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Transcript for audio podcast: May 2014 OIG Monthly Update

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

OIG's spring Semiannual Report to Congress, highlighting our work in the first half of the fiscal year - including more than $3.1 billion dollars in expected recoveries -- is on our website now; check it out.

Also posted is an OIG Supplemental Special Advisory Bulletin: Independent Charity Patient Assistance Programs. The bulletin expands on 2005 guidance, focusing on key safeguards to ensure the charities' independence from donors.

OIG agents were involved in a joint enforcement operation across the United States, aimed at stemming the tide of healthcare fraud. Ninety people were charged in six cities with submitting about $260 million dollars in fraudulent healthcare billing. In Florida alone, 57 were charged. OIG deployed more than 150 special agents and forensic specialists for the operation.

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

In one report, OIG urged establishing a method to identify Medicare Part B claims for compounded drugs.

In another, it was found that New York claimed $60.8 million dollars in unallowable room-and-board costs under its developmental disabilities waiver program.

And OIG found that Medicare inappropriately paid $6.7 billion dollars for evaluation and management services billed by physicians in 2010.

Go to our website to listen to a podcast on this report.

In another review, OIG found that Pennsylvania collected $1.76 BILLION dollars in impermissible healthcare-related taxes from Medicaid managed care organizations over three years.

Medicare overpaid hospitals $19.5 million dollars over four years because of improperly coded patient discharge claims, OIG noted in another report.

To listen to a podcast on this report, visit our website.

Amedisys, one of the nation's largest home health providers, is to pay $150 million dollars to resolve allegations that it submitted false billings to Medicare. The company, which entered a corporate integrity agreement with OIG, allegedly billed for unneeded services and ineligible patients; improper financial ties with referring doctors were also alleged.

A hidden camera allegedly revealed a disturbing pattern that led to charges of neglect of a disabled adult against 17 nurses and aides at a nursing home in Buffalo, N.Y. Duties were ignored, medicines not dispensed and records falsified, authorities said.

27 defendants now stand convicted in a massive New Jersey clinical laboratory bribery scheme. The latest defendant, a New York doctor, admitted taking more than $100,000 dollars for referrals.

A New Jersey physician was jailed and fined in a diagnostic facility referrals scam; he is the 17th defendant convicted in a continuing investigation of illegal payments. OIG agents, under the direction of Tom O'Donnell, were credited by the U.S. attorney for their work on the case.

A Detroit-area patient recruiter was jailed for more than seven years for his role in a $14.5 million dollar home health scam; the recruiter promised destitute beneficiaries cash and drugs for their Medicare information, which was later used on fake medical records to support false billing. Restitution of $1.6 million dollars was ordered.

Eleven stand accused in an elaborate kickback scheme in Houston; $173 million dollars was billed to Medicare and Medicaid for fraudulent mental health services, authorities said.

A Louisiana pharmacy owner pleaded guilty in a $2.2 million dollar drug scheme that included collecting, repackaging and redistributing unused pills and billing Medicare as if the medications were new.

A Florida man was charged with failure to pay more than $100,000 dollars in child support for his children, who live in Orange County, N.Y.

Brian Ritchie, Acting Deputy Inspector General for the Office of Evaluation and Inspections, and Jodi Nudelman, Regional Inspector General for the Office of Evaluation and Inspections, testified before two different House subcommittees on Medicare issues and oversight. You can read their testimony on the OIG website.

The Miami Strike Force team, represented by OIG agents Omar Perez and Reginald France, was selected as a finalist for the 2014 Samuel J. Heyman Service to America Medals for record-breaking fraud prosecutions. The medals pay tribute to a dedicated federal workforce, highlighting those who have made significant contributions to our nation.

Proposed revisions to OIG exclusion authorities are available for your review. Visit our website or check out the Federal Register.

And you can review proposed revisions to OIG civil monetary penalty rules. Take a look on our website or in the Federal Register.

Scott Vantrease, OIG's director for hotline operations, talked with Federal News Radio about the way whistleblower hotlines are changing how IGs respond to fraud, waste and abuse.

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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