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Transcript for audio podcast:
January 2016 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).

Joanne Chiedi, OIG's Principal Deputy Inspector General, appeared on Federal News Radio's "Women of Washington." To listen to the interview, go to FederalNewsRadio.com

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

Most children covered by Medicaid in four states are not receiving all required dental services, OIG found in one report.

Not all Washington State marketplace controls ensured that applicants were enrolled in Affordable Care Act health plans according to federal requirements, OIG noted in another review.

The Centers for Medicare & Medicaid Services could not ensure that Affordable Care Act advance premium tax credit payments went to insurers only for enrollees who had paid premiums, OIG found in a third study.

OIG also found that childcare home providers in Puerto Rico did not always comply with the commonwealth's health and safety rules.

A doctor who owns clinics in New York was sent to prison for 12 years for illegally distributing more than five million oxycodone pills with a street value of $165 million dollars. Twenty-four people -- physicians, clinic employees and drug traffickers - have been jailed in the scheme.

The nation's largest nursing home therapy provider, Kindred/RehabCare, is to pay $125 million dollars to resolve allegations that it caused skilled nursing facilities to submit false claims to Medicare for rehabilitation therapy that was not reasonable, necessary and skilled, or that never occurred. And four nursing homes that used Kindred/RehabCare reached settlements that call for them to pay, together, more than $8 million dollars. The government alleged that Kindred/RehabCare set unrealistic financial goals and scheduled therapy to gain the highest level of reimbursement regardless of patients' needs.

Nashville Pharmacy Services and its owner are to pay up to $7.8 million dollars to settle allegations of overbilling Medicare and Medicaid.

The former CEO of Bostwick Laboratories agreed to pay up to $3.75 million dollars to resolve allegations of billing for medically unnecessary cancer tests and illegal remuneration to physicians.

A California hospital is to pay more than $3.2 million dollars to settle allegations that it violated the physician self-referral law, also known as the Stark Law. The Stark Law generally forbids a hospital from billing Medicare for certain services referred by physicians who have a financial relationship with the hospital.

New York reached settlements with two laboratories to halt "direct access testing." The settlements keep patients from getting clinical lab tests without the required medical oversight.

A Texas nurse who co-owned a home health care agency was sent to jail for 10 years in a multimillion-dollar Medicare fraud conspiracy.

A Chicago-area doctor was sent to prison for two years for fraudulently certifying patients for home care, costing Medicare millions of dollars.

A doctor in California, who pre-signed thousands of prescriptions for anti-psychotic drugs in a $20 million dollar scheme, was imprisoned for nine years. The U.S. attorney said the physician "essentially sold his prescription pad" in the conspiracy, defrauding the government of millions.

A former clinic owner in Los Angeles was jailed for 6 1/2 years for submitting more than $4.5 million dollars in fraudulent claims to Medicare; restitution of more than $1.6 million dollars was ordered. The scam included kickbacks, unneeded or never provided services and false documentation.

A former insurance agent in California was sent to prison for 10 years for financial elder abuse. After gaining the trust of two people, ages 93 and 74, the man acted as their financial planner, purchasing, selling and repurchasing long-term annuities without his clients' knowledge, which resulted in the victims together losing more than $2 million dollars.

OIG Most Wanted fugitive Maelis Fernandez, accused of working as a patient recruiter for a number of pharmacies and paying kickbacks in a prescription drug fraud scheme, was taken into custody in the Miami area.

Another OIG Most Wanted Fugitive, who had fled to Cuba, was taken into custody at Miami International Airport. Sandy De La Fe has been charged in a $2.8 million dollar pharmacy scam.

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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