EMTALA Patient Dumping
12-23-2005
Queen of the Valley Hospital, California, agreed to pay $80,000 to resolve its liability for CMPs under the patient dumping statute arising out of two incidents. The OIG alleged that the hospital refused to accept the transfer of a critical patient to its intensive care unit and failed to provide an appropriate medical screening exam to a pregnant patient who presented to the hospital’s maternity ward.
12-06-2005
Methodist Healthcare System of San Antonio, Ltd., LLP, d/b/a Metropolitan Methodist Hospital (MMH), Texas, agreed to pay $12,500 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that MMH failed to provide a medical screening examination to a patient who suffered a syncopal episode in an ambulance located on the property of MMH (based on MMH’s assertion that the ED was on diversion). The ambulance transported the patient to another hospital where she was treated and released.
12-05-2005
Kaiser Foundation Hospital, California, agreed to pay $20,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide an appropriate medical screening examination to a 53-year-old man who presented to its emergency department after being in a motorcycle accident. The patient returned to the ED the following day, was admitted and treated.
11-03-2005
Cordell Memorial Hospital, a small hospital in Oklahoma, agreed to pay $7,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide appropriate medical screening examinations for three patients who presented to its emergency department.
11-02-2005
Pekin Memorial Hospital, Illinois, agreed to pay $35,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide appropriate medical screening examinations in two separate incidents to patients who presented to its hospital. The first incident involved a patient in her 37 th week of pregnancy who arrived at Pekin to be evaluated before going to the hospital where she planned to deliver. Pekin staff allegedly informed her that since she was not registered at Pekin and her physician did not have privileges at Pekin, she should go on to the other hospital. The second incident involved a 16-year-old male presenting to Pekin’s adolescent chemical dependency unit. The patient exhibited symptoms of chemical dependency and mental illness, including disorientation, diminished responsiveness, auditory hallucinations and suicidal ideations. Pekin allegedly referred the patient to another hospital without providing an appropriate medical screening examination.
10-13-2005
Clark Memorial Hospital, Indiana, agreed to pay $35,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide two patients with sufficient medical screening examinations to determine if the patients had emergency medical conditions. The first incident involved a patient presenting to the emergency department (ED) with complaints of not having slept for three days. The second incident involved a patient presenting to the ED with complaints of hearing voices, believing people were following her, and having mood swings from depression to elation. The OIG alleged that neither patient was adequately evaluated given their symptoms and complaints and neither was evaluated by a physician.
10-03-2005
Mease Countryside Hospital, Florida, agreed to pay $25,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that Mease failed to provide an appropriate medical screening examination to an 81-year-old male with a history of heart disease who presented to Mease’s emergency department via ambulance with complaints of nausea and shortness of breath. The OIG further alleged that Mease directed the ambulance attendants to place the patient in the hallway. The patient did not receive any medical attention for approximately 40 minutes and left the hospital against medical advice.
08-12-2005
Paradise Valley Hospital, California, agreed to pay $40,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that on five separate occasions, the hospital failed to provide an appropriate medical screening examination to five patients. Four of the alleged violations involved patients who left the hospital’s emergency department (ED) after waiting three or more hours and without being seen. The fifth alleged violation involved a 37-year-old male who presented to the hospital’s ED with a chief complaint of suicidal ideation. The hospital allegedly refused requests from the patient and police to admit the patient, and refused police requests to arrange a transfer of the patient to another facility. Ultimately, the police transported the patient to another hospital.
07-22-2005
Hickman Community Hospital, a small hospital in Tennessee, agreed to pay $5,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide appropriate medical screening examinations for two patients that presented to its emergency department.
07-14-2005
Lakeside Hospital, Louisiana, agreed to pay $20,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide an appropriate medical screening examination for two patients that presented to its emergency department (ED). The first incident involved a 64-year-old woman who presented to the hospital’s ED via ambulance with a complaint of being raped and experiencing chest pains. A nurse on duty allegedly directed the EMS attendant to take the patient to another facility. The second incident involved a two-month-old infant that presented to Lakeside’s Urgent Care Center for evaluation of its breathing and breathing apparatus. A physician on duty allegedly directed the parents to take the child to another facility without performing a medical screening examination.
