Medicaid Michigan Sanction Provider List January 29, 2019 ...

1 Entity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReason1st Priority Physical Therapy LLCG roup1134422363 Detroit8/2/2016 MDHHS-OIGS ummary SuspensionAGSS Properties LLCHome Help AgencyAnn Arbor8/29/2017 MDHHSA Dental Center PC - Allen ParkDental GroupAllen Park5/20/2004 HHS1128(a)(1)A Dental Center PC - SouthgateDental GroupSouthgate7/20/20041128(a)(1)A Place Called HomeGoreeJimmieNon Emergency TransportationDetroit6/1/2017 MDHHSA byssinia Love Knot Physical Therapy LLCM edical Group1255667556 Southfield8/3/2016 MDHHS-OIGS ummary Supension Absolute ApothecaryPharmacy/Medical SupplierDetroit53010040655/24/1994 HHS1128(b)(3)Absolute Prescription CenterPharmacy/Medical SupplierDetroit53010045945/23/1994 HHS1128(b)(3)Advanced Care Services Group1811290794 Oak Park12/22/2015 HHSS ummary SuspensionAdvanced Homecare PharmacyPharmacy1710923107 Redford530100828410/14/2015MI-Licensing and Regulatory AffairsVoluntarily SurrenderedAdvanced Sleep Neurodiagnotics PCMedical Group1134143654 Farmington Hills10/15/2017 MDHHS-OIGS ummary SuspensionMedicaid Michigan Sanction Provider List February 12.

2 2018 Entity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Alam, Waseem MD PCMedical Group1184724114 Bloomfield Hills7/29/2015 Summary SuspensionAli Elhorr Group1558651422 Dearborn5/19/2015 DCH-OIGS ummary SuspensionAllied Geriatric Services PCMedical Group1821196551 Birmingham3/6/2013 DCHS ummary SuspensionAmerican Clinical Lab, of Medicaid False Claim ActAmerican Medical Missionary CareGroup1578600920 Saginaw12/5/2016 MDHHS-OIG1/9/2017 MDHHS-OIGS ummary Suspension TerminationAmericare LLCW illiamsJamesHome HelpSaginaw10/28/2016 MDHHSAndy's Motown PharmacyPharmacyDetroit53010084073/28/20 11MI-Licensing and Regulatory AffairsSuspended Angels Touch Home Health Care LLCHome Health1922252865 Taylor3/6/2013 DCHS ummary IncHome Health Agency1598814501 Livonia7/22/2015 MDHHSS ummary SuspensionA Plus Hospice & Palliative Care.

3 SuspensionApplewood ManorNursing FacilityMcMillan484013/19/1999MI-Licensi ng and Regulatory AffairsLicense RevocationEntity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Associated Physicians of Southeast Michigan SuspensionAt Home Doctors TerminatedAttarMD PCGroup1275720716 Livonia9/19/2017 MDHHS-OIGS ummary SuspensionAwerbuch, Gavin MD PCGroup1003130352 Saginaw6/19/2014 DCH-OIGS ummary SuspensionB3 Diagnostic Laboratory LLCL aboratory1902287279 Troy9/20/2017 MDHHS-OIGS ummary SuspensionBay City Vascular City9/30/2015 MDHHSS ummary SuspensionBelle Woods Continuing Care CenterNursing FacilityBellville8243910/30/1999MI-Licen sing and Regulatory AffairsLicense Revocation and Summary SuspensionBeval Medical Equipment & SuppliesSupplier1235163551 Royal Oak562580933 06/11/2015 CMSR evokedBirmingham Rehab & Physical Therapy Center, Therapy ServicesDetroit3668712/18/2003 HHS1128(a)(1)

