2014: More News
OIG Update has expanded its coverage. Here is more news that you won't hear in the monthly podcast.
In another report, OIG recommended more effort to ensure appropriate oversight and use of Medicare Advantage data.
OIG noted in another review that more than half of Part D plan sponsors did not report potential fraud and abuse data between 2010 and 2012.
OIG found high-risk security vulnerabilities during reviews of information technology controls at state Medicaid agencies.
OIG posted a budget document for fiscal year 2015. It's on our website.
A former District of Columbia government worker pleaded guilty to conspiring to steal about $800,000 in Medicaid and other benefits.
A Salt Lake City psychologist was indicted on fraud charges; he allegedly billed for services not rendered.
A Tennessee woman is facing 15 fraud counts; she allegedly passed forged prescriptions paid for by Medicaid.
A South Carolina woman was jailed for four years for identity theft and false billing; she must repay Medicare $411,000.
The owner of nurse staffing agency in Maryland admitted submitting false Medicaid claims for 69 dates of service. The services were never provided.
Three in New York were charged in pharmacy scheme, accused of preying on HIV patients and fraudulently billing Medicaid.
A former doctor in Iowa pleaded guilty to fraud and illegal distribution of a drug resulting in a death.
A Massachusetts dentist is to repay Medicaid $400,000 in a civil case; he allegedly billed improperly for nursing home services.
A Florida woman was sent to jail and must repay Medicaid $200,000 in a speech therapy scam.
An ex-office manager in Ohio was charged with manipulating the reimbursement process to get higher insurance payments. The suspect is believed to have caused more than $100,000 in excessive billings to Medicare, Medicaid and other healthcare benefit providers.
A Maryland ophthalmologist is to pay $1.4 million to settle allegations that he performed medically unnecessary laser procedures. He also agreed to a 20-year exclusion as a provider from federal health programs.
A former Department of Veterans Affairs psychiatrist was imprisoned for 18 months, must forfeit $1.2 million and pay restitution for falsely claiming to provide Medicare at-home services. He submitted about $4 million dollars in Medicare claims for home treatment of beneficiaries while holding a full-time, salaried position as a psychiatrist at the VA hospital in Brooklyn, N.Y.
A physician in Massachusetts admitted falsely certifying hundreds of Medicare patients for home care in a $27 million scam.
In a Detroit-area Medicare fraud case, an ex-doctor posed as if he were licensed and illegally claimed to provide physician home care for beneficiaries in an $11.5 million scheme.
A New Jersey doctor admitted submitting more than $13 million in false billing; he gave patients free food and spa services in exchange for their Medicare IDs. He could get as much as 10 years in prison.
Another New Jersey doctor admitted embezzling more than $1 million from a medical practice to pay personal expenses.
A Miami physician pleaded guilty in a $2.5 million fraud scheme linked to narcotics violations.
An Illinois doctor admitted healthcare fraud and illegal distribution of controlled substances. Authorities said he prescribed outside the usual course of professional conduct and without legitimate medical purpose.
In a Florida civil "whistleblower" case, a doctor is to pay $750,000 to resolve allegations that he and his clinic billed Medicare for physician office visits that were not performed. The U.S. attorney characterized the case as "a troubling pattern of billing fraud." The doctor also entered into an integrity agreement with OIG.
The owner of a phony psychotherapy clinic in Michigan was jailed for eight years and must repay Medicare nearly $1 million. The case included the promise of narcotics for patients, fabricated records and $3.2 million in false billing.
A Georgia woman who ran counseling agency that served children and adolescents was sent to jail for 10 years; she was convicted of billing for bogus services, defrauding Medicaid of more than $200,000.
A Connecticut physical therapist was charged with healthcare billing fraud involving services allegedly not rendered; authorities said the woman also altered patients' records before a Medicare audit.
New Jersey pharmacists - twins - are each to serve 3 1/2 years in prison and pay fines totaling $150,000 for bilking customers, Medicaid and private insurers out of $1.5 million over 15 years.
A California pharmacy and its owner are to repay Medicare $1 million for selling foreign oncology drugs to doctors, knowing that Medicare patients would be given the drugs, which were not approved by FDA, and that the doctors would bill Medicare for the drugs.
A Californian is to pay more than $500,000 for falsely billing Medicare for wheelchairs that were not provided or not needed.
A Mississippi nurse was charged with murder, accused of turning off machines that helped keep an elderly patient alive; if convicted, she could get a could get life in prison.
A New York postal worker and his wife were charged with taking nearly $100,000 in Medicaid benefits for which they weren't eligible.
