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Transcript for audio podcast:
June 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).

At least 243 suspects, including 46 doctors, nurses and other licensed medical professionals, were charged in the largest criminal healthcare fraud takedown in U.S. history. More than 900 law enforcement agents from some 20 agencies, including OIG and the FBI, took part from coast to coast. The suspects were charged with participating in Medicare and Medicaid fraud schemes involving about $712 million dollars in false billing.

In a fraud alert, OIG is warning physicians that commercially unreasonable compensation arrangements may result in liability. You can read the alert on our website.

OIG Special Agent Robert Murphy was honored with the Attorney General's Directors Award for Superior Performance by a Litigative Team. He was recognized for his work on the Halifax Hospital Medical Center and Halifax Staffing case, which settled civilly for $85 million dollars - the largest-ever Stark Law settlement.

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

Visit our website to read the latest OIG Portfolio, an overview of efforts to ensure the integrity of Medicare Part D. OIG has found that Part D - the prescription drug program -- remains vulnerable to fraud. Questionable billing and geographic hotspots point to such problems. And since 2006, Medicare spending for commonly abused opioids has grown faster than spending for all Part D drugs. To fully protect Part D, the Centers for Medicare & Medicaid Services should take further action to put into practice OIG recommendations that have not been implemented.

OIG has reviewed financial assistance for health insurance Marketplace enrollees under the Affordable Care Act. You can read the report on our website.

OIG found in one report that Texas paid millions of dollars for unallowable Medicaid orthodontic services.

Visit our website to listen to a podcast on the Texas report.

OIG found in another review that some Pennsylvania family child daycare home providers did not always comply with state health and safety requirements.

In another study, OIG found that the Centers for Medicare & Medicaid Services could not rely on New York state's qualification rules for home health workers to ensure Medicaid patient safety and quality of care.

A former assistant administrator at a Texas hospital was imprisoned for 40 years and must repay more than $31 million dollars for his role in a $116 million dollar Medicare scheme that included kickbacks, services that were unnecessary or never provided and fraudulent billing.

A Florida skilled nursing facility is to pay a record $17 million dollars to resolve allegations that it used a sophisticated scheme to pay kickbacks for referrals. The settlement is the largest by a skilled nursing facility for alleged violations of the Anti-Kickback Statute.

A Washington, D.C., pediatric hospital is to pay $12.9 million dollars to resolve allegations that it submitted false cost reports to the Department of Health and Human Services and to Medicaid.

Nursing home owners, operators and a manager in California are to pay $3.8 million dollars to settle allegations that they provided worthless services. Authorities allege that between 2007 and 2012, the defendants persistently overmedicated elderly and vulnerable residents of the nursing homes, causing infection, sepsis, malnutrition, dehydration, falls, fractures, pressure ulcers, and for some residents, premature death. The defendants also agreed to abide by a corporate integrity agreement with OIG.

Six defendants were charged in North Carolina in a $10 million dollar scheme that targeted Medicaid; bogus documents and false claims are alleged.

A Detroit-area neurosurgeon admitted harming patients in an $11 million dollar fraud scheme that included spinal surgeries never done. Commenting on the case, the U.S. attorney said: The physician acted "out of his own greed instead of the best interests of his patients."

Raymond Payne, charged with failing to pay more than $60,000 dollars in child support, was arrested in North Carolina.

And Jon McLendon, charged in South Dakota in 2010 with failing to pay more than $40,000 dollars in child support, was arrested in Roseburg, Ore.

OIG reports, in its Spring 2015 Semiannual Report to Congress, more than $1.8 billion dollars in expected recoveries during the first half of fiscal year 2015. For more from the Semiannual, visit our website.

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.

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