Recent Cases

Pharmacies Targeted for Exclusion Violations by OIG and States

By Catalina Jandorf In what appears to be a growing enforcement trend, the Department of Health and Human Services, Office of Inspector General (HHS/OIG) and State Medicaid Fraud Units are aggressively pursuing pharmacy retailers for exclusion violations.  In recent investigations, pharmacies are being targeted for failing to screen prescribers as well as employing pharmacists who have been […] more>>

Excluded Dentist Pays Record $1.1 Million and Agrees to 50 Year Exclusion

Exclusion Violation by Dentist "Sends a Strong Warning" February 1, 2017 By Paul Weidenfeld The Office of the Inspector General's (OIG) announced last week that it had reached a settlement in excess of a million dollars with an excluded dentist for violations of the provisions of the regulations denying participation in federal health care programs […] more>>

OIG Imposes Record Penalties for Exclusion Violations

OIG Imposes Record $21.5 Million in Penalties for Exclusion Violations! The OIG imposed a record $21.5 million civil money penalties and restitution against an Ohio corporation that operates pharmacies and supermarkets in 34 states for exclusion violations involving the employment of excluded individuals and fulfilling prescriptions by excluded prescribers! The settlement alleged that the company filled […] more>>

Excluded Employees Cost Hospitals Over $1.5 Million in Civil Penalties

I. Excluded Employees cost Hospitals $1.64 Million in Penalties In the past two months, the Health and Human Services, Office of Inspector General (HHS/OIG) has announced the imposition of over $2 million in penalties in cases involving excluded employees.  The total amounted to more than $2 million in Civil Money Penalty (CMP) settlements. Out of these settlements, three hospitals […] more>>

Health Care Fraud: Second Conviction Secured in Michigan Excluded Provider Scheme

In February, we reported that the Michigan Attorney General secured a racketeering and health care fraud conviction against an excluded Michigan podiatrist. The podiatrist participated in an elaborate health care fraud scheme with another Michigan provider. In early July, the Michigan Attorney General successfully convicted the doctor who knew or should have known that the […] more>>

Pennsylvania Judge Holds that CIA violations May Result in FCA Liability

  In late July, a federal district court in Pennsylvania joined in the flurry of False Claims Act (FCA) decisions. These decisions further interpreted the ACA’s amendments to the law. The court in United States ex rel. Boise v. Cephalon, Inc. considered two important issues. The issues regarded when a party has an obligation to pay […] more>>

Southern District of New York Provides Clarity on “Identifying” Overpayments

In early August of 2015, the Southern District of New York (SDNY) provided insight as to when the 60-day clock for returning an overpayment begins to run under the Patient Protection and Affordable Care Act of 2010 (ACA). This decision is particularly relevant to screening for exclusions because the government has started to penalize providers who […] more>>

Home Health and Nursing Home Facilities a Major Target for OIG Enforcement

I.  Civil Monetary Penalties Twenty-five out of the fifty-five exclusion enforcement actions reported in 2014 have occurred in home health, hospice, or nursing and rehabilitation facilities. The Civil Monetary Penalties (CMPs) imposed in these cases range from $10,000 to $428,935 for employing just one individual that the employer knew or should have known was excluded […] more>>