OIG Administrative Sanctions

During this reporting period, OIG administered 2,135 sanctions in the form of program exclusions or administrative actions for alleged fraud or abuse or other activities that posed a risk to Federal healthcare programs and their beneficiaries. A brief explanation of these sanction authorities can be found in Appendix G.

Program Exclusions
During this reporting period, OIG excluded 2,111 individuals and entities from participating in the Medicare and Medicaid programs and other federally sponsored healthcare programs. Most of the exclusions resulted from convictions for crimes relating to Medicare or Medicaid, for patient abuse or neglect, or as a result of license revocation. Examples include the following:

Colorado - A certified nurse aide was excluded for 25 years based on his conviction for sexual assault against a 77-year-old Alzheimer's nursing home patient. The man was sentenced to serve 15 years to life in prison.

Missouri - Two individuals were excluded based on their multiple convictions for abuse that took place at a home for children with mental retardation. One individual was an emergency medical technician who was sentenced to 12 years in prison and excluded for 20 years. The other individual was a licensed practical nurse who was sentenced to 5 years in prison and excluded for 15 years.

New York - A dentist's license was revoked by the New York State Education Department after he sexually assaulted numerous minor patients. Based on the action, OIG excluded the dentist for an indefinite period.

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Civil Monetary Penalties

The Civil Monetary Penalties Law (CMPL) authorizes OIG to impose administrative penalties and assessments against a person or entity that, among other reasons, submits claims to a Federal healthcare program that the person or entity knows or should know are false or fraudulent. During this reporting period, OIG collected $6.4 million in civil monetary penalties and assessments.

For example:

District of Columbia - MedStar Health Visiting Nurse Association, Inc., formerly known as The Visiting Nurse Association of Washington, D.C., and its home office, Visiting Nurse Association, Inc. (collectively, "MedStar VNA"), agreed to pay $1.36 million and enter into a 5-year corporate integrity agreement to resolve their liability under the CMPL. OIG alleged that MedStar VNA submitted cost reports to the Medicare program for fiscal years ending in June 1998, 1999, and 2000 that contained claims that were false or fraudulent or that were not provided as claimed. In particular, OIG's investigation focused on fraud allegations that MedStar VNA failed to disclose certain costs or provide documentation associated with related third parties in the relevant cost reports. The settlement agreement included the resolution of nonfraudulent adjustments that resulted in an outstanding Medicare overpayment for the fiscal year June 2000 cost report.

Virginia - A practitioner agreed to pay $46,000 to resolve his liability under the CMPL for allegedly violating the terms of his exclusion. OIG alleged that despite his exclusion, he sought and received employment with a nonprofit provider of community-based physical disability, mental health, and mental retardation services. The man allegedly served as the medical director for two of the facilities that received reimbursements for items and services furnished or prescribed by him. OIG learned of the alleged violation when the matter was self-disclosed by the practitioner's employer.

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