Transcript for audio podcast:
December 2015 OIG 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 that not all Colorado marketplace controls ensured that applicants were enrolled in Affordable Care Act health plans according to federal rules.
In another study, OIG raised concerns about high-risk security vulnerabilities in Medicaid systems at three managed care organizations in California.
In a third review, OIG found that the Centers for Medicare & Medicaid Services has not performed required closeouts of contracts worth billions of dollars.
Listen to a podcast on the contract-closeouts report. Visit our website!
New York State improperly claimed at least $70 million dollars in Medicaid reimbursement for some adult day healthcare services, OIG noted in a fourth report.
A Utah man was charged in a $100 million dollar fraud scheme. Authorities allege that the man, a drug wholesaler, purchased prescription medications on the black market and resold them as new to pharmacies across the United States, putting customers at risk. The alleged scam was dangerous to the thousands of patients who ultimately took these black market medications, not knowing that they had been prescribed to others and then resold and trafficked, often in unsafe conditions, authorities said.
Two Louisiana doctors and a nurse were given long jail terms in a $50 million dollar home health fraud scheme; millions of dollars in restitution was ordered.
Qualitest Pharmaceuticals is to pay $39 million dollars in a civil fraud settlement. The company admitted that it sold half-strength fluoride tablets, causing federal healthcare programs to be fraudulently billed millions of dollars.
32 hospitals in 15 states are to pay more than $28 million dollars total to settle allegations of false claims linked to spinal treatment.
Dynasplint Systems, a Maryland splint supplier, and its president are to pay more than $10 million dollars to resolve allegations of false claims. The government alleged that Medicare was improperly billed for splints provided to patients in skilled nursing facilities.
A Texas management firm is to pay more than $3 million dollars to settle claims that it engaged in "ambulance swapping" kickback arrangements. Authorities, including OIG, allege that the management company got free or discounted patient transport in exchange for referring to ambulance companies other lucrative Medicare and Medicaid business. The settlement is believed to be the first in the nation to hold accountable hospitals and skilled nursing facilities in addition to ambulance companies for these kinds of "ambulance swapping"
New York resolved a lawsuit over an Alzheimer drug by allowing low-cost generic drugs to enter the market unimpeded. The state prohibited drugmaker Allergan from engaging in a tactic - sometimes called a "forced switch" -- that would have needlessly disrupted patient treatment plans solely to protect corporate profits.
An Iowa hospice is to pay more than $1 million dollars to settle claims of false Medicare billing for certain ineligible patients.
A Miami pharmacy owner was jailed for nine years and must repay nearly $21 million dollars in a massive Medicare Part D scam that included the use of patient recruiters, bogus prescriptions, sham pharmacy owners and false billing.
An Ohio cardiologist was jailed for 20 years for overbilling Medicare and other insurers $5.7 million dollars for unneeded procedures.
A New York physician's assistant was imprisoned for 11 years in a massive oxycodone distribution conspiracy. He was also ordered to forfeit more than $1.8 million dollars.
A doctor in Texas and his assistant entered guilty pleas in a healthcare fraud and kickback scheme. Authorities asserted, among other things, that the physician had sought reimbursement for services to patients who were deceased on the alleged dates of service.
The owners of a Dallas-based home health company and nurses who worked there were charged in a $13.4 million dollar Medicare fraud scheme.
A Detroit-area home health agency owner, who led a $7 million dollar scam, was sent to prison for nearly 7 years. He billed for unneeded services and paid for referrals and false certifications that home care was necessary. He must repay Medicare more than $4.5 million dollars.
Christopher Carroll, a former business executive, was charged in Rhode Island with failing to pay more than $250,000 dollars in child support for his three children, ages 14, 11 and 9. Carroll was also added to OIG's list of "deadbeat parents."
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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