Recent HHS-OIG Exclusions and Penalties for Employing Excluded Individuals
One of the consequences of convictions in enforcement actions by the Department of Health and Human Services Office of Inspector General (HHS-OIG) and prosecutions by the Department of Justice is exclusion from participating in federal health care programs. The HHS OIG Exclusions List includes individuals and organizations that have received mandatory exclusion, such as being found guilty of Medicare or Medicaid fraud, patient abuse or neglect, or financial misconduct, and permissive exclusions, which come from convictions for fraud in non-healthcare programs and obstruction of an investigation or HHS-OIG audit. The length of the exclusion depends on the nature of the offense. For some offenses, there is no minimum exclusion period while others have a minimum exclusion period is 5 years for a first offense up to permanent exclusion for multiple offenses.
Recent enforcement actions that have resulted in individuals being added to the HHS-OIG exclusion list include violations of the False Claims Act (FCA), the Anti-Kickback Statute (AKS), and the Physician Self-Referral (Stark) Law. An HHS-OIG investigation of a Texas marketing company revealed several healthcare companies had received kickbacks for arranging and/or recommending laboratory tests at three clinical laboratories in New Jersey, Dallas, and Florida. The laboratories were alleged to have paid commissions to the marketing company based on reimbursements from the healthcare providers’ laboratory testing referrals. Shahram Naghshbandi of Fort Worth, Texas, and his marketing company allegedly paid thousands of dollars in kickbacks. According to HHS-OIG, the payments for laboratory referrals were disguised as investment distributions from purported management service organizations. On October 9, 2024, Shahram Naghshbandi of Fort Worth Texas, agreed to be excluded from all federal healthcare programs for 10 years for paying improper remuneration.
In December 2024, HHS-OIG confirmed that the Connecticut doctor, Naimetulla Ahmed Syed, M.D., had agreed to be excluded from federal healthcare programs for 20 years. An HHS-OIG investigation revealed Syed had issued medically unnecessary prescriptions, including prescriptions for controlled substances, resulting in false claims being submitted by a pharmacy to the Medicare and Medicaid programs. Syed was also alleged to have billed Medicare and Medicaid for medically unnecessary office visits related to the medically unnecessary prescriptions.
Individuals and organizations are regularly added to the HHS-OIG Exclusions List, and there are harsh penalties for engaging with or employing an excluded individual or organization. Three recent examples of enforcement actions by HHS-OIG against individuals and organizations for violating the Civil Monetary Penalties Law for employing an excluded individual include Sharp Healthcare, American Healthcare Management Services, and Adriana Strimbu, DPM.
HHS OIG Exclusions List
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In December 2024, Sharp Healthcare in San Diego, CA, agreed to settle an HHS-OIG investigation that revealed Sharp Healthcare had employed a nurse excluded from federal healthcare programs and provided items/services billed to federal healthcare programs. Sharp Healthcare agreed to pay a $153,072.64 penalty to settle the alleged violation. American Healthcare Management Services, doing business as Accura Healthcare Management Services, and Knoxville Care Partners, doing business as Accura Healthcare of Knoxville in West Des Moines, IA, were similarly found to have employed an excluded nurse and provided items/services billed to Medicare or Medicaid, and agreed to settle the alleged violation and pay a $60,281.86 penalty. Adriana Strimbu, DPM, in Florida, employed a receptionist on the HHS-OIG exclusions list, resulting in products or services being billed to Medicare or Medicaid. The alleged violation was settled for $41,739.66.
These enforcement actions demonstrate the importance of conducting checks of the HHS-OIG exclusion list, Medicare Exclusion Database, and National Practitioner Data Bank as part of the recruitment process and before onboarding any new vendor to ensure they have not been excluded.
