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Transcript for audio podcast:
November 2013 OIG Monthly 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 begin today with one of the largest health care fraud settlements in U.S. history. Johnson & Johnson and its subsidiaries are to pay more than $2.2 BILLION dollars to resolve criminal and civil allegations that they promoted several drugs for unapproved uses and paid millions of dollars in kickbacks.

Johnson & Johnson also agreed to a corporate integrity agreement with OIG, requiring major changes in the company's business practices.

In another high-profile case, a captured OIG Most Wanted Fugitive, Irina Shelikhova, was sent to prison for 15 years, must forfeit more than $36 million dollars and pay nearly $51 million dollars in restitution in a health clinic scam in Brooklyn, N.Y. As part of the scheme, Medicare beneficiaries were paid kickbacks to induce them to get fraudulent services and procedures, for which Medicare was billed. The scam included a phony doctor, fictitious medical notes that were forged and money laundering. Shelikhova, one of 13 defendants convicted in the case, faces deportation from the United States after serving her sentence.

In another New York case, an ambulette driver was charged with the negligent homicide of a nursing home patient, who was 86. The driver allegedly failed to buckle the seatbelt of the patient, who was ejected from her wheelchair when the vehicle in which she was riding came to a sudden stop. And, authorities said, the driver refused to take the patient, who was injured, to the hospital. The patient died a month after she was thrown from the wheelchair.

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

In one report, OIG found that Medicare improperly paid millions of dollars for prescription drugs for thousands of unlawfully present beneficiaries.

In another review, OIG found that Medicare improperly paid $23 million dollars on behalf of deceased beneficiaries. But that figure was less than 1/10 of 1percent of 2011 expenditures.

Go to our website to listen to a podcast on Medicare payments made on behalf of deceased beneficiaries in 2011.

States' childcare monitoring rules don't always meet U.S. guidelines for background screenings or inspections, OIG noted in another review.

To listen to a podcast on the monitoring of licensed childcare providers, visit our website.

In another podcast, OIG's Tom Salmon talks with Federal News Radio about risk assessment and planning. Check our website.

In another review, OIG recommended that more attention be paid to the rates at which Medicare nursing home patients are admitted to hospitals.

For a related podcast, check our website.

In other actions, McKesson and First DataBank are to pay Wisconsin more than $14 million dollars to settle allegations of inflated drug price reports sent to Medicaid.

Baptist Health Systems in San Antonio, Texas, has paid more than $3.6 million dollars to settle allegations of false claims to Medicare. A whistleblower lawsuit claimed that Baptist failed to disclose on claims that patients had other health insurance that covered their care. The lawsuit also alleged that Medicare overpaid Baptist from 2003 through 2007.

Hospice of the Comforter in Florida is to pay $3 million dollars to resolve allegations that it billed Medicare for patients who were not terminally ill. The hospice allegedly falsified records, limited physician assessment of patients and delayed discharges, all to boost revenue.

The attorney general of Minnesota is seeking a federal investigation of complaints from senior citizens alleging improper handling of Medicare Advantage claims by insurance giant Humana.

Three defendants in Los Angeles pleaded guilty in a $49 million dollar ambulance scheme involving fraudulent claims for unneeded transportation services.

13 people were charged in a string of pharmacy burglaries in New York. Authorities allege that the ring stole millions of dollars' worth of drugs and hundreds of thousands of dollars in cash in a drug distribution scheme.

A patient broker for a South Florida psychiatric hospital was jailed for two years for her role in a $67 million dollar Medicare fraud; the defendant and her co-conspirators were ordered to pay $14 million dollars in restitution.

Also in Florida, a therapist for a mental health clinic conducted sham sessions for patients he knew to be ineligible for treatment as part of a $55 million dollar scam. The defendant was jailed for 10 years and must pay, with his co-conspirators, $11 million dollars in restitution.

The owner of a Detroit-area home health agency was jailed for five years in a $13.8 million dollar Medicare fraud scheme; he is to repay more than $1.7 million dollars.

On a final note, OIG's Strategic Plan for fiscal years 2014 through 2018 is available on 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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