Transcript for audio podcast:
July 2015 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 (oig.hhs.gov) and on Twitter (@OIGatHHS).
Since our last podcast, OIG has issued a number of reports.
OIG found in one review (A-05-14-00055) that enrollment and profitability were lower than health insurance co-ops had projected.
Go to our website to listen to a podcast on the health insurance co-ops report.
OIG noted in another report (A-09-14-02024) that Medicare Part B overpaid providers $35.8 million dollars for outpatient drugs from 2009 through 2012.
Don't miss the podcast on Medicare Part B outpatient drug overpayments. Visit the OIG website.
OIG recommended in one review (A-04-14-08035) that North Carolina refund to the federal government $34.8 million dollars in unallowable bonus payments linked to increased enrollment of children in Medicaid.
In another study, OIG recommended (A-03-13-00202) that Maryland refund $34 million dollars to the federal government after finding that the state claimed unallowable Medicaid costs.
Gregory Demske, Senior Counsel to the Inspector General, testified before a House subcommittee on continuing concerns with the Federal Select Agent Program - Department of Defense shipments of live anthrax. Go to our website to read the testimony.
OIG's Ann Maxwell, Assistant Inspector General for Evaluation and Inspections, testified on Capitol Hill on strengthening Medicare Part D program integrity; read the testimony on our website.
A Detroit-area oncologist was sentenced to 45 years in prison after being convicted of falsely diagnosing cancer and administering chemotherapy to 553 patients who did not need it. The doctor lied to patients "and intentionally put their lives at risk," authorities said, in a $34 million dollar fraud scheme.
In California, a scam artist was sent to prison for 15 years in a $20 million dollar Medicare/Medicaid drug conspiracy in which anti-psychotics were fraudulently prescribed, and the government was billed over and over for those drugs.
Drugmakers AstraZeneca and Cephalon are to pay a total of $54 million dollars to settle allegations that they underpaid Medicaid rebates. AstraZeneca will pay $46.5 million; Cephalon is to pay $7.5 million
The State of New York reached a $22.4 million dollar settlement with a New York City pharmacy over allegations of improper billing for an injectable pediatric drug.
Community Health Network, a nonprofit system with more than 200 sites and affiliates in Indiana, agreed to a $20 million dollar civil settlement over allegations that it filed false outpatient surgery claims.
A charge of drug distribution resulting in death was added to a Pennsylvania doctor's "pill mill" case indictment. Eight new defendants - members of the Pagans - were also charged.
Six defendants were sent to prison in a $25.2 million dollar international Medicare/Medicaid fraud and wire fraud scam. Authorities said the scheme involved submission of false and fraudulent enrollment applications that claimed beneficiaries lived in Florida when, in fact, they lived in Nicaragua and the Dominican Republic.
A New York man was sent to prison for up to 21 years and fined $1.7 million dollars after illegally billing Medicaid for pricey pediatric nutritional formula. The "formula for fraud," as the New York attorney general put it, was to file inflated claims for specialized nutrition for needy children with rare illnesses and instead dispense an over-the-counter formula that is much cheaper.
A Connecticut advanced practice registered nurse admitted getting $83,000 dollars in kickbacks from a drug manufacturer for prescribing a pain medication used to treat cancer patients. A review of Medicare Part D records for prescribers of the drug showed that the nurse was responsible for more than $1 million dollars in claims and was the highest prescriber of the drug in Connecticut.
Five nursing home employees in New York were convicted in the death of patient on a ventilator; authorities noted "callous acts of neglect."
Two nurses and an aide at a New York nursing home were charged with neglect and abuse. Authorities allege that a patient was dragged across the floor and left there, bleeding from a head wound, for more than 20 minutes. The alleged act was caught on a surveillance camera, court papers said.
Michael Paul Marsh, an OIG Most Wanted deadbeat parent charged with failing to pay more than $100,000 dollars in child support, was taken into custody.
OIG Audit Manager Richard Navarro was interviewed on Federal News Radio. He discussed the Centers for Medicare & Medicaid Services' reported Federal Fraud Prevention System savings.
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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