Transcript for audio podcast:
October 2013 OIG Monthly Update
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).
Since our last podcast, we've issued a number of reviews.
OIG found in one report that Connecticut family day care providers did not always comply with health and safety requirements for kids. Check out a podcast on our website about family day care providers.
OIG noted in a second report that New York improperly claimed an estimated $31.5 million dollars from Medicaid for some certified home health agency services.
In a separate report, OIG found that Medicare paid nearly $17 million dollars for sleep studies that did not meet requirements.
OIG also found in a review that inadequate IT security controls at the Substance Abuse and Mental Health Services Administration posed a risk to its operations and mission.
OIG found in another review that the University of Miami Hospital received an estimated $3.7 million dollars in overpayments from Medicare because the hospital lacked adequate controls to prevent billing errors.
Go to our website to listen to a podcast about the first level of the Medicare appeals process and read a related report.
OIG released onsite reviews of Nevada and Montana Medicaid Fraud Control Units. From fiscal years 2010 to 2012, the Montana unit reported recoveries of $9.8 million dollars. From fiscal years 2009 to 2012, Nevada reported recoveries of $13.4 million dollars.
Also on our website is an updated list of corporate integrity agreements and civil monetary penalties, as well as two new advisory opinions.
In other news, Kmart Corporation agreed to pay more than $2.5 million dollars to the federal government and to 32 states to settle allegations that it billed government health care programs for all drugs included in a prescription when, for many prescriptions, it dispensed only a portion of the prescribed drugs.
Boston Scientific and its subsidiaries are to pay $30 million dollars to settle claims that they knowingly sold defective heart devices that were subsequently implanted into Medicare patients.
The owner and the program coordinator of two Michigan adult day care centers were convicted in a $3.2 million dollar Medicare fraud scam. Mentally disabled residents and people seeking narcotics were promised that, if they signed up for psychotherapy services, they could see a doctor who would prescribe the drugs they wanted. Their names and signatures were then used to bill Medicare, but psychotherapy services were never provided.
Two Miami-area residents were indicted in $190 million dollar Medicare kickback scheme linked to the defunct American Therapeutic Corporation.
Also in Miami, five were charged in a $48 million dollar home health kickback scam that led to two agencies' alleged false billing of Medicare. The agencies' two owners were sentenced earlier to long prison terms after pleading guilty to health care fraud conspiracy.
A California lab is to pay $17.5 million dollars to settle claims that it paid nursing homes kickbacks, in the form of illegal discounts, in return for referrals.
And, a pastor and owner of a Los Angeles-area medical supply company was sentenced to seven years in prison and must repay Medicare more than $5.7 million dollars for his role in an $11 million dollar power wheelchair scam.
The District of Columbia won a protracted court battle over a health plan's Medicaid claims, saving $10 million dollars.
A hospice owner was convicted in a $14 million dollar Medicare scam that involved submitting claims for patients who never received services or were ineligible for them. The Pennsylvania man also diverted money, spending it on extensive home renovations, travel expenses, his son's college tuition, and a luxury car.
And in New York, a man who posed as a doctor was sentenced to two years in jail and ordered to pay more than $220,000 dollars in restitution. A 5-year-old died shortly after treatment by the defendant, according to evidence presented during the prosecution.
OIG added five fugitives to its Most Wanted list: Janaki Chettiar, Ike Okeke, Joan Noalles, Ram Rajulapati, and Gurgen Tsaturyan. See all of our fugitives on the OIG website.
In FY 2013, OIG 's Miami investigations team had a record-setting year, including a total of 252 criminal and civil actions.
A year after Hurricane Sandy, don't fall victim to Sandy-related grant fraud schemes. Read more on grant #fraud on our website.
And, OIG's Office of Counsel to the Inspector General is seeking second- and third-year law students for extern positions in Spring 2014. For more information, go to our website.
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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Unimplemented OIG recommendations summarized.
FY 2014 Work Plan
OIG projects planned for 2014.
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