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Transcript for audio podcast:
October 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).

The FY 2016 Work Plan, a compilation of OIG"s planned reviews for the coming year, is on our website. Don"t miss it!

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

In one review, OIG found that Medicaid could have saved millions of dollars if New York had required medical loss ratios similar to those of the Patient Protection and Affordable Care Act.

In another review, OIG noted that internal controls for the Kentucky health benefit exchange were generally effective in enrolling individuals according to Federal requirements. However, OIG found deficiencies in the maintenance of identity documentation, eligibility verification, and the resolution of inconsistencies of eligibility data.

The executive director of a New Jersey child development organization was charged with stealing over $200,000 dollars in Federal funds intended to benefit children. He allegedly spent the money on a 2007 Maserati and a fur coat, among other things.

The United States and Tuomey Healthcare System resolved a $237 million dollar False Claims Act judgment. As part of the settlement, the South Carolina healthcare system agreed to pay $72.4 million dollars and be sold to Palmetto Health. Tuomey also entered into a corporate integrity agreement with OIG.

PharMerica Corporation, the nation"s second-largest nursing home pharmacy, is to pay $9.25 million dollars to settle allegations that it took kickbacks from pharmaceutical manufacturer Abbott Laboratories for promoting the prescription drug Depakote for nursing home patients.

American Access Care Holdings is to pay more than $3.5 million dollars to settle civil allegations that it improperly billed Medicare and Medicaid. The company also agreed to pay $2.6 million dollars to resolve false claims allegations linked to its site in Providence, R.I.

Two psychologists were charged with participating in a $25 million dollar Medicare fraud scheme involving psychological testing in nursing homes in Gulf Coast states.

A Miami doctor was charged in a $20 million dollar fraud scheme. Authorities allege that, in exchange for kickbacks and bribes, the physician and his co-conspirators wrote prescriptions for home health care and other services for Medicare beneficiaries that were not medically necessary or not provided. It was also alleged that patient records were falsified to make it appear as if the beneficiaries qualified for the services for which Medicare was billed.

A Minnesota pain management doctor was charged in a large-scale Medicare/Medicaid fraudulent billing scam. Authorities allege that the physician took kickbacks from a pharmacy for writing unwarranted prescriptions and had the pharmacy funnel the kickbacks to a purported charitable trust that she controlled.

A Florida doctor was convicted of intentionally misdiagnosing more than 500 Medicare patients and billing for unneeded treatment.

An Indianapolis businessman was jailed for nearly four years in a fraud and identity theft case involving the sale of power wheelchairs and beds. The man billed Medicare, Medicaid and others for used equipment, claiming it was new.

Agents apprehended OIG Most Wanted Fugitive Ubert Guillermo Rodriguez at Miami International Airport. Investigators believe that he submitted more than $2.5 million dollars in false Medicare claims.

OIG issued an Alert on how "information blocking" may affect safe harbor protection under the Federal anti-kickback statute. You can read the Alert on the OIG website.

Gary Cantrell, Deputy Inspector General for the Office of Investigations, testified before the Senate Special Committee on Aging about protecting seniors from identity theft. Visit our website to read the testimony.

Sue Murrin, Deputy Inspector General for the Office of Evaluation and Inspections, was interviewed by ABC News about an OIG report that found improper payments and questionable billing for Medicare Part B ambulance transports, which cost Medicare millions of dollars in the first half of 2012 alone.

Jodi Nudelman, a Regional Inspector General for the Office of Evaluation and Inspections, talked with National Public Radio about a report that recommended reforming the payment system for skilled nursing facilities. Such reform, the report said, could save Medicare billions of dollars.

OIG found that payments for therapy greatly exceeded the providers" costs.

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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