CORPORATE INTEGRITY AGREEMENT ENFORCEMENT ACTIONS
Additional Information
Corporate Integrity Agreement Enforcement
The Office of Inspector General (OIG) enters into Corporate Integrity Agreements (CIAs) and Integrity Agreements (IAs) with health care providers and other entities as part of the settlement of Federal health care program investigations arising under a variety of civil false claims statutes. The CIA/IA breach and default provisions allow the OIG to impose certain monetary penalties (referred to as Stipulated Penalties) for the failure to comply with certain obligations set forth in the CIA/IA. In addition, a material breach of the CIA/IA constitutes an independent basis for the provider's exclusion from participation in the Federal health care programs.
08-12-2020
OIG Excluded Charter Home Health, Jo Allyson Williams, and Wandell Ray Roger for Material Breach of their Integrity Agreement
On August 12, 2020, OIG excluded Charter Home Health, Inc., Jo Allyson Williams, and Wandell Ray Rogers (collectively, "Charter Home Health"), for a period of five years based on a material breach of their Integrity Agreement (IA). On March 10, 2020, OIG issued a letter demanding stipulated penalties of $280,500 based on Charter Home Health's failure to submit their second Annual Report. After Charter Home Health failed to pay the stipulated penalties and cure the breach or request a hearing by an HHS Administrative Law Judge, OIG issued a notice of material breach and intent to exclude in May 2020. Under the terms of the IA, Charter Home Health had 25 days to request a hearing with an Administrative Law Judge. Charter Home Health did not request a hearing. OIG excluded Charter Home Health effective August 12, 2020. Senior Counsel Nancy Brown represented OIG.
06-01-2020
DAB Upholds OIG Demand for Stipulated Penalties
On June 1, 2020, the Departmental Appeals Board (DAB) upheld OIG's demand that Friendship Home Health, Inc., et al. (Friendship Entities) pay $1,322,500 in stipulated penalties for breaches of their CIA. On November 19, 2018, OIG sent the Friendship Entities a demand for $1,322,500 in stipulated penalties for their failure to repay overpayments identified in their second and third annual reports. The Friendship Entities appealed this demand and requested a hearing with a DAB Administrative Law Judge (ALJ). On October 31, 2019, the ALJ upheld OIG's demand. The Friendship Entities then appealed to the DAB. In its decision, the DAB agreed with the ALJ's conclusions that the CIA's auditing and repayment provisions created independent obligations to repay overpayments to Medicare and Medicaid, and that each time the Friendship Entities violated those obligations to repay overpayments, it created a separate basis for OIG to demand stipulated penalties. The DAB also agreed that the Friendship Entities were properly subject to stipulated penalties arising from those failures and further held that the CIA authorizes per-day stipulated penalties to run concurrently for each failure to make timely repayment.
11-15-2019
California Skilled Nursing Facility Pays CIA Stipulated Penalty
On November 15, 2019, B-Spring Valley, LLC d/b/a Brighton Place - Spring Valley (Brighton Place - Spring Valley), paid a stipulated penalty of $30,000 for failing to comply with certain CIA requirements. Specifically, Brighton Place - Spring Valley failed to: (1) implement procedures for tracking service and activity logs for parties to Focus Arrangements; (2) implement written review and approval processes for Focus Arrangements; and (3) failed to timely engage a Compliance Expert to perform a Compliance Program Review.1
1-15-2019
California Skilled Nursing Facility Pays CIA Stipulated PenaltyOn November 15, 2019, B-San Diego, LLC d/b/a Brighton Place - San Diego (Brighton Place - San Diego), paid a stipulated penalty of $30,000 for failing to comply with certain CIA requirements. Specifically, Brighton Place - San Diego failed to: (1) implement procedures for tracking service and activity logs for parties to Focus Arrangements; (2) implement written review and approval processes for Focus Arrangements; and (3) failed to timely engage a Compliance Expert to perform a Compliance Program Review.
11-15-2019
California Skilled Nursing Facility Pays CIA Stipulated Penalty
On November 15, 2019, B-East, LLC d/b/a Amaya Springs Health Care Center (Amaya Springs), paid a stipulated penalty of $30,000 for failing to comply with certain CIA requirements. Specifically, Amaya Springs failed to: (1) implement procedures for tracking service and activity logs for parties to Focus Arrangements; (2) implement written review and approval processes for Focus Arrangements; and (3) failed to timely engage a Compliance Expert to perform a Compliance Program Review.
