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Transcript for audio podcast:
April 2015 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).

IG Dan Levinson was the keynote speaker at the Health Care Compliance Association's 19th Annual Compliance Institute. After the HCCA appearance, the IG was interviewed on RAC Monitor. Check our website for updates so that you can watch or listen to his presentation.

A team of Wall Street Journal reporters won a Pulitzer Prize for "Medicare Unmasked." The series of articles covered several OIG reports and Office of Investigations cases relevant to Medicare fraud and waste, including excessive billing in hospital outlier payments and urine drug testing. OIG subject matter experts and attorneys, serving as primary sources for the reporters, were interviewed and quoted in the articles, helping to shape the groundbreaking series.

OIG and industry collaborated on a new educational resource - practical guidance about compliance oversight for healthcare governing boards. Check our website.

CNBC's Andrea Day interviewed OIG's New York Special Agent in Charge Scott Lampert about a more than $200 million dollar fraud that involved a number of doctors and a blood testing laboratory in New Jersey. Watch the video on our website.

Four more doctors were sent to jail in the New Jersey lab-test-referrals scheme that Special Agent in Charge Lampert discussed on CNBC. A fourth physician entered a guilty plea in the same scam; he is to be sentenced in June. Some 38 defendants, including 26 doctors, have now pleaded guilty in the scheme.

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

OIG issued an Early Alert, warning that State-based healthcare Marketplaces might use U.S. grant funds for operational expenses, which is prohibited.

In another review, OIG found that Medicare could have saved $251 million dollars over 18 months had the Centers for Medicare & Medicaid Services implemented the payment system that OIG recommended for infusion drugs used in conjunction with durable medical equipment.

In another study, OIG found that Missouri did not follow rebate rules and claimed more than $34 million dollars in unallowable reimbursement for physician-administered Medicaid drugs.

A fourth OIG report noted that mandated Medicaid rebates for brand-name drugs exceeded negotiated Medicare Part D rebates by a substantial margin.

Two cardiovascular disease testing laboratories are to pay $48.5 million dollars to resolve claims that they paid for physician referrals and billed federal healthcare programs for tests that were unnecessary. Health Diagnostics Laboratory of Richmond, Virginia, will pay $47 million dollars, and Singulex of Alameda, California, is to pay $1.5 million dollars. Both labs have agreed to enter into corporate integrity agreements with OIG.

A South Florida ophthalmologist was indicted on 76 counts in a Medicare fraud scheme that allegedly used false diagnoses and bogus records to support false billing. The doctor billed for full doses of Lucentis, authorities alleged, but gave only partial doses to patients.

Twenty-three defendants, including nine doctors, were charged in a massive healthcare fraud case in New York. Authorities said that offers of free shoes lured low-income and homeless patients to what were described as corrupt clinics for tests and treatments that were not needed. Medicare and Medicaid were illegally billed $7 million dollars, according to the indictment.

A Pennsylvania caregiver and his girlfriend were charged with using her 24-year-old special-needs son to commit Medicaid fraud. Authorities alleged that fraudulent timesheets were submitted for care that was not given to the son, who, according to the criminal complaint, was malnourished, weighing just 58 pounds. The woman was also charged with aggravated assault, authorities said, after she put her son's hand in liquid hot enough to cause a burn.

A husband and wife who owned a Philadelphia nightclub admitted tax evasion and fraud linked to a healthcare benefit program. Authorities said the couple offered to teach undercover agents how to successfully cheat the government. Sentencing is scheduled in June.

On the run for seven years, OIG Most Wanted fugitive William Acosta, an admitted fraudster, was arrested in Panama.

And on a final note, don't forget OIG's new webpage for internship opportunities, and stay tuned for new postings.

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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