4 BrightSmilesDental Group1508229014 West Bloomfield201534211/26/2017 MDHHST erminatedBrightSmiles PA 161 Dental Group1083848311 Waterfrd201521611/26/2017 MDHHST erminatedBroadstreet Nursing CenterNursing Facility834189/27/2000 Entity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Canton Urgent Care SuspensionCedar Knoll Care CenterNursing FacilityGrass Lake3/7/2007 DCHL icense RevocationCentrad Healthcare LLCG roup1346243979 Naperville, IL11/14/2017 MDHHS-OIGS ummary SuspensionCertified Air Respiratory Equipment, Inc. (aka CARE, Inc.)Medical SupplierSouthfield7/4/1996 HHS1128(a)(1)Chiropractic Associates, GroupLudington5/6/1996 HHS1128(b)(8)Clinical Psychiatric Medicine PCGroup1386677185 Grandville7/18/2013 DCH-OIGS uspendedCommerce Township PharmacyPharmacy1851616452 Commerce Township8/31/2011 DCH5/30/2016 MDHHS-OIGS ummary Suspension TerminatedCommunity Rehabiltation ServicesGroup1669424776 Rose City7/13/2016 MDHHS-OIGS ummary SuspensionCompassionate Doctors PCGroup1326153578 Southfield7/30/2013 DCH-OIG1128(a)(2)

5 Complete Health, LLC GroupGroup1083801500 Livonia6/21/2011 HHSC orner Drugstore of DetroitPharmacyDetroit53010038628/19/198 8 DCHV iolation of Medicaid False Claim ActEntity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Courtyard Manor Farmington Hills, INCG roupWalled Lake9/24/2012 HHS1128(a)(2)Creams N CapsPharmacy1386972859 Southfield530101057010/14/2015MI-Licensi ng and Regulatory AffairsVoluntarily SurrenderedCutting Edge Orthopaedics LLCG roup1295070746 Sylvania, OH9/15/2015 MDHHS-OIGS uspendedDai Care Services LLCHome Help AgencyFarmington Hills1/18/2017 MDHHS-OIGS ummary SuspensionDaneshvar, Gerald MD PLLCM edical Group1316347917 West Bloomfield7/29/2015 DCH-OIGS ummary Suspension Davenport PharmacyPharmacy1548585136 Saginaw8/31/2011 DCH-OIG5/23/2016 MDHHS-OIGS ummary Suspension TerminationDearborn Family Medicine CenterMedical Group1467407080 Dearborn7/8/2013 DCH-OIG5/5/2016 MDHHS-OIGS ummary Suspension TerminatedDearborn Internist Group1023314341 Dearborn3/14/2017 MDHHS-OIGS ummary SuspensionDearborn Pharmacy, (a)(3)

6 Dearborn Podiatric Surgeons PCGroup1447467485 Dearborn12/3/2017 MDHHS-OIGS ummary SuspensionEntity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Dearborn Nuro Clinic PCGroup1568638088 Dearborn12/1/2016 MDHHS-OIGS ummary SuspensionDearborn Rx PharmacyGroup1982054383 Dearborn7/26/2017MI-Licensing and Regulatory Affairs12/13/2017MI-Licensing and Regulatory AffairsSummary Suspension Voluntary TerminationDental Health Care Clinics, GroupDetroit4/11/1995 HHS1128(a)(1)Detroit Diverse Care, GroupDetroit3/16/1997 HHS1128(a)(1)Detroit Medical ClinicMedical Group1245244110 Detroit7/30/2013 DCH-OIGS ummary SuspensionDiamond Pharmacy`Pharmacy1720380140 KalamazooNCPDP 23747248/19/2011 DCH6/2/2016 MDHHSS ummary Suspension TerminationDownriver Medical Associates PLCP hysician Group1114055811 Monroe3/21/2013 DCH3/21/2013 DCHS ummary Suspension TerminationDurand Clinic PCPhysician GroupDurand9/20/2001 HHS1128(a)(3)Dwight E.

7 Smith MD PCPhysician Group1003849753 Detroit5/29/2012 DCHS ummary SuspensionEast Village PharmacyPharmacy1982928818 Dearborn8/29/2016 MDHHS-OIGS ummary SuspensionEB James Nursing CenterNursing FacilityDetroit834222/12/2002MI-Licensin g and Regulatory AffairsLicense revocation and summary suspensionEntity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Elrington Medical Center PLLCM edical Supply Company1205875697 Redford10/22/2013 DCH-OIGS ummary SuspensionElrose Health Services, TreatmentDetroit214314/17/1995MI-Licensi ng and Regulatory Affairs10/20/1998 HHS10/20/98: 1128(a)(1)Elrose Health Services, TreatmentDetroit213914/17/1995MI-Licensi ng and Regulatory Affairs10/20/1998 HHS10/20/98: 1128(a)(1)Elrose Health Services, TreatmentDetroit207314/17/1995MI-Licensi ng and Regulatory Affairs10/20/1998 HHS10/20/98.

