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Transcript for audio podcast: September 2013 OIG Update

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

http://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).

We start today with a consumer alert, which can be found on the OIG website: Be wary of con artists trying to take advantage of shoppers seeking to use the new online health insurance marketplace; if you'd like to help educate others about scammers, place our new widget on your website so the public can click on it to see our new anti-fraud material.

You can listen to a related podcast also on our website.

Since our last podcast, OIG issued a number of reviews.

Medicare could collect billions of dollars, OIG found in one report, if manufacturers were required to pay rebates for Part B drugs.

In another report, OIG found that Maryland claimed an estimated $20.6 million dollars in unallowable costs under a program that assists the developmentally disabled.

In another, OIG recommended that States be encouraged to re-evaluate their Medicaid drug-pricing programs for more cost savings.

And in a fourth report, OIG found that Alabama received more than $88 million dollars in unallowable Medicaid performance bonus payments.

OIG recommended in another review that the Centers for Medicare & Medicaid Services act on Recovery Audit Contractors' referrals of potential fraud and monitor their performance.

Go to our website to listen to a podcast on Recovery Audit Contractors and improper payments.

The upgraded national Medicaid database should improve oversight: listen to a podcast and read a report on our website.

OIG found in one report that Bravo Health of Pennsylvania was overpaid an estimated $22.1 million dollars because diagnoses it submitted to Medicare did not meet requirements.

And OIG found in a separate review that Wisconsin improperly claimed $22.8 million dollars in residential care center payments from Medicaid.

A Hawaii hospital is to pay more than $451,000 dollars to settle claims that it submitted bills to Medicare and Medicaid for services of resident physicians who were not supervised at the level required by federal law. The U.S. attorney credited the OIG Offices of Audit Services and Investigations for their contributions in the whistleblower case.

In other cases, three Florida psychiatric hospital executives were sentenced to prison terms of 25, 15, and 12 years in an extensive Medicare scam that included bribes, kickbacks, false records, ineligible patients and false billing; restitution of $59 million dollars was ordered.

A New York doctor, convicted in a massive false claims case, was jailed for nearly 13 years and must repay more than $50 million dollars. The physician allowed others at a clinic to use his Medicare billing number to charge for services that were never provided. Authorities said the doctor almost never visited the clinic -- except to pick up his paycheck.

The owner of a home health firm in Texas was jailed for 10 years and must repay more than $25 million dollars in a complex false billing Medicare fraud. He must also forfeit four vehicles, 21 parcels of real estate and cash.

A Los Angeles man who recruited so-called "patients" from Skid Row in a multimillion-dollar fraud scheme was sent to prison for 18 months and must repay Medicare and Medicaid $9.8 million dollars. He also pleaded guilty to tax evasion.

A Michigan oncologist who was charged earlier in a chemotherapy false claims case was indicted on 13 more counts in a $225 million dollar scheme.

A former Health Care Solutions Network office manager was jailed for nearly six years and must repay $17.4 million dollars for her role in $63 million dollar fraud in Florida.

The CEO of a Chicago home-visit medical practice that operates in six states and a physician who works for the practice were charged with billing fraud, including upcoding and making false certifications. OIG, FBI & other agents executed search warrants at offices in Chicago, Indianapolis and Detroit; they also executed warrants to seize more than $2.5 million dollars in alleged fraud proceeds from bank accounts.

A Maryland pharmacist was jailed for 2.5 years and must pay more than $289,000 dollars in restitution, fines and forfeiture in a Medicare/Medicaid billing fraud case. The pharmacist filled illicit prescriptions for Schedule II drugs and, among other things, served up dangerous drug "cocktails" to vanloads of customers - some apparently from out of state -- who showed up at his pharmacy.

One OIG Most Wanted Fugitive, Carmen Gonzalez, was captured in Florida; another, Francisco Chavez, was extradited from Spain and is awaiting prosecution in Miami; and three others -- Marina Nazarova and the Barcelo brothers -- all of whom are believed to have fled the U.S., were added to the fugitives list.

And OIG's Kay Daly testified on Capitol Hill about health exchange Data Services Hub security and reliability. before the House Homeland Security Committee's Subcommittee on Cybersecurity, Infrastructure Protection and Security Technologies. Read her testimony on our website.

For more on the fight against health care fraud, waste and abuse, click "More News" on the podcast webpage.

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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