11-14-2019
California Skilled Nursing Facility Pays CIA Stipulated PenaltyOn November 14, 2019, Point Loma Rehabilitation Center, LLC d/b/a Point Loma Convalescent Hospital (Point Loma), paid a stipulated penalty of $25,000 for failing to comply with certain CIA requirements. Specifically, Point Loma failed to: (1) implement procedures for tracking service and activity logs for parties to Focus Arrangements; (2) implement written review and approval processes for Focus Arrangements; and (3) failed to timely engage a Compliance Expert to perform a Compliance Program Review.
09-18-2019
California Home and Community-Based Services Provider Pays CIA Stipulated Penalty
On September 18, 2019, Alternative Learning Center and Alice Soard, paid a stipulated penalty of $5,000 for failing to repay within 60 days the overpayments identified in the Claims Review Reports for the first and second annual reporting periods.
09-10-2019
Montana Health System Pays IA Stipulated Penalty
On September 10, 2019, Kalispell Regional Healthcare System, Kalispell Regional Medical Center, Inc., Health Center Northwest, LLC, and Northwest Orthopedics & Sports Medicine, LLC (collectively, "KRHS"), paid a stipulated penalty of $65,000 for failing to comply with certain CIA requirements. Specifically, KRHS: (1) failed to conduct Board Member training within 90 days after the CIA effective date for six of its Board members; and (2) falsely certified that it was in compliance with all the requirements of the CIA.
07-23-2019
Hawaii Hospice Pays IA Stipulated Penalty
On July 23, 2019, Hospice of Kona (HOK), paid a stipulated penalty of $9,500 for failing to comply with certain IA requirements. Specifically, HOK failed to timely: (1) appoint a Compliance Officer; (2) post a notice that provides the name and phone number of the Compliance Officer and the HHS OIG Fraud Hotline telephone number; (3) engage an IRO; and (4) submit its Implementation Report.
06-28-2019
Florida Hospital District Pays CIA Stipulated Penalty
On June 28, 2019, North Broward Hospital District d/b/a Broward Health (Broward Health), paid a stipulated penalty of $690,000 for failing to comply with certain CIA requirements. Specifically, Broward Health failed to: (1) develop and implement written policies designed to promote compliance with the Anti-Kickback Statute and the Stark Law; (2) provide all employees with general compliance training; (3) implement and comply with all of the arrangements procedures and arrangements requirements of the CIA; and (4) comply with certain disclosure program requirements.
04-23-2019
Georgia Podiatrist and Practice Pay IA Stipulated Penalty
Melissa Robitaille, D.P.M and Atlantic Foot and Ankle Specialists, P.C. paid a Stipulated Penalty of $16,500 based on the late submission of their Quarterly Claims Review Report.
04-03-2019
OIG Excludes Indiana Ambulance Provider for Material Breach
On April 3, 2019, OIG excluded Tri-County Ambulance (Tri-County), for a period of five years based on a material breach of its Corporate Integrity Agreement (CIA). On November 9, 2018, OIG issued a letter demanding stipulated penalties of $25,000 based on Tri-County's failure to submit its Annual Report. After Tri-County failed to pay the stipulated penalties and cure the breach or request a hearing by an HHS Administrative Law Judge, OIG issued a notice of material breach and intent to exclude in January 2019. Under the terms of the CIA, Tri-County had 25 days to request a hearing with an Administrative Law Judge. Tri-County did not request a hearing. OIG excluded Tri-County effective April 3, 2019. Senior Counsel Sarah Kessler represented OIG.
03-12-2019
New York Specialty Pharmacy Pays CIA Stipulated Penalty
On March 12, 2019, Sorkin's Rx Ltd. t/a and/or d/b/a CareMed Pharmaceutical Services paid a Stipulated Penalty of $12,500 based on the late submission of their Claims Review Report that was due with their Third Annual Report.
02-04-2019
Nursing Home Facility Operator Pays CIA Stipulated PenaltyOn February 4, 2019, Cornerstone Healthcare Services, LLC (Cornerstone) paid a stipulated penalty of $22,500 for failing to pay two invoices received from the Quality Monitor in accordance with the requirements of its CIA with OIG.