A Florida clinic owner and patient recruiters were imprisoned and must repay hundreds of thousands in an $8 million dollar home health fraud.
A Miami clinic owner was jailed for nine years in a multimillion-dollar home health and therapy prescription fraud; the woman must repay more than $8.4 million.
An Ohio acute care hospital is to pay $8.5 million to settle claims that it had improper financial ties with referring doctors.
A Texas doctor was jailed for nearly five years and must repay nearly $9.5 million in a fraud centered on a physician house-call company.
American Family Care is to pay $1.2 million dollars to resolve allegations of overbilling Medicare at its walk-in clinics.
A New York orthopedic surgeon was sentenced to 4.5 years in jail for lying about the nature and scope of surgeries he performed in an extensive false claims scam. He was also ordered to forfeit $5 million. The surgeon performed thousands of surgeries, often as many as 20 or more in a single day, for which he and his medical group submitted claims to insurers for more than $35 million.
The "straw" owner of a Florida clinic was jailed for 2.5 years in a $28 million Medicare scam; forfeiture and restitution of nearly $900,000 was ordered.
A Massachusetts pain management physician was charged with healthcare fraud; he allegedly trained his employees to overbill Medicare, seeking payment for services that far exceeded the scope and duration of those provided. Authorities also asserted that the doctor often arrived to work four hours late and conducted appointments lasting less than 10 minutes, and sometimes only 2 or 3 minutes.
- An Atlanta doctor was jailed for more than four years and fined $3.5 million in a healthcare fraud, tax fraud and money laundering case.
- A Chicago-area physician was charged in a drug and false billing case; an undercover agent posed as one of his patients.
- A Houston doctor was charged in a fraud case involving diagnostic tests that allegedly were not needed or not provided.
- A Missouri physician admitted billing Medicare for seeing patients in his office when he was, in fact, out of the country.
- A Washington State doctor and a clinic have agreed to a civil settlement of more than $89,000 for alleged improper billing of Medicare/Medicaid.
- A New Yorker who posed as optometrist was convicted of defrauding Medicaid of more than $115,000.
- A Maryland dentist is to repay Medicaid $25,000 in civil damages for services billed but allegedly never rendered.
- A Missouri in-home healthcare provider was indicted on bank fraud charges. She also faces healthcare fraud charges, and her trial in that case is set for May.
- Submitting false home-care timesheets put a Kansas Medicaid provider under house arrest; she must also repay more than $50,000.
- Eleven home-care workers in Michigan were charged with defrauding Medicaid of more than $60,000.
- Submitting false home-care timesheets put a Kansas Medicaid provider under house arrest; she must also repay more than $50,000.
- An Arkansas attendant-care provider was charged with billing Medicaid for services allegedly not provided.
- A community mental health center in Tennessee is to pay $800,000 to settle allegations that it submitted false Medicaid claims.
- Three from Miami were charged with fraud in multimillion-dollar American Therapeutic Corporation false billing case.
- And a patient recruiter admitted playing a role in the same scam. His sentencing is set for March.
- A Florida man was convicted of running an unlicensed clinic, filing false claims & identity theft and must repay more than $83,000.
- Three Floridians were charged with billing Medicaid more than $80,000 for services allegedly never rendered.
- A Texas ambulance company owner was charged with filing more than $500,000 in false claims for services not provided.
- A Texas woman admitted conspiring with a doctor and submitting false healthcare claims.
- A pharmacist in New Jersey was charged with paying more than $50,000 in kickbacks to a doctor for prescription referrals.
- A New Jersey man admitted selling oxycodone to an undercover agent; the state is recommending a seven-year jail term.
- A South Dakota man was charged with presenting a pharmacy with a falsified, forged prescription for hydrocodone, a controlled substance.
- An Idaho woman was jailed and must repay more than $47,000 for fraudulently billing Medicaid for transportation services.
- A nursing home bookkeeper in Louisiana was charged with stealing $133,000 from patients.
- Orthopedic clinics in Tennessee and Virginia together must pay $1.85 million dollars to settle claims that they billed state and federal health care programs for reimported medications used to treat osteoarthritis, knowing that such reimports were not reimbursable.
- Insurer CIGNA must reprocess and pay hundreds of nutrition counseling and mental health claims it had denied in New York.
- Also in New York, EmblemHealth is to offer reinstatement of health insurance coverage to more than 8,000 young adults and pay about $90,000 in denied claims.
- A Texas pharmacist, doctor's office manager and three drug dealers were convicted in a "pill mill" conspiracy that had run since 2010.
