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Transcript for audio podcast: August 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).

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

In one report, OIG found that Data Services Hub security is being addressed, but critical tasks remain before Affordable Care Act health insurance exchanges open.

Check our website for a Federal News Radio interview with OIG's Kay Daly about CMS's implementation of the Data Services Hub, which is to be used in conjunction with the exchanges, slated to open October 1.

Another review found that the Department of Health and Human Services met Affordable Care Act requirements in awarding co-op loans and that the department should continue to monitor co-ops.

And Medicare could save millions of dollars, OIG found in another report, by strengthening billing requirements for canceled elective surgeries.

OIG noted in one report that Medicare and its beneficiaries could save millions of dollars if critical access hospital location rules were revised.

Go to our website to listen to a podcast on critical access hospital designations.

Wyeth Pharmaceuticals, which was acquired by Pfizer in 2009, is to pay nearly $491 million dollars to resolve criminal and civil liability linked to the company's unlawful marketing of Rapamune, a drug that prevents the body's immune system from rejecting a transplanted organ.

Shands Healthcare is to pay $26 million dollars to resolve allegations that six of its Florida hospitals filed false claims for inpatient procedures that should have been billed as

Northwestern University is to pay nearly $3 million dollars to settle a whistleblower lawsuit; the university allegedly allowed a researcher to file false claims under research grants from the National Institutes of Health.

A former New Hampshire hospital worker entered a guilty plea for his role in the hepatitis C outbreak that led to the infection of dozens of people.

A New York racketeer was jailed for nearly 10.5 years and must forfeit more than $1 million dollars for his role in a $100 million dollar fraud that included "phantom clinic" healthcare providers in 25 states, false Medicare billing, extortion and immigration fraud.

A Brooklyn, N.Y., clinic worker was jailed for eight years for his part in a $77 million dollar Medicare scam; he was ordered to repay $10 million dollars and to forfeit almost a half-million dollars.

An Ohio spine surgeon was charged with persuading patients to have unnecessary surgery for which, authorities said, he fraudulently billed Medicare.

Also in Ohio, 7 oncologists were charged with importing cancer medications that were not approved by the Food and Drug Administration.

A Michigan doctor was charged in a $35 million dollar scheme involving false claims to Medicare for unneeded chemotherapy and other services. The scheme, authorities said, included deliberate misdiagnoses to justify treatment and false billing.

In Louisiana, two defendants are to serve terms of five and 15 years, forfeit more than $9 million dollars and repay more than $17 million dollars in a Medicare home health scam.

A New York doctor who falsely diagnosed his girlfriend with trygeminal neuralgia and gave her a prescription for Dilauded, a controlled substance, pleaded guilty in a drug fraud case.

And a doctor in Westchester County, N.Y., admitted that he fraudulently prescribed oxycodone worth more than $480,000 on the street.

A candidate for comptroller of New York City was charged with illegal distribution of prescription pills, which authorities allege were sold on the street.

In New Jersey, three doctors admitted taking tens of thousands of dollars as part of a sophisticated multimillion-dollar bribes-for-lab-referrals scheme.

A North Carolina mental health counselor was sent to jail for 6 years and must repay more than $6 million dollars in a Medicaid false billing fraud. As part of the scheme, the woman "rented out" her Medicaid provider number to co-conspirators. And she used proceeds from the fraud to buy more than $550,000 dollars in jewelry and vehicles.

Medicare and Medicaid at times pay more for the same service or product than private firms do. To learn more, read an OIG Spotlight article on our website.

And OIG has announced its summer law clerk program for 2014; the application deadline is September 16. Don't miss it!

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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