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Transcript for the audio podcast: OIG Update August 2012

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 at and on Twitter @OIGatHHS.

OIG issued a number of reports since our last podcast. One found inappropriate and questionable Medicare billing by home health agencies; OIG urged more monitoring.

Additional monitoring was also recommended for community mental health centers as a result of questionable Medicare billing practices highlighted in a separate OIG report. Listen to a podcast about the report on our website.

In another report, OIG found that had the Centers for Medicare & Medicaid Services implemented drug-price substitution, Medicare would have saved about 4.6 million dollars in one quarter alone.

In other actions, McKesson Corporation will pay the state of New York 64 million dollars as part of a 151 million dollar multistate Medicaid drug-pricing settlement.

And eight pharmaceutical companies are to repay Louisiana Medicaid 38 million dollars to settle a lawsuit over inflated drug costs.

The Mayo Clinic is to pay 1.26 million dollars to settle whistleblower claims that it billed for pathology services that were not provided.

In other cases...

A former nursing home operator was imprisoned for 20 years in a Medicare/Medicaid "worthless services" fraud and was ordered to repay 7.6 million dollars. The defendant, who is from Georgia, spent millions on real estate while residents in his three nursing homes went without food and lacked basic necessities.

Eight people were charged in an extensive mental health services fraud scheme in Houston that billed Medicare for 97 million dollars.

In separate cases, the owners of home health care agencies in Miami pleaded guilty in scams that sought to defraud Medicare of more than 100 million dollars.

And a home health provider in Tennessee is to pay more than 9 million dollars to settle a lawsuit filed under the False Claims Act alleging false reports to Medicare and sham ownership of the company.

A medical equipment company owner in Louisiana was sent to prison for 15 years and ordered to repay more than 13 million dollars in Medicare schemes involving fraudulent claims and kickbacks for unneeded or never provided durable medical equipment.

In Mississippi, a doctor was imprisoned for 14 years and must repay nearly 14 million dollars in a massive Medicare/Medicaid physical therapy scam.

In New York, a Long Island medical supplier was convicted of stealing nursing home patient information and filing false Medicare claims in a 10.7 million dollar scheme.

Also in New York, five people were charged in a complex auto insurance-Medicare/Medicaid scheme to illegally market narcotics. Authorities allege that the defendants, using what is known as doctor and pharmacy shopping, illegally obtained and sold more than 5,000 oxycodone pills in just one year. ...And in a separate case, a cardiologist in Yonkers, New York, was charged with illegally distributing oxycodone in exchange for cash.

The co-owners of a durable medical equipment business in the Houston area were sentenced to long prison terms and ordered to repay more than 560 thousand dollars in a Medicare scam that included illegal payments and so-called "arthritis kits" that beneficiaries did not need.

Also in Houston, a prominent radiologist is to pay 650,000 dollars to settle allegations of illegal compensation to as many as 17 doctors in exchange for patient referrals.

A divorced couple was jailed in a brazen multimillion-dollar medical equipment billing scam that continued even after the woman had been excluded as a provider from Federal health care programs.

Two people were charged in California in a 1.3 million dollar scam involving medically unnecessary power wheelchairs. For more on power wheelchairs, see the Spotlight section on our website.

Francisco Chavez, charged in an 11 million dollar Medicare durable medical equipment fraud, has been added to OIG's Most Wanted fugitives list.

Also added to that list was Gevork Aidinian, charged with using the identities of doctors to fraudulently bill Medicare for lab work that was neither prescribed nor provided.

In a child-support case, Kenneth Jones, who owes more than 275,000 dollars and who may be living in Australia, has been added to OIG's Child Support Enforcement webpage.

And in a final note, OIG's Office of Counsel is seeking applicants for its 2013 Spring Semester Legal Extern Program; the deadline is Sept. 21. See our website for details.

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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