Transcript for the audio podcast:
OIG Update May 2013
From the Office of Inspector General of Department of Health and Human Services
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.
In the continuing fight against health care fraud, OIG agents and others, part of the Medicare Fraud Strike Force, seized 89 suspects in eight cities across the country. The suspects were charged with $223 million dollars in false Medicare billings. IG Dan Levinson, commenting on the operation, said, "Taxpayers expect us to work harder and smarter, and that is exactly what happened..."
Since our last podcast, OIG issued a number of reports.
OIG found in one report that Maryland improperly claimed an estimated $10.9 million dollars for personal care services under its Medicaid Home- and Community-Based Services Waiver for Older Adults.
A second report found that New York made at least $7.3 million dollars in unallowable Medicaid managed care payments to beneficiaries with multiple ID numbers.
Another review showed that CIGNA Healthcare of Arizona was overpaid an estimated $28 million dollars because risk data that it reported to Medicare did not meet requirements.
A separate review found Ohio Medicaid could have saved millions of dollars by establishing competitive bidding for durable medical equipment.
And Illinois significantly cut Medicaid costs for home blood-glucose test strips but could save even more, OIG found in another review.
Listen to a podcast on home blood-glucose test strips on our website.
Another OIG podcast focuses on anesthesia service payments, and you can read the related Work Plan summary.
Go to our website to read an updated Special Advisory Bulletin on the effect of exclusion from participation in federal healthcare programs.
Generic drugmaker Ranbaxy pleaded guilty to felony charges and is to pay $500 million dollars. The company admitted selling adulterated drugs and making false statements to the Food and Drug Administration. The case represents the largest drug safety settlement with a generic drug manufacturer.
Medical products firm C.R. Bard is to pay more than $48 million dollars to resolve allegations that it filed false Medicare claims for a prostate cancer treatment.
The United States has sued Chemed Corporation and subsidiaries, including Vitas Hospice Services and Vitas Healthcare. According to the complaint, Vitas, the largest for-profit hospice in the United States, submitted false claims to Medicare, and the government contends that tens of millions of taxpayer dollars were misspent.
Adventist Health in Roseville, Calif., is to pay more than $14 million dollars to resolve claims that it improperly compensated doctors for referrals.
In another referrals case, two Montana hospitals - in a self-disclosure -- agreed to pay nearly $4 million dollars.
To settle a False Claims Act lawsuit, the California Rural Indian Health Board is to pay $532,000 dollars and give up $4.6 million dollars in federal grants. The settlement is the result of a four-year investigation led by OIG Special Agent Jennifer Spaulding.
In the wide-ranging Health Care Solutions Network mental health care scam, a former program coordinator was jailed for nearly 6 years and must pay more than $19 million dollars. A supervisor was convicted of orchestrating the scam in Florida and North Carolina and is to be sentenced in July. And a psychologist who was a clinic director pleaded guilty in Miami. Fifteen people have been charged and 13 have entered guilty pleas.
A husband was sentenced to more than 8 years and his wife 1 year for submitting $10 million dollars in billings in just three months for infusion therapy treatments that were never provided. The Miami couple was also ordered to pay about $6 million dollars in restitution.
A Minnesota couple who had more than $10 million dollars in assets admitted lying to get federal aid for their disabled children; the husband was jailed; fines and restitution of $1 million dollars were ordered.
Robert Sand, the OIG Most Wanted deadbeat parent who owed more than $1 million dollars in child support, was jailed for more than 2½ years and must pay restitution.
A former OIG Most Wanted fugitive, Godwin Nzeocha, was imprisoned for more than 9 years in the $45 million dollar City Nursing Medicare/Medicaid scam in Houston.
And two fugitives were added to OIG's Most Wanted list: Jahaziel Gonzalez and Jorge Fernandez were charged separately with defrauding Medicare of millions. Fernandez is believed to be in south Florida.
And on a final note, OIG now allows state Medicaid fraud units to seek approval to use data mining as a way to fight fraud. 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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Unimplemented OIG recommendations summarized.
FY 2013 Work Plan
OIG projects planned for 2013.
Significant OIG activities in 6-month increments.