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Transcript for audio podcast:
December 2016 OIG 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).

Inspector General Dan Levinson was interviewed on Federal News Radio’s “The Business of Government Hour” about OIG’s key priorities and the top management and performance challenges facing the Department of Health and Human Services. You can listen to the interview on the Federal News Radio website.

OIG’s Rob DeConti, Assistant Inspector General for Legal Affairs, discussed safeguarding federal healthcare programs and their beneficiaries during an interview with Compliance Today, a publication of the Health Care Compliance Association.

Don’t miss new OIG regulations that strengthen fraud prevention, detection, enforcement and compliance. They’re posted on our website.

And take a look back with Eye on Oversight! A video and a podcast recap OIG's work in 2016. Visit our website!

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

In one review, OIG found that Medicare paid nearly $2.9 billion dollars for inpatient hospital stays that were potentially inappropriate under the two-midnight policy. Under that policy, inpatient payment is generally appropriate if doctors expect care to last for at least two midnights; otherwise, outpatient payment would generally be appropriate. OIG recommended that the Centers for Medicare & Medicaid Services improve its oversight of hospital billing under the two-midnight policy and increase beneficiary protections. OIG also noted that the two-midnight policy reduced access of certain beneficiaries to skilled nursing services and increased their out-of-pocket costs.

In another review, OIG found that California failed to seek millions of dollars in rebates for drugs that physicians administered to enrollees of some Medicaid managed care organizations.

Over five years, Florida overpaid managed care organizations an estimated $15.4 million dollars on behalf of deceased Medicaid beneficiaries, OIG noted in another study (A-04-15-06182).

Forest Laboratories and a subsidiary, Forest Pharmaceuticals, are to pay $38 million dollars to resolve allegations that they paid kickbacks to induce doctors to prescribe three drugs.

Six former Insys Therapeutics executives and managers were charged with engaging in a nationwide conspiracy to bribe medical practitioners, many of whom operated pain clinics, to unnecessarily prescribe a fentanyl-based drug.

A Philadelphia-area doctor was convicted of 308 felony counts linked to drug distribution and the death of an addicted patient.

A New York pharmacist was jailed for four years for Medicare fraud, money laundering and illegally distributing 100,000 oxycodone pills and is to forfeit $800,000 dollars and repay $520,000 dollars.

A Florida man was charged in a healthcare fraud scheme involving Tricare, which provides medical coverage for military personnel, military retirees and military dependents. Authorities said a compounding pharmacy paid the man about $20 million dollars in exchange for referrals of Tricare patients. According to the indictment, the scheme included invalid prescriptions, lack of medical necessity and money laundering.

A hospital in Miami is to pay $12 million dollars to settle allegations that it submitted claims for unneeded cardiac procedures.

Vitas Health Corporation Midwest and others agreed to pay $200,000 dollars to resolve allegations that they paid convicted oncologist Farid Fata for hospice referrals. Dr. Fata, who used false cancer diagnoses and unwarranted and dangerous treatments to steal millions of dollars from Medicare, pleaded guilty in 2015 and was sent to prison for 45 years.

A North Carolina man was sent to prison for nine years for fraudulently billing for behavioral health services that were not rendered; he must repay more than $5.7 million dollars.

OIG Most Wanted Fugitive Martinez Ruiz, charged in a $4.7-million-dollar home health scam, was taken into taken into custody in Miami.

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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