- A Baltimore auto shop owner and his son admitted trafficking in illegal narcotics, including oxycodone, and taking part in armed burglaries; each faces up to 25 years in jail.
- A Maryland physician, busted in an undercover investigation, prescribed drugs without a medical exam to patients he knew abused and/or sold them.
- Three medical groups and a billing firm are to pay more than $3.3 million to resolve claims that they overbilled for nuclear stress tests.
- Seven nursing home workers in New York were charged in the death of a resident and in an alleged cover-up; two other workers were facing separate charges of falsifying business records and willful violation of the health laws. Authorities said the pair neglected other residents and gave false statements to conceal the neglect. The state also filed a civil lawsuit against the nursing home, alleging an extensive pattern of neglect and corporate looting.
- A suspended Illinois doctor was charged in a false claims case that included alleged sexual contact with a patient. Authorities said the physician obtained information about Medicare beneficiaries without their knowledge through his affiliation with assisted-living facilities, billed for medical services to patients he never treated and billed for routine visits at the highest levels of in-home care when he knew that the visits did not qualify for such billing.
- A patient recruiter in New York pleaded guilty in a $13 million fraud scheme that included kickbacks and money laundering.
- A New York physician was charged with illegally selling prescriptions for a controlled substance. Authorities said the doctor sold the painkiller prescriptions to a Medicaid recipient, who returned half of the drug to physician.
- In California, a doctor, who authorities said dispensed nearly 1,600 oxycodone pills in the summer of 2012, was charged with, among other things, prescribing drugs without legitimate medical purpose.
- A couple who owned a Tennessee ambulance service were sentenced to prison terms of more than six and more than five years in $1.2 million Medicaid fraud case that included aggravated identity theft and billing for services for unqualified beneficiaries.
- An Ohio couple, owners of an ambulette service, were charged with defrauding Medicaid of about $750,000 after allegedly providing rides to patients who did not use or need wheelchairs, billing for transports that did not occur and charging for attendants who were not present.
- Seven Ohio oncologists are to pay a total of $2.6 million after importing cancer medications that were not approved by the Food and Drug Administration.
- Also in Ohio, a nurse was charged in a Medicaid fraud scheme that included the alleged theft of more than $200,000.
- A man convicted in an oxycodone distribution case in Maine used the illegal proceeds from the drug diversion to finance a nightclub venture. He is serving nine years in prison.
- An Indiana businessman was charged in a wheelchair-scooter fraud and identity theft case that included alleged submission of claims to Medicare/Medicaid for used equipment that was sold as new.
- A former chiropractor from Louisiana was indicted on fraud and identity-theft charges involving alleged extensive false billing. Authorities said the case includes alleged billing for X-rays, tests & braces never provided.
- A Wisconsin private-duty nurse who falsified patient records and billed for services not provided was placed on probation and must repay nearly $46,000.
- Several nationwide contract therapy providers are to pay $30 million to settle civil allegations of kickbacks for referrals of nursing home business.
- A Kentucky addiction clinic, lab and two doctors are to pay $15.75 million dollars to settle claims that they falsely billed Medicare and Medicaid for tests that were medically unnecessary, were more expensive than those actually done or were billed in violation of the Stark Law.
- Medical device maker EndoGastric Solutions is to pay up to $5.25 million to settle civil false claims allegations linked to one of its products. Authorities said the firm misled providers, leading to overbilling of federal healthcare programs; payment of kickbacks was also alleged.
- The federal government has intervened in False Claims Act lawsuit against Tenet Healthcare and five hospitals, alleging that kickbacks were paid to obstetric clinics in return for referral of patients for labor and delivery at the hospitals.
- A Texas doctor who submitted thousands of fraudulent bills to Medicare and Medicaid pleaded guilty and could be sentenced to as much as 20 years in prison. Authorities said the physician billed for patients who died before the dates of his claimed services and filed claims that indicated he worked more than 24 hours in a single day.
- An Illinois hospice executive was charged with fraud after allegedly falsely raising patient-care levels in a multimillion-dollar healthcare scam. The levels of care exceeded what was medically necessary or what was provided, authorities said, leading to increased Medicare and Medicaid payments.
- A New York doctor was sentenced to serve a year and a day in prison in a $15 million scam involving physical therapy and lesion-removal services that were not provided or were not medically necessary. As part of the scheme, Medicare beneficiaries were given a variety of spa services, including massages and facials, as well as free meals, to induce them to allow their Medicare numbers to be used in billing for medical services that were not provided or not medically necessary.