05-24-2005
Florida Hospital Heartland, Florida, agreed to pay $20,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide an appropriate medical screening examination to a 21-year-old woman who presented to its emergency department (ED) three times over a 12-day period complaining of head pain. On the first visit, the hospital did provide an appropriate medical screening examination and proper testing that concluded that the patient had meningitis and communicating hydrocephalus. The OIG alleged that during the second and third visits, the hospital failed to provide an appropriate medical screening examination or treatment given the patient’s worsening condition. The patient died two days after her last visit to the hospital’s ED. An autopsy revealed that the patient died of a rare parasitic infection.
05-18-2005
Wilson Medical Center, North Carolina, agreed to pay $15,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide appropriate medical screening examinations and treatment for three patients that presented to its emergency department between January 31, 2001 and May 20, 2001.
05-16-2005
Bessemer Carraway Medical Center - University of Alabama Medical West, Alabama, agreed to pay $40,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that Bessemer failed to provide a complete medical screening examination for a female patient who presented to Bessemer’s emergency department complaining of a fever and chills related to a kidney infection that had lasted for four days. The patient was seen by the triage nurse who took her vital signs and allegedly concluded that the patient would be classified as non-urgent. The triage nurse allegedly instructed the patient to go to the registration desk to pay $85. The patient left the hospital and went to another hospital where she was admitted and treated with IV antibiotics.
04-05-2005
Proctor Hospital, Illinois, agreed to pay $15,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide an appropriate medical screening examination, stabilizing treatment, or an appropriate transfer for an infant that presented to its emergency department with altered and decreased levels of consciousness and seizure-like activity.
03-23-2005
St. Joseph Hospital, California, agreed to pay $30,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide an appropriate medical screening examination and treatment to stabilize the emergency medical condition of a 15-year-old girl who presented to their emergency department, via ambulance, after overdosing on methadone. The hospital allegedly treated the girl with a narcotic antagonist and discharged her three hours later. After returning home, the patient died from aspiration of gastric content due to methadone intoxication.
03-23-2005
Caritas Norwood Hospital, Massachusetts, agreed to pay $25,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide an appropriate medical screening examination to an elderly male who presented to its emergency department (ED) via ambulance with complaints of hypertension and an altered mental state. The emergency service personnel (EMS) contacted the hospital and were allegedly informed by a nurse that the hospital was on diversion status. The EMS decided to take the man to the hospital’s ED anyway and again were allegedly informed by another nurse that the hospital was on diversion and that they could not take the patient.
03-18-2005
St. James Psychiatric Hospital, Inc., Louisiana, agreed to pay $30,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to accept appropriate transfers of two patients with psychiatric emergencies who needed the specialized capabilities of the hospital.
03-18-2005
Hospital San Francisco, Puerto Rico, agreed to pay $10,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide an appropriate medical screening examination to a 3-year-old boy who presented to its emergency department. The boy did not have health insurance and the OIG alleged that the admissions department requested that his mother pay a private deposit of $2,150. The mother took her soon to another hospital where he was hospitalized for four days and treated for right bronchopneumonia and maxillary sinusitis.
03-17-2005
Midwestern Regional Medical Center (Midwestern), a small hospital in Illinois, agreed to pay $15,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that Midwestern failed to provide an appropriate medical screening examination to a pregnant woman who presented to its emergency department complaining of vaginal bleeding and passing blood clots. Midwestern allegedly asked the patient whether she had insurance and she stated that she did not. Without providing any further medical screening, Midwestern allegedly discharged the patient a few minutes later.
01-06-2005
Dameron Hospital Association (Dameron), California, agreed to pay $75,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that Dameron failed to provide an appropriate medical screening examination to 16 individuals that presented to its emergency department. The individuals presented with a variety of complaints, including, chest pain, abdominal pain, vaginal bleeding, fever, vomiting, dizziness, and coughing. The individuals were triaged by a nurse and then asked to wait in he waiting area. After waiting between three and six hours, the individuals left the hospital without receiving an appropriate medical screening examinations.
January 2005 Criminal Enforcement Report
Hospitals, Laboratories, and Clinics
In Texas, a woman was ordered to pay $964,000 in restitution for her involvement in a scheme to defraud. During a 6-month period, the woman and her co-defendant, who owned and operated two physical therapy clinics, billed Medicare for evaluations and services that were not performed, billed for services provided by unlicensed technicians without necessary supervision, and paid kickbacks to individuals that referred patients to the clinics. When the two clinics closed, the woman operated another clinic and continued her fraud scheme. In November 2004, the co-defendant was sentenced and held jointly responsible for $894,000 of the restitution amount.
