIA). During the first reporting period of its CIA, Gainesville’s Independent Review Organization (IRO) identified an error rate of 28% in its Discovery Sample and an error rate of 37.98% in its Full Sample, resulting in an extrapolated overpayment of $239,961.80. On July 16, 2015, OIG issued a letter demanding stipulated penalties in the amount of $34,000 based on Gainesville’s failure to repay the overpayment identified by its IRO. After Gainesville failed to respond to OIG’s demand letter, OIG issued a notice of material breach and intent to exclude on August 21, 2015. Under the terms of the CIA, Gainesville had 25 days to request a hearing with an Administrative Law Judge. Gainesville did not request a hearing and the exclusion went into effect on November 5, 2015. Senior Counsel Nicole Caucci represented OIG.

OIG Excludes Todd Roberts and his Practice for Material Breach

On November 15, 2015, OIG excluded Todd Roberts and Roberts Physical and Aquatic Therapy, LLC a/k/a Roberts Physical Therapy and Wellness Center, LLC (collectively, Roberts), for a period of six years based on a material breach of its Corporate Integrity Agreement (CIA). During the first reporting period of its CIA, Roberts’ Independent Review Organization (IRO) identified an overpayment of $32,295, which Roberts has not paid. Roberts also failed to timely submit its Implementation Report, First Annual Report, and Second Annual Report. On June 16, 2014, OIG issued a letter demanding stipulated penalties in the amount of $24,000. OIG issued a notice of material breach and intent to exclude on September 1, 2015 for repeated and flagrant violations of the CIA and Roberts’ failure to respond to OIG’s demand letter. On October 15, 2015, OIG sent Roberts an exclusion letter. Under the terms of the CIA, Roberts had 25 days to request a hearing with an Administrative Law Judge. Roberts did not request a hearing, and the exclusion went into effect on November 15, 2015. Senior Counsels Lee Penninger, Tamara Forys, and Lauren Marziani represented OIG.

Two Companies Hit for Employing Excluded Individual

After it self-disclosed conduct to OIG, 125 Alma Boulevard Operations LLC d/b/a Island Health and Rehabilitation Center (IHRC), Florida, agreed to pay $30,924.11 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that IHRC 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, AHS Oklahoma Physician Group, LLC d/b/a Utica Park Clinic (UPC), Oklahoma, agreed to pay $13,467.01 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UPC employed an individual that it knew or should have known was excluded from participation in Federal health care programs.

Nurse Aide Allegedly Punched Nursing Home Resident

Attorney General Eric T. Schneiderman announced the arraignment of Sonya King, 42, a Certified Nurse Aide, for allegedly punching an 87-year-old male resident on the right side of the face. It is charged that the physical altercation resulted in fractures of the right orbit of the right eye, non-displaced fractures of the right and left nasal bones, and a non-displaced fracture below the eye. King later allegedly omitted the fact that she was responsible for his injuries in facility reports. The incident took place on January 23, 2016, at Focus Rehabilitation and Nursing Center at Utica.

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