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Transcript for audio podcast: April 2014 OIG Monthly Update

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).

OIG excluded CSHM Incorporated, the manager/operator of Small Smiles Dental Centers, from participation in federal healthcare programs for 5 years. The exclusion is based on alleged material breaches of a corporate integrity agreement with OIG. Inspector General Dan Levinson asserted that the health and safety of young patients and quality of care were put at risk. To minimize disruptions in healthcare, the exclusion is effective Sept. 30, 2014.

You can watch or listen to IG Levinson's HCCA Compliance Institute keynote presentation.

Gloria Jarmon, Deputy Inspector General for Audit Services, testified before the House Ways and Means Committee's Subcommittee on Health about "Medicare Program Integrity." You can read her testimony on our website.

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

In one study, OIG noted questionable billing in New York: Medicaid paid 29 dentists $13.2 million dollars in 2012 for pediatric services.

A related podcast is available on our website.

OIG urged more monitoring after it noted that nearly 5,000 doctors had submitted questionable Medicare billing for electrodiagnostic tests.

The Centers for Medicare & Medicaid Services generally selected suppliers and computed payment for medical equipment properly under a competitive bidding program, OIG found in another report.

To hear more about the medical equipment Competitive Bidding Round 1 Rebid Program, listen to our podcast.

OIG noted in another review that, for nearly one-third of home health claims, doctors' records of face-to-face encounters with patients did not meet Medicare requirements.

Listen to a podcast on limited compliance with home health face-to-face documentation requirements.

Medicare could save billions, OIG found in another report, if hospital outpatient surgery payment rates matched those of ambulatory centers.

Listen to a podcast on outpatient surgery payment rates. Check our website.

A Tennessee substance abuse treatment center has agreed to pay $9.25 million dollars to settle allegations that it filed claims for care that was substandard.

Astellas Pharma is to pay $7.3 million dollars to settle claims that it marketed a drug for use in children that was not approved.

The Duke University Health System is to pay $1 million dollars to settle allegations of false claims to federal healthcare programs. Duke allegedly "unbundled" claims to get bigger payments and claimed unallowed physician assistant services during heart surgeries.

A Kansas cancer treatment center and its owner, a doctor, are to pay $2.9 million dollars to settle allegations that they billed for drugs and services that were never provided. "Health care providers that try to make a quick buck by billing taxpayers for services never provided will instead pay a high price for their greed-fueled fraud," said Gerald Roy, an OIG Special Agent in Charge.

Two North Carolina women were sentenced to long prison terms for fraud; together they are to repay more than $10 million dollars. The fraud included theft of the Medicaid IDs of children and families and false billing for sham mental and behavioral health services.

A New York physician was accused of "creating phantom medical procedures" and falsely billing Medicare for $85 million dollars. OIG Special Agent in Charge Thomas O'Donnell said: "For a single physician, the alleged conduct in this case is among the most serious I've seen in my law enforcement career."

Two doctors became the 25th and 26th defendants convicted of taking bribes in a long-running New Jersey lab referral case. The New York physician took $1,000 a month in bribes; the New Jersey doctor accepted $2,000 a month.

A Texas father was jailed for nearly 22 years and his son for more than 11 years in an $11 million dollar Medicare physician-house-call fraud scam; restitution was ordered.

An Ohio doctor and three of his employees were charged with prescribing hundreds of thousands of pills for no medical purpose. Authorities said the physician continued to prescribe controlled substances, including painkillers, despite the overdose-related deaths of some patients.

A former doctor from New Mexico was charged in a 111-count indictment with illegally dispensing painkillers and billing Medicare and Medicaid for them. Two deaths resulted from the alleged illegal prescriptions, authorities said.

Check our website for OIG's Medicaid Program Integrity Report for fiscal year 2013.

And on a final note, visit our website for a widget that you can put on your website to help OIG fight fraud. Viewers who click on the widget can navigate directly to the OIG Hotline webpage, which accepts tips and complaints about potential fraud, waste, abuse, and mismanagement in Department of Health and Human Services programs.

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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