In California, the owner of a laboratory company was sentenced to 10 months incarceration and ordered to pay $180,000 in restitution for health care fraud. The man billed Medicare for diagnostic tests, including echocardiograms and ultrasounds, which were not ordered by a physician and were never interpreted by a physician.
Physicians and Other Health Care Professionals
In Washington, a doctor was sentenced to 12 months and 1 day in prison and ordered to pay $46,000 in restitution and a $100,000 fine for health care fraud. The doctor billed for services not rendered or for services that were upcoded.
Durable Medical Equipment
In Florida, a man was sentenced to 18 months in prison for his involvement in a money laundering scheme. In addition, the man will be deported to Peru after his sentence. The man's advertising company served as a vehicle to launder over $2.5 million in Medicare funds for eight Miami-based medical organizations. The investigation revealed that the DME companies and pharmacies involved in the scheme billed for equipment or services for beneficiaries who either had no need for, or did not receive, the equipment or services.
February 2005 Criminal Enforcement Report
Physicians and Other Health Care Professionals
In Florida, two chiropractors were each sentenced to six months home detention, ordered to pay a $10,000 fine and pay $400,000 in joint and several restitution for their involvement in a variety of fraud schemes. Among other things, the chiropractors were involved in an illegal kickback arrangement with a diagnostic company, billed Medicare using a physicians' Medicare number without his knowledge or consent, utilized unlicensed and unsupervised personnel to perform procedures, billed chiropractic services as physical therapy, and routinely upcoded services.
Employee Misconduct
In South Dakota, a former Indian Health Service (IHS) employee was sentenced to 200 hours of community service and ordered to pay a $6,000 fine for false statements involving Federal health care programs. The woman was a medical records technician at an IHS hospital. Investigation revealed that during a two-year period, in order to save time and avoid workload backlogs, the woman entered the same diagnosis code for patients seen in the emergency room regardless of their medical condition.
March 2005 Criminal Enforcement Report
Transportation Fraud
In Delaware, the co-owner of a non-emergency transportation company was ordered to pay $88,000 in restitution for health care fraud. Investigation revealed that Medicaid was billed for trips to non-medical destinations, trips that never occurred, and for escorts that were not present.
Physicians and Other Health Care Professionals
In California, a doctor was fined $5,000 pursuant to his guilty plea for importing an unapproved drug from the United Kingdom. In addition to the sentencing, a $150,000 civil settlement was reached. The settlement resolved the doctor's liability for billing vein procedures performed on patients using the unapproved drug.
Child Support Enforcement
In Ohio, a man was sentenced to 5 years probation and ordered to pay $52,000 in restitution for failure to pay child support. In 1988, the man was ordered to pay support for his three children. He made sporadic payments until May 1997 at which time he stopped paying completely. As part of his probation, the man was ordered to participate in a drug treatment program.
April 2005 Criminal Enforcement Report
Durable Medical Equipment
In Texas, a durable medical equipment (DME) company owner was sentenced to 24 months in prison and ordered to pay $265,000 in restitution for health care fraud. The woman allowed a DME company owner, whose provider number was revoked, to use her provider number to bill Medicare for power wheelchairs that were either not provided or not medically necessary. The two split the Medicare proceeds.
In Illinois, a man was ordered to pay a $10,000 fine for violating the anti-kickback statute. As a sales manager for a large medical equipment distributor, the man provided enteral pumps at no charge in order to induce the purchase of related enteral products and advised nursing homes on how to submit charges to Medicare for the enteral pumps.
Prescription Drug Fraud
In Massachusetts, a former pharmacist for a hospital was sentenced to 42 months in prison and ordered to pay $507,000 in restitution for charges related to diverting pharmaceuticals to a New Jersey pharmacist. As a buyer for the hospital, the pharmacist ordered and authorized the hospital to pay for prescription drugs and other pharmaceuticals, which he diverted on numerous occasions.
Child Support Enforcement
In North Carolina, a man was sentenced to 8 months imprisonment, 1 year supervised release and ordered to pay $77,000 in restitution for failure to pay child support. The man, who resides in Oklahoma, failed to pay any support for his daughter who suffers from cerebral palsy.
