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Transcript for audio podcast:
September 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, several of them related to the Affordable Care Act.

In those reports, OIG found:

That the Centers for Medicare & Medicaid Services, CMS, did not always manage and oversee contractor performance for the federal marketplace, as required.

That CMS did not identify all health insurance marketplace contract costs or properly validate the amount to withhold for correcting defects.

That although CMS had implemented controls to secure the Multidimensional Insurance Data Analytics System and personally identifiable information, areas for improvement in information security controls remained.

That New York health insurance marketplace internal controls were not always effective in verifying applicants' eligibility for health plans.

That the Office for Civil Rights, OCR, should strengthen its oversight function to ensure that patient health information is protected.

That OCR should improve its follow-up of breaches of patients' protected health information.

That improper payments and questionable billing for ambulance services cost Medicare millions of dollars in the first half of 2012.

That CMS should target questionable and inappropriate payments for chiropractic services.

That reforming the payment system for skilled nursing facilities could save Medicare billions of dollars.

Go to our website to listen to a podcast on the skilled nursing facilities report.

That New Jersey claimed at least $32.2 million dollars in unallowable Medicaid reimbursement for personal care services over about three years.

That there was questionable billing for ophthalmology services. OIG recommended that CMS increase its monitoring.

That some family child daycare centers in Pennsylvania did not always comply with state health and safety requirements.

OIG's John Hagg, Director of Medicaid audits, testified on Capitol Hill on strengthening Medicaid integrity and closing loopholes. You can read the testimony on our website.

A Houston psychiatrist was convicted of submitting false claims for mental health treatment in a $158 million dollar scheme. The psychiatrist and others defrauded Medicare by submitting, through Riverside General Hospital, false and fraudulent claims for intensive outpatient treatment that was not provided.

A pharmacy CEO in Michigan was imprisoned for 10 years in a $79 million dollar scheme. Drugs returned to the pharmacy that were supposed to be destroyed were instead repackaged, resulting in cross-contamination, improper labeling, placement of different dosages in stock bottles and placement of the wrong drugs in stock bottles. And, authorities said, some of the drugs were sold on the street.

A former medical director and three therapists were convicted in Miami in a $63 million dollar Medicare/Medicaid mental health services scam that included kickbacks, unneeded or never rendered services, bogus records and false billing.

Eight Californians were indicted in an alleged $50 million dollar scheme linked to alcohol and drug treatment for young people. The scam was said to involve often unneeded or never provided treatment.

A former clinics owner in New York City was jailed for more than seven years in a $31 million dollar healthcare and tax fraud scheme; full restitution and forfeiture were ordered. The so-called clinics, which authorities described as healthcare fraud mills, billed Medicare for diluted, never provided or unneeded injection and infusion treatments for HIV/AIDS patients.

Four defendants in New York, who were among those arrested in a nationwide fraud takedown in June, pleaded guilty in a $4 million dollar Medicare scheme. The four admitted filing false claims for unneeded or never provided therapy and services.

A hospital system and a doctor in Georgia are to pay more than $25 million dollars to settle civil allegations that Columbus Regional Healthcare System made excessive salary and directorship payments to the physician, and that Columbus Regional submitted claims to federal health care programs for services and therapy at higher levels than were supported by documentation or were provided.

Ilya Slepak, charged with billing Medicare and private insurance companies millions of dollars for never provided or unneeded medical care and equipment, was added to OIG's Most Wanted Fugitives list. He is believed to have fled to Russia.

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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