8 1128(a)(1)Emergency Medical Clinic, GroupHamtramck12/23/1991 HHS1128(a)(1)Enjoy Dental Care PCDental GroupDetroit5/20/2004 HHS1128(a)(1)Excellent Kare Home Agency for MichiganKnightEugeneHome HelpDetroit10/27/2016 MDHHSFour Leaf Clover IncMedical Group1750451357 Westland7/29/2015 MDHHS-OIGS ummary SuspensionFrancis Street Medical Associaes Group1730245499 Jackson6/29/2016 MDHHS-OIGS ummary SuspensionEntity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Friendship Manor Nursing HomeNursing FacilityDetroit3/21/2006 DCHL icense Revocation and Summary SuspensionFullerton PharmacyPharmacy/ Medical SupplierFairview53010062603/10/1998 DCHV iolation of Medicaid False Claim ActGeorgetown Podiatric Suregons PCGroup1508905985 Sterling Heights12/3/2017 MDHHS-OIGS ummary SuspensionGeriatric Care AssociatesGroup1063648269 Canton10/23/2017 MDHHS-OIGS ummary SuspensionGlen Saperstein LLCM edical Group1184045296 Saginaw3/15/2017 MDHHS-OIGS ummary SuspensionGodoy, Charles MD PCGroup1912298902 Livonia3/31/2016 MDHHSS ummary SuspensionGrand Blanc Apothecary, /Medical SupplierGrand Blanc530100498311/18/1999 HHS1128(b)(4)

9 Greater Detroit Physical Therapy & Rehabilitation PCGroup1598713430 Westland7/29/2015 MDHHS-OIGS ummary Suspension Green Cross Medical Center SuspensionHaggerty DrugsDME1821033028 Canton7/15/2015 CMSR evokedEntity NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Harmony InterationalGroup1487717666 Detroit1/16/2013 DCH-OIG1/16/2013 DCHS uspended Suspended TerminatedHarmony Turning Point PLLCG roup1588979686 Southfield10/20/2013 HHSE xcludedHartford Chiropractic ClinicGroup1063420529 Hartford6/6/2017 MDHHS-OIGS ummary SuspensionHatem Ataya PCGroup1528295375 Davison6/18/2015 DCH-OIGS ummary SuspensionHealing Hands Chiropractic Clinic LLCG roup1871779025 Coldwater4/29/2015 DCH-OIGS ummary SuspensionHealing Hands Urgernt Care Medical Clinic.

10 Suspension TerminationHealthy HeartsGroup1093908436 Livonia7/25/2016 MDHHS-OIGS ummary SuspensionHighland Park PharmacyPharamcy1104097781 Warren8/31/2011 DCH-OIG5/25/2016 MDHHS-OIGS ummary Suspension TerminatedHi-Tech Home Health Care Health Agency1669702593 Farmington Hills7/28/2016 HHST erminatedHomecare Doctors LLCG roup1487723771 Detroit7/30/2013 DCH-OIGS ummary SuspensionHome Clinic NameLast NameFirst NameMiddle NameProvider CategoryNPI#CityLicense# Sanction Date1 Sanction SourceSanction Date2 Sanction SourceReasonMedicaid Michigan Sanction Provider List February 12, 2018 Home Physician Services PCGroup1346347523 Troy3/6/2013 DCH-OIG3/6/2013 08/09/2016 DCH MDHHS-OIGS ummary Suspension Termination TerminationHouse Calls Physicians PLLCG roup1033273008 Allen Park5/21/2013 DCH-OIG5/5/2016 MDHHS-OIGS ummary Suspension TerminatedIndependent Care Pharmacy LLCP harmacy1619131141 Dearborn8/11/2011 DCH-OIG5/23/2016 MDHHS-OIGS ummary Suspension TerminatedJefferson Family Dental Center PCDental GroupDetroit6/6/1988 HHS1128(a)(1)Jefferson Medical Industrial Clinic Suspension TernminatedJohn R.