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Transcript for audio podcast: November 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).

Don't miss OIG's 2014 Top Management and Performance Challenges facing the Department of Health and Human Services. Check our website.

And IG Dan Levinson, in an appearance on Federal News Radio's "In Depth," talked about those challenges.

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

As a result of the findings in one review and at the urging of OIG, CMS is moving to change Part D payment rules.

OIG identified 95 dental providers in Indiana with questionable billing; Medicaid paid them more than $30 million dollars for pediatric services in 2012.

Missouri claimed unallowable payments for services to people with developmental disabilities; OIG recommended that the state refund $11.5 million dollars to the federal government.

Dialysis provider DaVita Healthcare, which has clinics in 46 states, is to pay $350 million dollars to settle allegations that it paid kickbacks for referrals.

Dignity Health is to pay $37 million dollars to settle allegations that 13 of its hospitals filed false claims. The United States contends that the hospitals admitted patients who could have been treated at less cost as outpatients.

Visiting Nurse Service in New York is to pay nearly $35 million dollars to settle civil fraud claims involving ineligible patients and substandard services.

CareAll is to pay $25 million dollars to settle claims that it overstated the severity of home healthcare patients' conditions and billed for unneeded services.

The Manhattan U.S. attorney sued the City of New York and Computer Sciences Corporation in an alleged multimillion-dollar fraud scheme. The suit contends that diagnosis codes on tens of thousands of claims were altered so that Medicaid would pay as much as possible as quickly as possible.

The owner of mental health centers in Louisiana and a patient recruiter were sentenced to terms of 7.5 and 5 years and are to pay nearly $47 million dollars in restitution for taking part in a $258.5 million dollar Medicare fraud scheme involving kickbacks, ineligible patients, falsified records, and treatment billed but not provided.

11 people were charged in a $25 million dollar Medicare, Medicaid and wire fraud scam that authorities said was operated in Florida, Nicaragua and the Dominican Republic. The indictment said that individuals who lived in Nicaragua and the Dominican Republic were recruited to enroll in Medicare Advantage plans and Florida Medicaid and fraudulently stated on enrollment applications that they lived in Florida. Through those allegedly fraudulent applications, Medicare and Medicaid paid the defendants millions. OIG's Derrick Jackson called the alleged healthcare enrollment scheme "in-your-face fraud."

A former hospital CEO in Texas admitted making a false statement about electronic health records. The official told Medicare that the hospital was a so-called "meaningful user" of electronic health records, when it was not. As a result of the statement, Shelby Regional Medical Center received more than $785,000 dollars from Medicare. More "meaningful use" case prosecutions are considered likely.

A father and son -- executives of a New York nonprofit that provided substance abuse treatment for tens of thousands of New Yorkers -- were charged in kickback and insurance fraud schemes. Authorities said the two men abused the organization to fund an extravagant lifestyle for themselves that included mansions, condos and luxury cars. A temporary restraining order was issued against the nonprofit's 10 clinics in Brooklyn, Queens and the Bronx.

A physician assistant in Miami was imprisoned for 15 years in the $200 million dollar American Therapeutic Corporation Medicare fraudulent claims scheme; restitution of more than $85 million dollars was ordered in this case. More than 20 defendants have pleaded guilty or been tried and convicted in this scam.

And some final notes:

Gary Cantrell, OIG's Deputy Inspector General for Investigations, took part in a panel discussion at the Newseum in Washington on the continuing battle against fraud, waste and abuse that costs the federal government an estimated $300 billion dollars a year.

OIG Chief of Staff Christi Grimm discussed audit and evaluation priorities in the FY 2015 Work Plan on RAC Monitor's "Monitor Monday" program.

Check out the Work Plan on our website.

And Steven Hernandez, OIG's chief information security officer, joined a Federal News Radio panel that discussed how a trusted cloud platform can help government agencies meet future demands while managing privacy and security mandates.

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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