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Transcript for the audio podcast: OIG Update
September 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 at oig.hhs.gov and on Twitter @OIGatHHS.

Since our last podcast, OIG issued a number of reports. One found that 10 states did not collect Medicaid managed care organization drug rebates from pharmaceutical companies.

Another found that New Mexico improperly claimed at least 11 million dollars for unallowable Medicaid personal care services.

In other actions, a health maintenance organization in Los Angeles is to pay California and the Federal Government more than 323 million dollars to settle a Medicare/Medicaid excess payments case.

Thirty-seven states reached a 181 million dollar settlement with Johnson & Johnson subsidiary Janssen Pharmaceuticals over deceptive marketing of antipsychotic drugs. Johnson & Johnson did not admit wrongdoing, nor did it pay a fine or penalty.

Hospital chain HCA Incorporated, which has facilities in 20 states and the United Kingdom, is to pay 16-and-a-half million dollars to settle allegations in a lawsuit that it financially rewarded a doctors' group that referred patients to HCA-owned facilities. "Improper business deals between hospitals and physicians jeopardize both patient care and Federal program dollars," said Inspector General Dan Levinson.

Pacific Health Corporation and hospitals affiliated with it are to pay California 16-and-a-half million dollars to settle a civil case involving ambulance transports and alleged kickbacks. The hospitals are said to have paid recruiters to deliver homeless Medicare or Medicaid beneficiaries by ambulance for treatment. The care often was medically not needed, but the hospitals allegedly billed the health care programs anyway.

New York Downtown Hospital is to pay 13.4 million dollars to settle alleged civil fraud tied to a drug and alcohol detox program and to illegal referrals.

In a rare case, a former hospital administrator in California was held criminally liable for failing to adequately supervise her director of nursing, who is charged with elder abuse resulting in the deaths of three patients.

Eight people and a corporation based in Miami were convicted in a 50 million dollar Medicare fraud involving mental health services never provided, false records, and kickbacks.

A New York man was charged in a 30 million dollar Medicare/Medicaid fraud that included the alleged theft of a doctor's ID, which, authorities said, was used to submit bills for radiological services that were not provided.

In a similar case, a physician assistant in Los Angeles was jailed for 6 years in an 18.9 million dollar Medicare scam; he stole the identities of doctors to write medically unneeded prescriptions for durable medical equipment and diagnostic tests.

Doctors and other health care professionals - for an online course on safeguarding your medical identity, go to the Compliance section of the OIG website.

A Detroit-area man pleaded guilty in a wide-ranging home health scam that bilked Medicare out of $13.8 million dollars. The scheme, which began in 2008, included kickbacks, falsified records, services never provided, phony physicians, and fraudulent claims.

A Virginia woman was jailed for more than 11 years and must repay over 7 million dollars for fraudulent billing for health care services not rendered and for income tax fraud.

A North Carolina woman, who "rented out" her Medicaid provider number, pleaded guilty in a 6.1 million dollar mental health services fraud. Court records indicate that the woman, a licensed professional counselor, oversaw a network of co-conspirators, who billed for false and fraudulent claims using her provider number. She kept a percentage of the Medicaid reimbursements, and she spent more than 500 hundred thousand dollars on jewelry and vehicles.

Jockey Julio Antonio Garcia Encarnacion, who owes 174 thousand dollars in back child support, has entered a guilty plea. He is to be sentenced in February.

Rapper "Capone," whose given name is Kiam Holley, was seized by OIG agents in New Jersey. Authorities say the singer owes more than 162 thousand dollars in back child support.

Martin Zaic, listed on OIG's Child Support Enforcement webpage, entered a guilty plea to failure to pay child support. He owes more than 38 thousand dollars.

In other, separate child support cases, two men were jailed and must pay a total of nearly 200 hundred thousand dollars in restitution.

In other developments, John Hagg, OIG's director of Medicaid audits, testified before a House subcommittee about Medicaid payment rates for developmental centers in New York. To read the testimony, see our website.

OIG's Office of Counsel is seeking applicants for its 2013 Summer Law Clerk Program. The deadline is Oct. 5. Check 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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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201