11-29-2018
Nursing Home Facility Operator Pays CIA Stipulated Penalty
On November 29, 2018, Cornerstone Healthcare Services, LLC (Cornerstone) paid a stipulated penalty of $15,000 for Cornerstone's failure to have its Compliance Officer make a quarterly report directly to Cornerstone's Governing Body during the first two calendar quarters of 2018.
11-19-2018
Independent Diagnostic Testing Facility Company and Owner Pay CIA Stipulated Penalty
On November 19, 2018, OSD Management, LLC and Fuad Rehman Cochinwala paid a stipulated penalty of $35,000 for failure to screen their Covered Persons in accordance with the requirements of their CIA with OIG.
10-26-2018
Pediatric Home Health Company Pays CIA Stipulated Penalty
On October 26, 2018, Pediatric Services of America, Inc. (PSA), paid a stipulated penalty of $22,500 for PSA's failure to establish and implement the obligations relating to having a Compliance Officer and a Compliance Committee. Specifically, PSA did not have its Chief Compliance Officer make a quarterly report directly to the Board of Directors during the first quarter of 2017. PSA also did not ensure that the Compliance Committee met at least quarterly during 2017.
09-14-2018
OIG Excludes Oklahoma Prosthetics Supplier for Material Breach
On September 14, 2018, OIG excluded La Fuente Ocular Prosthetics, LLC (La Fuente), for a period of five years based on a material breach of its Corporate Integrity Agreement (CIA). OIG determined La Fuente to be in material breach of its CIA when La Fuente failed to repay an overpayment identified by its Independent Review Organization in La Fuente's second annual reporting period. OIG issued a notice of material breach and intent to exclude on July 10, 2018. On August 14, 2018, OIG sent La Fuente an exclusion letter. Under the terms of the CIA, La Fuente had 25 days to request a hearing with an Administrative Law Judge. La Fuente did not request a hearing, and the exclusion went into effect on September 14, 2018.
07-18-2018
Electronic Health Records Software Company Pays CIA Stipulated Penalty
On July 18, 2018, eClinical Works, LLC paid a stipulated penalty of $132,500 for failure to comply with its obligation to timely report Patient Safety Issues as Reportable Events, as required by its CIA with the OIG.
12-21-2017
Connecticut Dentist and Practice Pay IA Stipulated Penalty
On December 21, 2017, Jesus Villegas, D.D.S., Fairfield Pediatric Dentistry, LLC, and Haven Pediatric Dentistry, LLC (collectively, Dr. Villegas), agreed to pay $12,000 for his failure to screen Covered Persons against the OIG exclusion list.
10-31-2017
New York Physician and Practice Pay IA Stipulated Penalty
On October 31, 2017, Dr. Feng Qin, M.D. and Qin Medical PC (collectively, Dr. Qin) paid a $12,000 stipulated penalty for his failure to screen Covered Persons against the OIG and GSA exclusion lists.
12-29-2016
California Skilled Nursing Facilities Pay CIA Stipulated Penalty
On December 29, 2016, CF Watsonville East, LLC and Watsonville, West, LLC (Watsonville) paid a stipulated penalty of $70,000 for Watsonville's failure to notify OIG of adverse final determinations made by the State of California Health and Human Services Agency.
11-04-2016
Missouri Hospital Management Company and Owner Pay CIA Stipulated Penalty
On November 4, 2016, SpecialCare Hospital Management Corporation and Robert McNutt (collectively, SpecialCare) paid a stipulated penalty of $30,000 for SpecialCare's failure to conduct legal review of new, renewed, and existing Focus Arrangements during the first Reporting Period and to timely submit its first Annual Report as required by its CIA with OIG.
09-13-2016
Kindred Healthcare Pays CIA Stipulated Penalty
On September 13, 2016, Kindred Healthcare, Inc. (Kindred), paid a Stipulated Penalty in the amount of $3,073,961.98.
HHS's Office of Inspector General Levies Largest Penalty Under a Corporate Integrity Agreement Against Nation's Biggest Provider of Post-Acute Care
September 20, 2016
Kindred Health Care, Inc., the nation's largest provider of post-acute care, including hospice and home health services, has paid a penalty of more than $3 million for failing to comply with a corporate integrity agreement (CIA) with the Federal Government, Department of Health and Human Services' Inspector General Daniel R. Levinson announced today.
