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Transcript for audio podcast: December 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).

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

In one report, OIG questioned some Connecticut adoption-related background checks; an estimated 2,800 children may have been at risk. http://oig.hhs.gov/oas/reports/region1/11202507.asp

In another review, OIG found that Medicare contractors overpaid providers about $24.2 million dollars for full vials of the breast cancer drug Herceptin.

Listen to a podcast on the Herceptin report.

OIG found in another report that stronger efforts are needed to address vulnerabilities to fraud in electronic health records.

And OIG noted that high-billing Part B clinicians cost Medicare millions of dollars; better oversight was recommended. http://oig.hhs.gov/oas/reports/region1/11100511.asp

Listen to a podcast on clinicians associated with high cumulative Part B payments.

A former hospital technician who worked in eight states was jailed for 39 years for causing a widespread Hepatitis C outbreak. The tech injected himself using stolen syringes of Fentalyn, an anesthetic, and refilled them with saline. The tainted syringes were later used on unsuspecting patients. http://oig.hhs.gov/fraud/enforcement/criminal/index.asp#CEA2013120403

Forty-nine current and former Russian diplomats and their spouses were charged in a healthcare fraud scheme that cost New York Medicaid $1.5 million dollars. While allegedly applying for and receiving Medicaid benefits for which they did not qualify, authorities said, the defendants spent tens of thousands of dollars on luxuries.

A Medicare Fraud Strike Force takedown in the Detroit area apprehended 20 suspects who were charged in various schemes to submit more than $34 million dollars in false billing to

In other actions, the Ensign Group, a skilled nursing provider in the Western United States, is to pay $48 million dollars to settle civil allegations that six of its California nursing homes billed Medicare for unneeded rehabilitation therapy.

Biotech firm Genzyme is to pay more than $22 million dollars to resolve allegations linked to a "slurry" used on patients during laparoscopic surgeries.

http://oig.hhs.gov/fraud/enforcement/criminal/index.asp#CEA2013122302

A prominent New Jersey cardiologist was imprisoned for 6 years and must repay $19 million dollars in a Medicare scheme that exposed patients to unnecessary treatment that was potentially life-threatening. The doctor falsified patient charts with boilerplate symptoms and false diagnoses. He also employed an unlicensed physician, who cared for patients but was not licensed to practice.

In a multimillion-dollar drug diversion case that allegedly included high-cost medications used to treat HIV, a New York pharmacy owner was charged with buying drugs from patients, repackaging and then reselling them and fraudulently billing Medicare and Medicaid. He was also charged with money laundering.

Captured OIG Most Wanted fugitive Carmen Gonzalez was jailed for nine years in an $11 million dollar HIV infusion fraud scheme.

Another captured OIG fugitive, Francisco Chavez, admitted his role in a medical equipment scam that defrauded Medicare of $11 million dollars. He is the former owner of a Miami firm that submitted bills for equipment that was neither prescribed by a doctor nor medically necessary.

A number of home health care cases in Florida ended in convictions.

A recruiter for Caring Nurse Home Health Care in Miami, was jailed for nine years and, with co-conspirators, must repay $24 million dollars in a $48 million dollar kickback and false billing scam.

Two other patient recruiters for health care companies in Miami, one of them Caring Nurse, were given long jail terms and must, with their co-defendants, repay $5.5 million dollars in the same $48 million dollar scheme.

And three more recruiters for Caring Nurse admitted taking kickbacks and bribes. They are to be sentenced in February.

The owner of another Miami home health company was imprisoned for nearly 20 years and must repay almost $7 million dollars. The scheme to defraud Medicare included bogus services, kickbacks, false billing and money laundering.

A doctor in California pleaded guilty to a tax offense linked to the fraudulent recruitment of Los Angeles "Skid Row" homeless for treatment they did not need. The physician received nearly $700,000 in cash kickbacks for admitting the so-called "patients" to skilled nursing facilities -- income he did not report on his tax returns.

Don't miss OIG's latest Semiannual Report to Congress. It's on our website now.

Check our website, too, for OIG's 2013 summary of the most significant management and performance challenges facing the Department of Health and Human Services.

And don't miss a Spotlight article on the OIG crackdown on fraud at community mental health centers. It's available on our website.

And on a final note, more than 68 percent of the $3.8 BILLION dollars in U.S. False Claims Act recoveries for fiscal year 2013 are from health care fraud, up from about 60 percent in FY 2012.

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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