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Transcript for audio podcast: OIG Update July 2013

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 ( and on Twitter (@OIGatHHS).

Check the OIG website for the latest on our Exclusions database upgrade, including a video tutorial.

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

Hospitals' use of observation versus short stays can be costly to Medicare and to patients, OIG found in one report.

Another found that Affordable Care Act insurance co-ops appear to be making progress, but success depends on a number of unpredictable factors.

In another, OIG found that gaps in states' rules for license-exempt childcare providers could lead to harm for children.

Go to our website to listen to a podcast on license-exempt childcare providers.

In another review, OIG noted that some states improperly limit eligibility for Medicaid mandatory home health services for the homebound.

And another OIG study found that a California Head Start grantee claimed at least $967,000 dollars in unallowable costs; read a related Spotlight article on our website.

Check our website, too, for a podcast discussion of monitoring the use of AIDS-relief funding by the Centers for Disease Control and Prevention.

55 hospitals across the nation are to pay more than $34 million dollars to resolve false claims allegations linked to spinal-fracture procedures.

Amgen, a biopharmaceutical firm in California, has paid $15 million dollars to settle civil claims that it illegally paid doctors to prescribe a cancer drug.

A North Carolina device manufacturer, TranS1, now known as Baxano Surgical, is to pay $6 million dollars to resolve allegations that it caused providers to submit false claims for spinal surgeries.

In a self-disclosure, the University of Louisville Hospital is to pay more than $2.8 million dollars to settle a false Medicare billing case involving professional services.

And here's a heads-up for health care providers: Go to our website to see the new process for submitting your self-disclosure information online. The Self-Disclosure Protocol doesn't take as long as you might think, on average just 12 months.

Fifteen people from Illinois and Missouri have been charged in personal care services fraud cases; Medicaid allegedly was billed for, among other things, services to inmates, and services never provided. And authorities said that abuse of the program included splitting Medicaid checks with the people personal care aides were supposed to be helping.

In Alaska, 29 people were charged in a $362,000 dollar Medicaid personal care services scam in which billed services allegedly were not rendered.

For more on personal care services, check our website for Spotlight and Portfolio articles.

Four linked to a Miami-area mental health hospital were convicted in a nearly $70 million dollar Medicare false billing scam.

The supervisor at the center of a $63 million dollar Florida healthcare scam knew that kickbacks were being paid and oversaw the fabrication and forgery of records used in support of fraudulent claims. She was sentenced to 10 years in prison and must repay nearly $15 million dollars.

In a related case, a medical director and six therapists were charged in the same scheme.

A Washington State medical firm, Sound Inpatient Physicians, has agreed to pay $14.5 million dollars to settle allegations that it submitted inflated claims for health care services.

Six people and three corporations were charged in a $16 million dollar multiyear HIV-drug-related Medicaid scam in New York. Authorities allege that the scam paid at-risk HIV patients NOT to fill prescriptions and, at the same time, billed Medicaid for the drugs.

Five people were charged in New York City with prescription drug trafficking. Authorities allege that the five diverted $3.4 million dollars in highly addictive pills.

A New York oxycodone trafficker whose ring sold tens of thousands of pills was sent to prison for 5 years. He admitted selling 15,000 pills with a street value of nearly $500,000 dollars.

Learn more about drug diversion; read OIG's Spotlight article on our website.

And listen to a podcast on drug diversion.

A Texas equipment firm owner was jailed for 12 years and must pay $12.2 million dollars in a false claims case involving power wheelchairs.

In a Los Angeles-area case, a doctor and patient recruiter pleaded guilty in a $10 million dollar power wheelchair scam.

To learn more about power wheelchair schemes, read an OIG Spotlight article on our website.

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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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201