It is the largest penalty for violations of a CIA to date, the Office of Inspector General (OIG) said.
The record penalty resulted from Kindred's failure to correct improper billing practices in the fourth year of the five-year agreement. OIG made several unannounced site visits to Kindred facilities and found ongoing violations.
"This penalty should send a signal to providers that failure to implement these requirements will have serious consequences," Mr. Levinson said. "We will continue to closely monitor Kindred's compliance with the CIA."
OIG negotiates CIAs with Medicare providers who have settled allegations of violating the False Claims Act. Providers agree to a number of corrective actions, including outside scrutiny of billing practices. In exchange, OIG agrees not to seek to exclude providers from participating in Medicare, Medicaid, or other Federal health care programs. CIAs typically last five years.
In this case, CIA-required audits performed by Kindred's internal auditors in 2013, 2014, and 2015 found that the company and its predecessors had failed to implement policies and procedures required by the CIA and that poor claims submission practices had led to significant error rates and overpayments by Medicare.
Kindred was billing Medicare for hospice care for patients who were ineligible for hospice services or who were not eligible for the highest level and most highly paid category of service, OIG said.
The Medicare hospice benefit covers services for beneficiaries with terminal illnesses who have life expectancies of six months or less. When patients elect hospice, they agree to stop receiving curative treatment and in its place receive palliative care. Benefits are largely for pain relief, respite care and grief and loss counseling for the patient and the family. Benefits can be provided in a person's home or an inpatient hospice facility.
As a result of the findings of CIA-required audits of its claims, Kindred decided to close 18 sites that it characterized as "underperforming" since March 2015. The company has paid a penalty of $3,073,961.98.
OIG also found that in 2016 the company took significant corrective actions, including upgrading internal audits and investigations and tracking resolutions of identified issues.
02-23-2016
Maryland Cardiology Practice and Physicians Pay IA Stipulated Penalty
On February 23, 2016, Advanced Cardiology Care, Mubashar Choudry, M.D., and Moshin Ijaz, M.D. (collectively, ACC) paid a stipulated penalty of $2,800 for ACC's failure to timely submit its second Annual Report as required by its IA with the OIG.
02-10-2016
North Carolina Physician Pays IA Stipulated Penalty
On February 10, 2016, John Sunghoon Won, D.D.S., M.D. paid a Stipulated Penalty of $10,000 based on his failure to comply with the following IA requirements: (1) post in a prominent place accessible to all patients and Covered Persons, a notice that provides the HHS OIG Fraud Hotline telephone number; (2) provide to all Covered Persons at least one hour of training within 60 days of the Effective Date of the IA; (3) screening of employees and contractors against the OIG and GSA exclusion lists; and (4) late submission of his Implementation Report.
11-15-2015
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.
11-05-2015
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.
08-07-2015
Florida Physician Pays IA Stipulated Penalty
On August 7, 2015, Dr. Steven Chun and Sarasota Pain Associates, P.A. paid a Stipulated Penalty of $20,000.00 for his late submission of his first Annual Report. The report was submitted 61 days past the due date.
05-15-2015
Renal Dialysis Company Pays CIA Stipulated Penalty
On May 15, 2015, Davita Healthcare Partners, Inc. paid a Stipulated Penalty in the amount of $450,000.00 for its failure to comply with certain CIA requirements, including Focus Arrangements Procedures and Focus Arrangements Requirements, Notice to Joint Venture Partners and Medical Directors, and Disclosure Program.
04-15-2015
Florida Physician Pays IA Stipulated Penalty
On April 15, 2015, Dr. Steven Chun and Sarasota Pain Associates, P.A. paid a Stipulated Penalty of $4,000, based on his late submission of his third Quarterly Claims Review Report.
10-03-2014
Florida Physician Pays IA Stipulated Penalty
On October 3, 2014, Dr. Steven Chun and Sarasota Pain Associates, P.A., paid a Stipulated Penalty of $8,050, based on his failure to timely implement several requirements of his IA with the OIG, including providing training, retaining and Independent Review Organization (IRO), and screening Covered Persons against the OIG and GSA exclusion lists, and his failure to timely submit an Implementation Report.
