50 is the New 20: First 50-Year Exclusion Imposed

50 is the New 20: First 50-Year Exclusion Imposed

OIG alleged that from November 2005 through October 2012, Brookhim owned, controlled, and managed Associated Dental NP, LLC (ADNP), a New Jersey dental practice with multiple locations, in violation of his exclusion from Federal health care program participation in August 2000.

As part of his fraud scheme, Brookhim assumed the identity of a licensed New Jersey dentist (“Dentist A”), to provide services to ADNP patients. Brookhim assumed Dentist A’s identity because Brookhim had lost his dental license in 2004. Brookhim presented claims for services to various New Jersey Medicaid Managed Care Organizations (MCOs), identifying Dentist A as having providing services. In fact, Dentist A never rendered services to ADNP patients. Brookhim continued to pose as Dentist A and submit claims in his name — even after Dentist A died.

In the past, the OIG would issue a 20-year exclusion for egregious behavior so as to prohibit the provider from billing federally funded healthcare programs (I.e., Medicare, Medicaid, TriCare, CHIPS). It was felt that a 20 year exclusion was considered long enough to both punish the provider as well as remove them from federally funded healthcare program reimbursement dependent companies. Now, 50 years appears to be a length that effectively is life time (assuming the provider is 30 years old or older).

The message is clear, according to Gregory E. Demske, Chief Counsel to the HHS Inspector General. “This case sends a strong warning that individuals who intentionally circumvent exclusion to defraud Federal health care programs face substantial consequences. OIG is committed to protecting program beneficiaries and funds from individuals who violate their exclusions.” “Fifty years is one of the longest exclusion periods ever imposed by our office,” said Gregory E. Demske, Chief Counsel to the HHS Inspector General. “This period of exclusion, coupled with the significant monetary recovery, is an appropriate resolution for an individual who went to such great lengths to defraud a Federal health care program and put patients at risk.”

The OIG has a lot or enforcement and fines in its arsenal. From Exclusions to Civil Fines and Monetary Penalties are some of them.  Under the Civil Monetary Penalties Law (CMPL), OIG may seek civil money penalties, assessments, and exclusion for causing submission of false or fraudulent claims to Federal health care programs. The CMPL is designed to deter individuals from defrauding those programs, to compensate the programs for damages resulting from such fraud, and to protect their integrity.

Michael Rosen, ESQ

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