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Transcript for audio podcast: August 2014 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).

Gary Cantrell, Deputy Inspector General for Investigations, spoke with ABC News about doctors who illegally prescribe highly addictive drugs for cash.

And Tom Salmon, Assistant Inspector General for Audit Services, talked with Federal News Radio about Homeland Security Presidential Directive 12 and the Department of Health and Human Services' verification of employee IDs.

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

OIG identified 27 Louisiana dentists with questionable billing; Medicaid paid them $12.4 million dollars in 2012 for pediatric services.

And OIG found that Texas did not ensure that preauthorization was used to determine the medical necessity of Medicaid orthodontic services.

In another review, OIG recommended that nursing facilities maintain policies for reporting abuse and neglect.

Go to our website for a podcast on this report.

In separate reports, OIG found that some child daycare centers and family child daycare centers in Maine did not always comply with state health and safety licensing requirements.

OIG noted that the office overseeing health information technology did not ensure that testing could protect electronic health records.

In another report, OIG noted that Medicare Advantage organizations were improperly paid $12.6 million dollars for services for mental health patients who were confined by the courts.

Almost 1,600 Medicare Part D beneficiaries exhibited patterns of questionable USE for HIV drugs in 2012, and OIG found that more scrutiny is warranted.

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

Community Health Systems, the largest acute care hospital operator in the United States, is to pay more than $98 million dollars to settle allegations that it billed government health care programs for inpatient services that should have been billed as outpatient or observation services.

Pfizer is to pay $35 million dollars to 41 states and the District of Columbia to settle allegations that it improperly marketed the immunosuppressive drug Rapamune.

Carondelet Health Network, an Arizona nonprofit, is to pay $35 million dollars to resolve allegations of false billing for inpatient rehabilitation services.

Argus Health Systems, headquartered in Kansas City, agreed to pay more than $2 million dollars to settle OIG allegations that it submitted fraudulent Medicare Part D claims.

A Florida laboratory is to pay nearly $200,000 dollars to settle OIG allegations that it submitted fraudulent claims to Medicare. OIG contends that the lab used a code to bypass computer programming that would have rejected claims for high complexity urine drug tests exceeding the number of units allowed by Medicare. OIG's Office of Audit Services and Office of Counsel collaborated on the settlement agreement.

A mental health clinics operator was jailed 8 years and must repay more than $43.5 million dollars as well as forfeit the proceeds of a seven-year $258 million dollar scheme in Louisiana and Texas.

A disbarred Florida lawyer was jailed for nearly six years for her role in a $28 million dollar Medicare scheme; restitution of $14 million dollars was ordered.

An ex-hospital executive and a former co-owner of a chain of clinics pleaded guilty in a $100 million dollar Medicaid pay-for-referrals scam in Georgia and South Carolina. Providers paid and received kickbacks to steer pregnant women to deliver at certain hospitals.

A Michigan business owner is the 38th defendant convicted in a multimillion-dollar healthcare fraud case involving corrupt pharmacies and kickbacks for referrals.

The leader of a $20 million dollar scheme in California involving bogus prescriptions for expensive antipsychotics was sent to prison for eight years and must repay more than $9 million dollars.

Daniel Guerra and Aiza Rodriguez, accused in a $9 million dollar durable medical equipment scam, were added to OIG's Most Wanted fugitives list.

Gunther Bogensperger, Michael Paul Marsh and James Austin, each charged with failing to pay at least $100,000 dollars in child support, were added to OIG's list of deadbeat parents.

Check out OIG's new Medicare Fraud Strike Force webpage: Learn more about the continuing battle against fraud, waste and abuse.

Want to help catch a thief? Learn how to report potential crime in Health and Human Services programs. Visit our website and watch OIG's Hotline video.

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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