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Transcript for audio podcast: OIG Update June 2012

From the Office of Inspector General of Department of Health and Human Services

http://www.oig.hhs.gov

Welcome to one of a continuing series of podcasts highlighting the work of the Office of Inspector General.

This is Mike Kane, inviting you to follow us on our website oig.hhs.gov and on Twitter @OIGatHHS.

Since our last podcast, OIG issued a number of reports, including one that found New Jersey improperly claimed more than 30 million dollars in Medicaid reimbursement for adult mental health rehabilitation services.

Another found that Pacificare of Texas was overpaid an estimated 115.4 million dollars because diagnoses it submitted to the Centers for Medicare & Medicaid Services for use in risk-score calculations did not always meet requirements.

In another, FDA was urged to define more clearly its rules for resolving scientific disagreements in the regulation of medical devices.

Yet another report uncovered vulnerabilities in vaccine storage and management in CDC's Vaccines for Children program. Don't miss the podcast related to the vaccines report on our website.

OIG also found that Medicare contractors failed to prevent millions of dollars in improper payments for some diabetic testing supplies.

And it was found, in a separate report, that Medicare continues to pay twice for nonphysician outpatient hospital services linked to inpatient stays.

One report raised concern about quality-of-care oversight in some Medicaid-funded long-term-care programs. To listen to the podcast that discusses this report, go to our website.

Another report found that the New York State Medicaid Fraud Control Unit recovered more than 750 million dollars for Medicaid from fiscal years 2008 to 2010.

And OIG is recommending that Pennsylvania refund 8 million dollars in excess Medicaid managed care payments.

In other actions, Orthofix, a Texas-based manufacturer of medical devices, is to pay more than 34 million dollars to settle allegations under the civil False Claims Act relating to its sale of bone growth stimulator devices. The company also agreed to plead guilty to obstruction of a Federal audit, a felony, and to pay a criminal fine of 7.7 million dollars.

A colorectal surgeon in Brooklyn, N.Y., was convicted of falsely billing Medicare and private insurers more than 22.6 million dollars for surgeries and other procedures that were never performed. His sentencing is scheduled for September.

The owner and an employee of a Miami home healthcare agency were given long prison terms and ordered to repay 16 million dollars in a Medicare scheme tied to kickbacks, bribes, and falsified files and claims.

In the Detroit area, the owner of 3 home health care agencies pleaded guilty in a 13 million dollar Medicare scam that involved phony doctors, falsified patient files, kickbacks, fraudulent claims, and money laundering.

In another case, 7 suspects in 3 cities were charged with money laundering - allegedly cashing checks worth more than 50 million dollars for scam health care firms.

A former dentist, who had been excluded as a provider from Federal health care programs and later allegedly hid his involvement in practices and clinics in Connecticut, was charged in a 20 million dollar Medicaid fraud scheme.

A physician assistant in Los Angeles was convicted of using the stolen identities of doctors to prescribe unneeded durable medical equipment and diagnostic tests in an 18.9 million dollar Medicare scam. Sentencing is scheduled for September.

Two OIG Most Wanted fugitives were captured recently. Irina Shelikhova, charged in a 70 million dollar Medicare scheme and believed to have fled to Ukraine, was arrested trying to re-enter the United States at JFK in New York. Miguel Cabello, who had fled to Cuba, was captured as he attempted to re-enter the United States through Champlain, New York. Cabello also faces Medicare fraud charges.

Regional Inspectors General Ann Maxwell and Robert A. Vito testified before three congressional committees about Medicare and Medicaid program integrity and fighting fraud and abuse. Read their testimony on our website.

OIG intends to update the Provider Self-Disclosure Protocol and is seeking public comment. See the Federal Register page on our website.

For links to these reports and stories and more, go to our website or follow us on Twitter.

Thanks for listening.

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