May 2005 Criminal Enforcement Report
Kickbacks
In California, a physician was sentenced to 5 months in prison, 150 days home confinement and ordered to pay $120,000 in restitution for illegal remuneration. The physician accepted kickbacks in exchange for the use of his provider number, which was used to fraudulently bill Medicare, Medi-Cal and private insurers for services provided by unqualified individuals.
Child Support Enforcement
In Vermont, a man was sentenced to 5 years probation and ordered to pay approximately $58,000 in restitution for failure to pay child support for his three children. He was arrested in September 2003 during �Operation Lost and Found�, a national round-up of child support defaulters. In 1999, the man was ordered to pay over $1,000 per month. In 2001, the court reduced his monthly obligation amount to $600 per month. The investigation revealed that the man worked as a mechanic and a truck driver.
June 2005 Criminal Enforcement Report
Practitioners
In Utah, pursuant to his guilty plea, a doctor was sentenced to time served and ordered to pay $146,000 in restitution. The doctor billed Medicare, Medicaid and private insurers for IV therapy but actually treated patients with chelation therapy, a non-covered service. In Wisconsin, a cardiologist was ordered to pay a $5,000 fine for transporting an unapproved medical device which he used in a medical procedure. In March 2005, the cardiologist entered into a $1 million settlement with the Government to resolve his liability under the False Claims Act for allegedly submitting claims to Medicare for medical procedures using the unapproved medical device.
Kickbacks
In Louisiana, the former owner/administrator of a geriatric psychiatric facility was sentenced to 15 months in prison and ordered to pay $313,000 in restitution for health care fraud and for illegal payment of kickbacks. The man failed to disclose a related party on the facility's 1999 cost report and paid marketers for Medicare referrals. In addition, for receiving illegal kickback payments, a marketer was ordered to pay $67,000 in restitution.
Child Support Enforcement
In Illinois, pursuant to his guilty plea, a man was sentenced to 5 years probation and ordered to pay $48,000 in restitution for failure to pay child support. A former law enforcement officer, the man never made a voluntary payment since ordered in 1992.
July 2005 Criminal Enforcement Report
Practitioners
In South Carolina, a licensed physical therapist was sentenced to 18 months in prison and ordered to pay $400,000 in restitution for health care fraud. The therapist billed Medicare and a private insurer for three to five hours of therapy when only a one-hour treatment was rendered.
Kickbacks
In Florida, a durable medical equipment (DME) company owner was sentenced to 5 months in prison, 5 months home detention and ordered to pay a $15,000 fine for conspiracy to violate the anti-kickback statute. Investigation revealed that the DME company owner received kickbacks from the owner of a pharmacy in return for referring patients in need of aerosol medications.
Employee Misconduct
In Maryland, a former NIH purchasing agent was ordered to pay $2,400 in restitution for theft of government property. The woman, who pled guilty, used her government-issued credit card to secure rental cars for her own personal use.
August 2005 Criminal Enforcement Report
Practitioners
An Indiana neuropsychologist was sentenced to 36 months in prison and ordered to pay $291,000 in restitution; he was found guilty of health care fraud following a jury trial in May 2005. Through his two clinics, the neuropsychologist used unlicensed undergraduate students from a State university to perform testing for Medicaid and Medicare patients. In addition, he inflated the number of hours of actual services performed by the unlicensed students.
September 2005 Criminal Enforcement Report
Prescription Drug Fraud
In Ohio, a woman was sentenced to 22 months in jail, suspended, for her scheme to obtain prescription drugs. While working at a dental office, the woman accessed protected patient information and subsequently used the information to phone in prescriptions to area pharmacies. She called in prescriptions in her name as well as the names of Medicaid recipients.
Durable Medical Equipment
In Texas, the owner of a durable medical equipment company was ordered to pay $546,000 in restitution for billing Medicare for power wheelchairs that were either not provided or were not medically necessary.
Practitioners
In Virginia, a psychologist was ordered to pay $11,000 in fines and restitution for health care fraud. The psychologist submitted fraudulent claims to Medicare for neuropsychological evaluations and testing on nursing home patients. Many of the claims submitted were for dates of service when the psychologist was out of town.
Child Support Enforcement
In South Dakota, a man was sentenced to 21 months in prison, 1 year supervised release and ordered to pay $33,600 in restitution for failure to pay child support. In 1995, the man was ordered to pay $300 a month; he failed to pay any support since 2002.
