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Transcript for audio podcast:
The HHS OIG Hotline

From the Office of Inspector General of Department of Health and Human Services

https://oig.hhs.gov

[Tyler Daniels] What should you do if you suspect fraud, waste or abuse in a health and human services program? There’s an OIG hotline for that. 1800-HHS-TIPS. That’s what we’re talking about. I’m Tyler Daniels and welcome to the HHS OIG’s Podcast.

[Intro Music]

[Tyler Daniels] The OIG Hotline accepts tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement in Department of Health and Human Services' programs. OIG Hotline Director Diane Cutler joins us to tell us more about it, Diane…

[Tyler Daniels] What is the OIG Hotline?

[Diane Cutler] The OIG Hotline is where people report tips about fraud, waste, and abuse involving HHS programs, participants, or employees. Tips are confidential and are evaluated by Investigations Analysts who determine if further action is warranted. Within the OIG internal structure, the Hotline is in the Office of Investigations.

Another way to think about the OIG Hotline is to consider how a community watch program functions. The Hotline operates in a similar way. Basically, the American people make up the national community and when they see suspicious activity involving HHS, they should contact the OIG Hotline.

[Tyler Daniels] Can you explain a little about HHS so people know when to contact the OIG hotline?

[Diane Cutler] The HHS community is huge. People often know that CMS, or Medicare, is part of HHS, but they may not realize that there are other parts of HHS, too, NIH, CDC, the FDA, HRSA and SAMHSA. HHS is the largest grant maker in the federal government, and one of the top three contracting agencies. HHS has a budget of nearly $1 trillion dollars.

OIG provides oversight of HHS. We are the HHS watchdogs. Tips from the public can help be a force multiplier for OIG in our oversight of HHS. The Hotline receives tips from anyone.

[Tyler Daniels] When should someone contact the OIG Hotline? What are tips the Hotline does not take?

[Diane Cutler] People should contact the OIG Hotline when they suspect fraud involving HHS programs and employees.

The Hotline receives tips about healthcare fraud in Medicare, or grant or contract fraud in ACF or HRSA programs, or research fraud at NIH, or embezzlement involving Indian Health Services. Tips are reported about ghost employees, providers billing for services not rendered, kickback schemes, suspected medical identity theft, or application fraud for entitlement programs. The Hotline receives tips about relatives or social club members who are getting paid cash on a weekly or monthly basis so that clinics can use their Medicare patient number. Those are exactly the types of tips that should be reported to the Hotline.

[Tyler Daniels] How should someone provide tip?

[Diane Cutler] It is best to be as specific as possible and provide relevant names, dates and times, and how they became aware of the problem. If the tip is about potential fraud in grants or contracts, we ask that they include the name of the contractor or grantee, and contract or grant numbers, and award dates. If they provide names of anyone else affected by the problem, then our Special Agents can use that information to conduct witness interviews or possibly to review Medicare billing claims information to identify patterns or anomalies.

[Tyler Daniels] What are tips the Hotline does not take?

[Diane Cutler] The Hotline is not staffed to support emergency responses, so in the case of a life-threatening emergency, people should call 911. Also, the people should not report issues involving personnel matters such as complaints of EEO discrimination and grievances against management officials, or equal employment and civil rights.

One thing to keep in mind is that we do not want people undertaking investigations. We employ over 420 Special Agents – criminal investigators – throughout the country who are specially trained to conduct these investigations and work with prosecutors at the Department of Justice to bring criminal perpetrators to justice.

[Tyler Daniels] What’s the impact of the Hotline? What results have occurred because of Hotline tips?

[Diane Cutler] The OIG Hotline recent results from fiscal year 16 should give you a good idea of Hotline’s impact and also about the volume of work. The Hotline received over 150,000 contacts and culled those down to a little over 20,000 that were viable tips that we referred to our Special Agents or to HHS program managers for review.

The Hotline also tracks criminal investigations and other cases that started from Hotline tips or were assisted by Hotline tips. The monetary results from those cases in FY16 totaled $45.8 million, with a little over $20 million resulting directly from cases that started as Hotline tips. And the non-monetary actions were also substantial. They totaled 57 actions with 25 of those being from cases that started from Hotline tips.

A tip was called into the OIG Hotline and our Special Agents used that information to open a criminal case. As a result of that case, in the summer of 2015, a pharmacy CEO in Michigan was sentenced to 10 years in prison, $8.8 million in restitution and was banned from participating as a provider in any federal healthcare programs for 50 years. Overall, that case resulted in a conviction of 18 employees. Insurers had paid over $80 million to the pharmacy for adulterated and misbranded drugs that were sent to patients at over 800 nursing homes and adult foster care homes.

[Tyler Daniels] What if I suspect a healthcare provider is committing healthcare fraud, but I do not want to get that person in trouble if it turns out it’s not true? Should I still report a tip?

[Diane Cutler] Yes! Definitely!

A tip is one very small piece of information that may be used as part of an investigation. Our Special Agents all over the country have a lot of “boots on the ground” intelligence, so when they receive good tips, they can often know how that information may fit into a larger scheme. Tips can also help provide supplemental information about a fraud scheme in an ongoing investigation and they are particularly useful when our Special Agents were unaware of the fraud. Fraud is a crime of deception. It is theft. It is intentional. Reporting a tip will not get anyone in trouble unless that person is intentionally breaking the law.

[Tyler Daniels] How can some submit a tip to the OIG Hotline?

[Diane Cutler] Hotline complaints can be reported by mail, telephone, fax, or submitted online on the OIG website.

The best way is to report tips online because then a person can directly explain the problem and they can also upload documents and any other supporting information. If the person reporting the tip has medical records, those can be uploaded online because disclosing those records to the OIG is not a HIPPAA violation.

People can report tips anonymously, but the problem with that is that then our Special Agents do not have anyone to contact for follow-up to discuss the tip.

The Hotline appreciates the effort that people make to report a tip. It can be frustrating for people who have reported a tip to not receive any feedback, but reporting a tip is the right thing to do.

The OIG Hotline is motivated by the constant awareness that this work impacts all Americans, including some of our most vulnerable citizens, like the elderly. Their tips are taken very seriously and OIG Hotline will get them into the right hands.

[Tyler Daniels] Diane Cutler Thank you for your time.

[Diane Cutler] Thank you.

[Tyler Daniels] Diane is the Director of the OIG Hotline. That’s all we have time for today. I’m Tyler Daniels and thanks for listening.

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