- St. Joseph London Hospital in Kentucky is to pay $16.5 million to settle civil claims that it falsely billed Medicare and Medicaid for medically unnecessary heart procedures by doctors working at the hospital. Authorities said that several doctors working at the hospital performed unneeded invasive cardiac procedures, including coronary stents, pacemakers, coronary artery bypass graft surgeries, and diagnostic catheterizations, and billed Medicare and Medicaid for them.
- A Michigan home health agency owner was jailed for 10 years and must repay, with his co-defendants, more than $10 million in a scam involving false claims for skilled nursing and physical therapy services.
- 24 people were charged in connection with a massive New York drug ring that authorities said distributed more than 5 million oxycodone pills.
- An Idaho man was convicted of failing to pay more than $62,000 in child support; full restitution was ordered.
- A Washington state man was also convicted of failing to make child support payments; restitution of more than $106,000 was ordered.
- In one review (A-02-12-01009), OIG noted that New Jersey improperly claimed at least $6.9 million for Medicaid-supported employment services.
- Another OIG study (A-05-12-00053) found that the transfer of true out-of-pocket costs between Medicare Part D plans needs more rigorous oversight.
- The United States has joined lawsuits against the hospital chain Health Management Associates. The government is alleging unnecessary inpatient admissions and kickbacks.
- A Delaware corporation is to pay nearly $3 million to resolve civil claims that for five years its ambulance companies falsely billed Medicare for transporting patients from one hospital to another on an emergency basis when the calls were not emergencies.
- A New York company is to pay $2.5 million to settle an investigation of alleged false, inflated Medicaid billing. Authorities said that the company billed Medicaid for nonpatient business costs and more than 6,500 service hours by uncertified aides.
- A New York nurse's aide admitted breaking the arm of an elderly patient; while taking the resident to her room, the aide grabbed the woman by the wrist and twisted her arm behind her head, resulting in a fracture. Sentencing in the abuse case is set for March.
- A New York nurse, who claimed she cared for a seriously disabled child but was on vacation, running errands or not working at all, was jailed for two years and must repay $900,000 in a home-care scam. She falsely billed Medicaid and private insurers.
- Two former executives of the Kentucky firm HealthEssentials Solutions are to pay more than $1 million to resolve false claims allegations that centered on services the company provided to patients in assisted-living facilities.
- A Miami clinic owner pleaded guilty in multiple scams that resulted in losses to Medicare of more than $20 million.
- A doctor in Florida is to pay $400,000 to resolve allegations that he billed for vein injections done by an unqualified employee. Authorities allege that the physician sent text messages to his office manager instructing her to do varicose vein injections on patients when he was not in the office. The government also alleged that, when the doctor was in the office, he gave unnecessary injections and did unneeded ultrasound imaging.
- A Florida clinic owner and two patient recruiters admitted that they took part in an $8 million kickback and false billing scam.
- A clinic owner in North Carolina admitted running a mental health services scam that defrauded Medicaid of at least $3.4 million. Authorities said t man bought luxury vehicles and jewelry with the stolen money.
- A California doctor was jailed for more than three years and must repay over $600,000 in a multimillion-dollar Medicare false billing scam.
- A Kansas physician pleaded guilty to conspiracy to distribute controlled substances. Authorities said the office staff gave drugs to patients, using blank prescription pads that the physician signed in advance.
- A Houston man was jailed for six years in a $3 million scam involving unlicensed doctors and false billings; he is to repay $880,000.
- A Texas doctor admitted misbranding cancer drugs and has agreed to pay more than $1 million. His sentencing date had not been set.
- Two Miami women were sent to jail for 10 years for conspiring to pay healthcare kickbacks; $733,000 in restitution was ordered.
- A Florida woman was charged with submitting more than $395,000 in false invoices to Medicaid from a nursing home.
- A doctor from Washington State admits getting cash for writing oxycodone prescriptions without medical purpose.
- The New Jersey comptroller is seeking to bar three healthcare facilities from Medicaid; they allegedly filed $2.7 million in improper claims.
- A New Jersey doctor admitted taking bribes in a long-running multimillion-dollar referrals scheme with a laboratory. Twenty-two people - 11 of them physicians - have pleaded guilty in the scam.
- A licensed Oklahoma counselor was jailed for nearly two years and must repay $140,000; she billed Medicaid for services never provided.
- A Medicaid provider in the District of Columbia is to pay nearly $200,000 to resolve allegations that it billed without proper documentation.
Let's start by choosing a topic
Priority recommendations summarized.
FY 2014 Work Plan
OIG projects planned for 2014.
Significant OIG activities in 6-month increments.