When a Five Year Exclusion Became Fifteen

What’s the expression – if at first you don’t succeed, try, try, and try again? One way to continue to be on the OIG list of bad actors is to get caught, become excluded, and continue to bill Medicare.

Seems pretty simple right? You might be thinking that no one could be so naive…unfortunately this isn’t hypothetical. Moral of this story, when at first you do not succeed, don’t compound your poor decisions.

Dr. Michael Esposito learned the hard way…again. In December 2016, Dr. Esposito, an Endocrinologist in New York, was ordered by the New York State Board of Professional Medical Conduct to stop practicing medicine due to the engagement of professional misconduct. As a result, Dr. Esposito entered into a settlement agreement with the OIG for HHS. The settlement was outlined to resolve allegations that he had forged the signature of another physician for prescribed opioids and other prescription drugs for himself and another individual that were in turn paid for by Medicare funds.

As a condition of the agreement, Dr. Esposito agreed to be excluded for five (5) years from billing CMS, including Medicare payments. However, Dr. Esposito admitted to continuing to bill Medicare while excluded and he acknowledged that this violated both his agreement with the OIG and the False Claims Act. In addition to paying a $100,000 restitution and fine, Dr. Esposito agreed to be excluded from Medicare and other federal health care program reimbursements for fifteen (15) years.  

Lesson learned: The feds mean it when they pose an exclusion and limitation on a provider. If the provider does not abide by order of the law, the imposition of expanded excluded time from billing federal healthcare program dollars will ensue. In addition, these are clearly false claims and subject the provider to additional fines and penalties.  

Have you heard any exclusion stories along these lines? Send us a comment!

Written by Michael Rosen, ESQ