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Transcript for audio podcast:
August 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).

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

In one report (A-09-14-01011), OIG recommended that the Centers for Medicare & Medicaid Services improve insurance marketplace controls for verifying eligibility and resolving inconsistencies.

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

In another review (OEI-06-12-00030), OIG found that 12 percent of providers terminated for cause from one state Medicaid program in 2011 billed from another state in 2014.

Pediatric Services of America and related companies are to pay $6.88 million dollars to resolve allegations of false claims to Medicare and Medicaid. The case includes alleged failure to disclose and return overpayments.

Two Southwest Missouri healthcare providers are to pay $5.5 million dollars to settle allegations of improper financial ties with referring doctors.

In a case of self-disclosure, a New York hospital is to pay more than $1.4 million dollars to resolve its liability linked to billing improprieties.

Two Detroit home health agency owners were convicted in a $33 million dollar Medicare fraud scheme that involved kickbacks, money laundering and obstruction of justice.

Also in Detroit, the owner of a pair of home health companies was sent to prison for nearly seven years in a $12.6 million dollar Medicare and tax fraud scheme. The businessman paid kickbacks to patient recruiters to obtain the information of beneficiaries, which he then used to bill Medicare for services that were not medically necessary or were not provided. And he admitted creating fake patient files to deceive an auditor. Eleven other defendants have been convicted in this case.

A physician was jailed for two years and must pay nearly $13 million dollars for his role in a Medicare/Medicaid bogus services and false billing scam run from a New York clinic.

A New York ob/gyn is to pay more than $8 million dollars in a civil Medicare/Medicaid settlement; prosecutors said the physician used unlicensed staff to treat patients.

Another New York doctor was charged with taking bribes for referrals in a massive New Jersey lab scheme. Authorities allege that the physician received $3,300 dollars a month, as well as sports, concert and Broadway tickets

A Brooklyn, N.Y., nursing home aide was charged with striking an elderly patient. The alleged mistreatment was caught on video, court papers say.

In a case of drug diversion, a New York nurse admitted stealing narcotics meant for nursing home patients. She used the drugs herself.

Another New York nurse was charged with using forged prescriptions to get more than 2,000 narcotic pills - and Medicaid paid the bill, authorities allege.

A Chicagoan was put behind bars for 21 months for conspiring in the Sacred Heart Hospital kickback scheme. The hospital's former chief operating officer arranged payoffs to doctors in exchange for referring patients to the now-closed facility on Chicago's West Side.

A North Carolinian pleaded guilty in a $4 million dollar fraud scheme after threatening to kill a witness if she spoke to law enforcement. An excluded provider, the man billed Medicaid for medically unnecessary services to beneficiaries, mostly children, and submitted a forged document.

Three defendants in Houston were charged in a $5.6 million dollar Medicare fraud conspiracy that authorities say included illegal payments, identity theft, medically unnecessary tests and false billing.

Miguel Hernandez and Maria Moreira, a married couple indicted in a nearly $7 million dollar Medicare scam, were added to OIG's Most Wanted Fugitives list. Authorities said the scam included billing for medical services that were unnecessary or not provided. The couple allegedly billed for trigger point injections, for which Medicare pays between $58 and $60 each, but instead administered vitamin B-12 shots, for which Medicare pays about 66 cents each. The couple also billed for medical services on days when they drove patients to restaurants for parties, authorities said. The two are believed to be in Spain.

Armando "Ana" Zamora, indicted in a $550,000 dollar Medicare scam, was added to the OIG Most Wanted list. She is believed to be in Central or South America.

Abayomi Onajobi, indicted in a $585,000 dollar healthcare scam, was also added to the OIG Most Wanted list. Investigators believe he fled the United States before a warrant could be issued for his arrest. He may be in his native Nigeria.

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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