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Transcript for audio podcast: July 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 issued a fraud alert in English and Spanish on a new scheme targeting families of unaccompanied children. Scammers are demanding cash to reunite families and kids. Check our website and don't fall prey to this scheme.

Kay Daly, Assistant Inspector General for Audit Services, and Joyce Greenleaf, Regional Inspector General for the Office of Evaluation and Inspections, Boston, testified before the House Energy and Commerce Committee about Affordable Care Act eligibility system concerns.

And John Hagg, director of Medicaid Audits for OIG's Office of Audit Services, testified before a House Oversight and Government Reform Subcommittee on a series of New York Medicaid audits.

To read their testimony, visit our website.

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

None of the 20 childcare home providers reviewed by OIG in Michigan met all state health and safety requirements.

Medicare paid $1.7 billion dollars for lab claims linked to questionable billing; OIG is urging stronger oversight.

OIG found in another report that the U.S. Virgin Islands may not have provided Head Start services to the neediest children.

And OIG advised New Jersey to redistribute to its subdivisions $45.2 million dollars in increased Recovery Act funding.

OmniCare, the nation's largest nursing home pharmaceutical company, is to pay $124 million dollars to settle allegations of false billing. The U.S. attorney said, "Omnicare provided improper discounts in return for the opportunity to provide medication to Medicare and Medicaid beneficiaries."

An Alabama hospital system and a physician group are to pay $24.5 million dollars to settle allegations that they paid for Medicare referrals.

The University of Utah health system settled OIG allegations that it employed three workers who had been excluded from participation in federal healthcare programs; under the settlement, the system is to pay nearly $200,000 dollars.

Four were imprisoned and must pay millions in restitution in a massive tribal program grant fraud scheme in Montana.

The chief financial officer of the Passamaquoddy tribe in Maine, who lied to get the job as CFO, admitted embezzlement and theft.

A Georgia lab owner admitted faking allergy test results, misleading doctors and billing insurers for services not rendered. OIG's Derrick Jackson, Special Agent in Charge, Atlanta, said, "The blatant disregard for potential patient harm is inexcusable, especially when many of the patients affected were children and the elderly."

A former operator of HIV/AIDS clinics in New York pleaded guilty in a $31 million dollar Medicare fraud scheme involving patient recruiting, unneeded or never delivered treatment, kickbacks and false billing.

Six were charged in New York with operating a prescription drug ring out of a Bronx grocery store. Authorities allege that Medicaid beneficiaries sold prescriptions in a backroom of the store, and later those drugs were resold.

A Texas pharmacist was jailed for five years for her part in a massive "pill mill" operation in Dallas. Twelve other defendants charged in the case have pleaded guilty and been sentenced, and 14 so-called "dealers" were indicted and convicted.

A New Jersey physician was given a two-year prison term and must pay a fine and forfeiture totaling $285,000 dollars after taking bribes in a massive New Jersey lab test-referrals scheme, and a New York doctor admitted taking more than $120,000 dollars as part of the same scam. Twenty-nine defendants have now pleaded guilty in the case.

Note that OIG has posted a Special Fraud Alert: Laboratory Payments to Referring Physicians. Check our website.

A Florida woman pleaded guilty in a $74 million dollar home health scam that included using patient recruiters, paying kickbacks and submitting false billing to Medicare for services that were not medically necessary and/or were not provided.

Sandy De La Fe, charged in a nearly $3 million dollar Medicare prescription fraud case, has been added to OIG's Most Wanted fugitive list. He is believed to be in Cuba.

Randy Lee Essary, an OIG deadbeat parent who fled the United States to avoid his child support obligations, was jailed for 21 months and must pay more than $170,000 dollars.

OIG's Russ Hereford talked with Federal News Radio about how health insurance marketplaces resolved applicant enrollment inconsistencies. He also briefly outlined OIG's Affordable Care Act-related work planned for the coming months.

And Assistant IG Les Hollie discussed with Bloomberg/BNA the serious, multifaceted problem of drug diversion and OIG's continuing battle against it.

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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