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Transcript for audio podcast: February 2014 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).

The Health Care Fraud and Abuse Control Program recovered a record $4.3 billion dollars in fiscal year 2013. Government healthcare-fraud-fighting teams have recovered $19.2 billion dollars over the last five years. And listen to this: For every dollar spent fighting fraud over the last three years, the government recovered eight dollars and 10 cents. It's all on our website. Check it out.

OIG's "Outlook 2014" and the 2014 Work Plan are on our website, too. Take a look.

Erin Bliss, Director of External Affairs, was interviewed recently on Federal News Radio and discussed what's ahead for OIG in 2014.

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

OIG found in one report that one-third of Medicare nursing home residents were harmed as a result of medical care.

Listen to a podcast about the adverse events report.

In another study, OIG found that states successfully implemented Medicaid cost-control measures for incontinence supplies, but further work was recommended.

In another review, OIG recommended that the Centers for Disease Control and Prevention strengthen its monitoring of World Trade Center Health Program contract terms.

Listen to a podcast on our website about the World Trade Center Health Program.

OIG found in one report that Medicare improperly paid for drugs for incarcerated individuals; stronger internal controls were recommended.

In another review, OIG found inconsistencies in how eligible prescriptions are identified in Medicaid's 340B Program, which has implications for oversight.

Listen to a podcast on the 340B Program.

One OIG report noted that New York made an estimated $23.4 million dollars in fee-for-service payments for patients who were already covered under managed care.

OIG recommended a path to big Medicare savings: Expand the "window" for billing outpatient services linked to hospital admissions.

Check our website for a podcast on expanding the "DRG window."

"The safety and efficacy of drugs must be shown by science, not sales pitches," a U.S. attorney said. Endo Health Solutions and Endo Pharmaceuticals are to pay $192.7 million dollars to resolve liability linked to the marketing of the painkiller Lidoderm for unapproved uses. IG Dan Levinson said: "...Endo profited at the expense of taxpayers and could have put patients at risk." As part of the settlement, Endo entered into a corporate integrity agreement with OIG.

"Medicaid fraud in the District of Columbia is at epidemic levels," said a U.S. attorney about the biggest healthcare fraud takedown in the history of the District. More than 20 suspects were arrested and charged in a multimillion-dollar home-health billing fraud case. OIG Special Agent in Charge Nicholas DiGiulio said: "Criminal organizations that steal from the District of Columbia Medicaid program are robbing the bank of healthcare money and cheating honest citizens."

A Florida man who owned rehabilitation facilities pleaded guilty and a disbarred North Carolina attorney admitted her role in a $28.3 million dollar healthcare fraud that involved services that were not legitimately prescribed or not provided; he could get 15 years in prison, and she could get 10 years.

A Michigan pharmacy owner and 13 of his employees were charged in an extensive drug reuse and restock scam that allegedly defrauded Medicare, Medicaid and Blue Cross Blue Shield of Michigan. Forfeiture of $60 million dollars is being sought.

Three Californians were convicted in a $20 million dollar fraud scheme involving bogus prescriptions for anti-psychotic drugs.

Randy Lee Essary, a former OIG deadbeat parent from Missouri, admitted failing to pay more than $164,000 dollars in child support.

Yousef Kurdy, charged in a $150,000 healthcare fraud in California, was added to OIG's Most Wanted Fugitives list.

A former OIG Most Wanted fugitive, Francisco Chavez, was sent to jail for nearly 6 years for his role in a medical equipment scam in Florida.

And Hector Hernandez, another fugitive, was captured while heading for Key West, Florida, and is awaiting trial on charges in a $3.1 million dollar fraud and money laundering case.

Dallas-based Medicus Laboratories has agreed to pay $5 million dollars in a civil money penalty settlement to resolve OIG allegations that it submitted multiple, prohibited claims to Medicare for a single patient encounter and submitted claims for laboratory tests not covered by Medicare. The company also entered into a corporate integrity agreement with OIG.

And on a final note, OIG has announced its Fall 2014 Legal Extern Program; applications are due March 24, 2014.

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

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

Thanks for listening.

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