09-18-2014
OIG Issues Demand for Stipulated Penalty to Louisiana Nursing Home Chain
On September 18, 2014, OIG issued a demand for a $25,000 Stipulated Penalty against Foundation Health Services, Inc. (Foundation), based on its failure to timely retain an Independent Quality Monitor as required by its CIA with the OIG. Foundation appealed the Stipulated Penalty demand to an Administrative Law Judge and the Stipulated Penalty was later withdrawn after Foundation retained a Quality Monitor and agreed to a two-month extension of its CIA.
06-17-2014
Florida Sleep Lab Pays CIA Stipulated Penalty
On June 17, 2014, American Sleep Medicine, Inc. paid a Stipulated Penalty of $5,000 for its failure to disclosure two Reportable Events that involved probable violations of the Anti-Kickback Statute, as required by its CIA with the OIG.
06-09-2014
Florida Medical Device Company Pays CIA Stipulated Penalty
On June 9, 2014, Exactech, Inc. (Exactech) paid a Stipulated Penalty of $15,000 based on its failure to comply with the following CIA requirements (1) screening of employees and contractors against the OIG and GSA exclusion lists, (2) failure to distribute or make available new or revised policies and procedures, and (3) failure to provide parties to Focus Arrangements with a copy of Exactech's Code of Conduct and Anti-Kickback Statute policies and procedures.
06-04-2014
Puerto Rico Physician Pays IA Stipulated PenaltyOn June 4, 2014, Dr. Salvador Ribot Ruiz and Policlinica Dr. Salvador Ribot Ruiz, Inc. (collectively, Dr. Ruiz) paid a Stipulated Penalty of $6,300 for his failure to engage a new Independent Review Organization (IRO) within 60 days of terminating his previous IRO, as required by Dr. Ruiz's IA with the OIG.
03-13-2014
Maryland Practice Management Company Issued CIA Stipulated Penalty Demand
On March 13, 2014, OIG issued a demand for Stipulated Penalties in the amount of $24,000 to Imagimed, LLC (Imagimed) for its failure to timely submit an Implementation Report required by its CIA with the OIG. Imagimed filed for bankruptcy and, therefore, did not pay the Stipulated Penalty.
03-07-2014
Notice of Exclusion Issued to Tennessee Dental Practice Management Company
On March 7, 2014, OIG issued a Notice of Exclusion to Church Street Health Management (CSHM), pursuant to the Breach and Default provisions of CSHM's CIA, based on numerous material breaches of the CIA and CSHM's failure to cure those breaches. Specifically, on December 6, 2013, OIG issued a Notice of Material Breach and Intent to Exclude Church Street Health Management (CHSM) for the company's failure to comply with the provisions of its Corporate Integrity Agreement relating to: (1) implementation of policies and procedures, (2) reporting Quality of Care Reportable Events, (3) maintaining a Disclosure Log, (4) hiring Regional Dental Directors and performing onsite reviews, and (5) refunding overpayments to Federal health care programs. Also, on January 7, 2014, OIG issued a Notice of Material Breach and Intent to Exclude Church Street Health Management (CHSM) for its failure to comply with the provisions of its CIA relating to: (1) conducting training and education of Covered Persons, (2) submitting false certifications from employees regarding compliance with Federal health care program and CIA requirements, (3) reporting Quality of Care Reportable Events, (4) reporting and refunding overpayments to Federal health care programs, (5) establishing a Disclosure Program and maintaining a Disclosure Log, and (6) developing, distributing and implementing policies and procedures.
12-10-2013
Massachusetts Pain Management Doctor Pays IA Stipulated Penalty
On December 10, 2013, Anil Kumar, M.D., Advanced Pain Management, Inc. and Northwest Ambulatory Center, Inc. (collectively, Kumar) paid a Stipulated Penalty of $5,000 for its failure to designate and maintain a Compliance Contact as required by Kumar's IA with the OIG.
03-04-2013
California Hospital Pays CIA Stipulated Penalty
On March 4, 2013, Tulare District Hospital (Tulare) paid a Stipulated Penalty of $105,000 based on Tulare's failure to comply with the Arrangements Procedures and Focus Arrangements Requirements of its CIA with the OIG.