Exam Content Explore the OIG Enforcement Actions page. Review and select one of

Exam Content
Explore the OIG Enforcement Actions page. Review and select one of the articles on a case of health care fraud.
Write a 700- to 1,050-word analysis of the case that includes the following:
Summarize the incident and the specific fraud that was enacted.
Determine what laws were broken and which regulatory bodies are responsible for oversight of the regulations that were violated.
Describe the communications and information that would have been exchanged among the regulatory bodies and the offending organization during the investigation and charge of fraud or abuse in the case.
Explain the outcome of the case. If a judgment has not yet been passed, what do you think the outcome of the judgment should be? Justify your response.
Format your citations according to APA guidelines.
Salisbury Medical Practice Pays the United States Over $286,000 to Resolve Claims that it Billed for Medical Services Not Provided
Baltimore, Maryland – Peninsula Internal Medicine, L.L.C., a medical practice located in Salisbury, Maryland, and the Estate of Candy Burns have paid the United States $286,631.33 to settle allegations that Peninsula Internal Medicine (“PIM”) and its former owner, Candy Burns, submitted false claims to the United States for medical services that were not provided.
The settlement agreement was announced today by United States Attorney for the District of Maryland Erek L. Barron and Maureen Dixon, Special Agent in Charge of the Office of Inspector General for the Department of Health and Human Services.
“Medical providers know that they can only bill for services that are actually provided,” said United States Attorney Erek L. Barron. “The United States Attorney’s Office is committed to ferreting out fraud in Medicare and other federal healthcare programs and will hold practices and individuals accountable for their actions.”
On June 25, 2019, Candy Burns was indicted by the United States on one count of health care fraud and nine counts of wire fraud. The criminal case was captioned United States v. Burns, Criminal Case No. JKB 19-CR-313. On or about December 5, 2019, Burns suffered a brain aneurysm and persisted in a vegetative state. The United States dismissed the indictment against Burns in April 2020. In January 2021, Burns died.
According to the settlement agreement, from January 1, 2009 to June 30, 2016, PIM and Burns billed and were paid for blood draws that were not rendered. The blood draws were performed by LabCorp while in PIM’s Winterplace Parkway location and LabCorp was paid for these blood draws. Additionally, PIM and Burns were paid by Medicare for smoking cessation counseling that was not performed. Finally, the settlement agreement resolves claims that PIM and Burns violated Medicare’s “incident to” rules by billing for services performed by mid-level providers on Fridays when no physician supervised or directed medical services. Medicare reimburses at a higher rate if the services provided by a mid-level provider is performed “incident to” the direction and supervision of a physician. The only physician employed at PIM did not work on Fridays. Notwithstanding that fact, Burns and PIM billed Medicare for services on Fridays as if they were supervised by a physician, thus falsely entitling them to greater reimbursement.
The civil settlement resolves a lawsuit filed by Kimberly Elliott, a former employee of PIM, under the whistleblower provision of the False Claims Act. The False Claims Act permits private parties to file suit on behalf of the United States for false claims and obtain a portion of the government’s recovery. The civil lawsuit is captioned United States ex rel. Kimberly Elliott v. Peninsula Internal Medicine, LLC and the Estate of Candy Burns, JKB 15-176 (D. Md). As part of the settlement, the Ms. Elliott will receive $57,326.26.
The claims resolved by this settlement are allegations only, and there has been no determination of liability.
U.S. Attorney Erek L. Barron commended the HHS Office of Inspector General for its work in the investigation. The case was handled by Assistant United States Attorney Thomas Corcoran.
For more information on the Maryland U.S. Attorney’s Office, its priorities, please visit www.justice.gov/usao-md and https://www.justice.gov/usao-md/affirmative-civil-enforcement.