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Transcript for the audio podcast:
OIG Update November 2012

From the Office of Inspector General of Department of Health and Human Services

https://www.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 at oig.hhs.gov and on Twitter @OIGatHHS.

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

One found that upcoding and other billing errors by skilled nursing facilities cost Medicare 1 and a half billion dollars in one year.

Listen to a podcast about the report on our website.

Another review found that the Centers for Medicare & Medicaid Services faces obstacles in overseeing the 6.6 billion dollar electronic health records incentive program.

And OIG found in another review that New Jersey claimed 50 million dollars in disproportionate share hospital payments that do not meet Federal requirements.

In a fourth report, OIG urged the Centers for Medicare & Medicaid Services to seek legislative authority to implement least costly alternative policies for Medicare Part B drugs.

Our Semiannual Report to Congress, a summary of OIG activities, has been posted on our website. And OIG's annual list of the Top Management and Performance Challenges confronting the Department of Health and Human Services is available as well. Check them out!

We've also launched something new - an OIG Portfolio - a comprehensive look at our work in Medicaid personal care services. This first Portfolio includes a related Spotlight article and podcast. Don't miss this new feature; it's on our website now!

In other actions, GlaxoSmithKline is to pay 90 million dollars to resolve allegations that it unlawfully promoted the diabetes drug Avandia. Glaxo has agreed to change how it markets and promotes any diabetes drug.

Orthofix subsidiary Blackstone Medical is to pay 30 million dollars to settle civil allegations that it paid kickbacks to spinal surgeons to induce them to use the company's products.

In another case, Novartis has agreed to pay the Federal government and the State of Texas nearly 20 million dollars to resolve civil allegations of unlawful and deceptive marketing of the skin cream Elidel.

A Florida hospital group, Morton Plant Mease Health Care, is to pay 10.1 million dollars to resolve claims in a whistleblower lawsuit that the group overbilled Medicare for heart and vascular procedures.

Freeman Health System in Joplin, Missouri is to pay 9.3 million dollars to resolve allegations that it improperly paid doctors for referrals for certain diagnostic testing and other services.

In other cases, a New York doctor was indicted in a 12 million dollar scheme that allegedly involved billing Medicare, Medicaid and private insurers indicating that on a daily basis he administered more patient treatments than would be possible to provide in 24 hours.

A Michigan physician who, according to a prosecutor, "exposed patients to electrical currents for neurological testing solely to generate money for himself" was sentenced to 5 years in prison and ordered to pay restitution in a 5.4 million dollar Medicare fraud scheme.

A Federal civil fraud lawsuit alleges that a Chicago psychiatrist took kickbacks for prescribing antipsychotic drugs to nursing home patients and filed at least 190,000 false health care claims.

A program director and a therapist are the latest of 22 defendants convicted in the 205 million dollar American Therapeutic Corporation Medicare fraud scam in Florida.

Two defendants in Miami entered guilty pleas in a multi-state 63 million dollar mental health care fraud scam involving kickbacks and unneeded and never-provided services. Nine defendants have been charged in this scheme. Six pleaded guilty, and three are scheduled for trial in January.

In Houston, a seventh defendant was sentenced to prison in the City Nursing fraud conspiracy that improperly billed Medicare and Medicaid for over 45 million dollars.

The high-living owner of two District of Columbia healthcare firms used fraud proceeds to buy four cars and two beachfront properties; she was jailed for more than 6 years and must repay over 6 million dollars in a phony claims case.

In a somewhat unusual case, an Illinois inmate used a furlough day from prison to meet with his case worker at his home so that he could continue receiving Home Services Program benefits. He returned to jail after being approved for personal assistant services, and Medicaid continued to pay for those services -- supposedly provided to the inmate by his girlfriend at home. But he remained in jail - not at home -- for several months.

Four people have been added to OIG's list of Most Wanted health care fugitives. Vivian Yusuf, Manuel Lopez, Rajindera Sachdeva, and Patricia Chisanga each were charged in separate scams that together, authorities say, bilked Medicare and Medicaid out of more than 7 million dollars. Authorities say Yusuf may be in Nigeria and Lopez in Cuba.

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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