October 2005 Criminal Enforcement Report
Medicaid Fraud
In Delaware, the owner/operator of a non-emergency medical transportation company was ordered to pay $30,000 in restitution for health care fraud. Investigation revealed that the Medicaid program was billed for transportation to a drug treatment facility that never occurred.
Other Health Care Professionals
In Pennsylvania, a licensed nurse was sentenced to four months imprisonment and ordered to pay $1,000 in fines and assessments for her guilty plea to health care fraud. A convicted felon, the woman concealed her criminal past from various employers. The woman then utilized her position as a nurse to steal from and defraud patients placed in her care.
Child Support Enforcement
In Oregon, a man was sentenced to 30 days home detention, three years probation and ordered to pay $69,000 in restitution for failure to pay child support for his three children currently in foster care. In a joint Social Security Administration investigation, it was revealed that the man used his son's identity to commit fraud and hide assets.
November 2005 Criminal Enforcement Report
Durable Medical Equipment
In California, a durable medical equipment (DME) company owner was sentenced to 33 months imprisonment and ordered to pay $170,000 in restitution for health care fraud. Through a highly complicated double-billing scheme, the man received reimbursements totaling 200 percent for power wheelchairs. The DME company owner submitted claims to Medicaid that were previously denied by Medicare. After receiving payment from Medicaid, the man resubmitted claims to Medicare or appealed the original denial, which resulted in the double payment.
Physicians
In Michigan, a doctor was sentenced to 5 months incarceration, 5 months home detention and ordered to pay $120,000 in restitution for health care fraud. The doctor, who was the owner/operator of a neurology center, routinely billed Medicare, Medicaid and a private insurer for two sleep studies when only one was performed.
Employee Misconduct
In Maryland, a former NIH purchasing agent was ordered to pay $12,000 in restitution for theft of Government property. The 20-year employee used her Government issued credit card to pay for her apartment rent, college tuition for her daughter, and kennel services for her dog. The woman resigned from her position.
Medicaid Fraud
In Illinois, a dentist was sentenced to 63 months in prison and ordered to pay $827,000 in restitution and a $20,000 fine; he was found guilty in a jury trial on charges of mail fraud and health care fraud. The dentist performed unnecessary dental procedures on patients and billed for services not performed or not performed as indicated.
Physicians
In Washington D.C., a podiatrist was sentenced to 6 months home detention and ordered to pay $30,000 in restitution for submitting false claims to Medicare. Investigation revealed that the podiatrist billed Medicare for services such as surgery when he actually only provided routine foot care. The podiatrist also submitted claims to Medicare for patients that he did not treat at all.
Child Support Enforcement
In Illinois, a man was sentenced to 22 months in prison, 1 year supervised release and ordered to pay $59,000 in restitution for failure to pay child support. In addition, after his release from prison, the man must obtain full-time employment or work 20 hours per week of community service until he secures a full-time job.
Child Support Enforcement
In Washington, a man pled guilty and was sentenced to 5 years probation and ordered to pay $135,000 in restitution for failure to pay child support. Since their 1991 divorce, the custodial parent has raised their five children on her own. The man worked in Texas and Colorado using an alias.
Durable Medical Equipment
An owner of a DME supply company was sentenced to 2 years imprisonment and ordered to pay $273,000 in restitution and pay a $2,500 fine for mail fraud in connection with a Medicaid fraud scheme. The man submitted claims to Wisconsin's medical assistance program for DME that was never provided.
In Tennessee, the sales manager for a DME supplier was ordered to pay $24,000 in restitution for his role in a scheme to defraud Medicare. A joint investigation with the Federal Bureau of Investigation and the Medicaid Fraud Control Unit revealed that the manager routinely completed the clinical sections of certificates of medical necessity, falsely stating patients had qualifying conditions for alternating pressure mattresses.
Home Health Agency
In Minnesota, the last subject in a complex home health care investigation was sentenced. The woman, a director of nursing, pled guilty and was ordered to pay $53,000 in restitution for health care fraud. Through the woman's involvement in the scheme, home health services were billed that were provided to beneficiaries who were not homebound and/or that were not medically necessary.
Medicaid Fraud
In Washington, a man was sentenced to 30 days in jail and ordered to pay $4,000 in restitution for defrauding the Medicaid program. As the State appointed guardian for his father, he continued to submit claims to Medicaid after his death.