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Transcript for the audio podcast:
OIG Update December 2012

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

https://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, as we start the New Year, to follow us on our website at oig.hhs.gov and on Twitter @OIGatHHS. We'd like to remind you, too, about "OIG Outlook 2013," which takes a comprehensive look at OIG priorities for the coming year. See our website.

As 2012 came to a close, our office issued a number of reports.

In one review, OIG recommended additional performance standards for contractors overseeing high-risk home health agencies in fraud-prone areas.

Listen to a podcast on our website about oversight of home health agencies.

In another report, OIG found that Medicare reimbursement for a specific type of back brace was more than 4 times the average supplier acquisition cost.

A third report found that New York State improperly claimed $69 million dollars from Medicaid for home health services in New York City.

Another review noted that noncompliant diagnosis data submitted by PacifiCare of California to the Centers for Medicare & Medicaid Services led to estimated overpayments of $423 million dollars.

And OIG found in a fifth report that the Namibia office of the Centers for Disease Control and Prevention did not always properly monitor the use of AIDS-relief funds.

Don't miss a podcast on our website about preventive medical screenings for children who receive Medicaid benefits. An OIG report found that many of these children are not getting all required screenings.

OIG's No. 1 Most Wanted deadbeat parent, Robert Sand, was captured in Los Angeles. Authorities say he owes more than $1 million dollars in child support.

Biotechnology giant Amgen is to pay $762 million dollars to settle criminal and civil liability tied to the illegal sale and promotion of three drugs, Aranesp, Enbrel and Neulasta.

Sanofi US, a subsidiary of the international drugmaker Sanofi, is to pay $109 million dollars to resolve allegations that it gave doctors kickbacks, free samples of a knee-injection drug, to induce them to prescribe the product.

Pfizer has agreed to pay $55 million dollars to resolve allegations that Wyeth, which Pfizer bought in 2009, illegally promoted the reflux drug Protonix for off-label use.

Healthpoint Ltd. and DFB Pharmaceuticals will pay up to $48 million dollars to resolve false claims allegations involving an unapproved drug, Xenaderm, a prescription skin ointment.

In other cases, the owner-manager of a Brooklyn, N.Y., clinic, who was an OIG Most Wanted fugitive, and three others pleaded guilty in a $71 million dollar Medicare scam involving kickbacks and fraudulent services; 12 defendants have been convicted in the scheme.

The owner of several mental health centers entered a guilty plea in a $63 million dollar multistate fraud scheme. Under his plea agreement, he will forfeit millions of dollars in cash and property.

A Mississippi oncologist convicted in a massive chemotherapy scam was sentenced to 20 years in prison, ordered to pay a $250,000 dollar fine and $8.1 million dollars in restitution. She also must forfeit land and another $6 million dollars. The doctor admitted billing for more chemotherapy drugs than she purchased, and she was not providing patients with fully prescribed dosages. She also admitted submitting claims for services supposedly rendered while she was out of the country.

The owners of two Miami home health agencies pleaded guilty in a $48 million dollar Medicare bribery-kickback scam.

A Los Angeles-area pastor who owned a medical equipment company admitted conspiring with doctors, clinics and recruiters to cheat Medicare out of $11 million dollars.

A doctor who recruited patients from Skid Row in Los Angeles was jailed for one year in an $11 million Medicare scam.

And a New York surgeon was imprisoned for two-and-a-half years and must repay more than $2.2 million dollars; he billed Medicare and private insurers for surgeries and services never performed and later sent letters to his patients, asking them to falsely certify in writing that they had had the phony procedures.

Two OIG Most Wanted fugitives - husband and wife Lazaro Betancourt and Elisabet Martinez - were taken into custody in Miami. They are charged, authorities say, in prescription, kickback and bribery schemes that defrauded Medicare of nearly $11 million dollars.

Another OIG fugitive, Juan Heredia, charged in a $4.9 million dollar Medicare false claims case, was also captured in Miami.

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

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