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Transcript for audio podcast:
March 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).

Erin Bliss, Assistant Inspector General for the Office of Evaluation and Inspections, testified before the Senate Finance Committee about "Healthcare.gov: A Review of Operations and Enrollment." Visit the OIG website to watch or read the testimony.

OIG Chief of Staff Christi Grimm and James Cannatti, Senior Counselor for Health IT, presented an introduction to OIG and our work in the area of health information technology during the 2016 Healthcare Information and Management Systems Society conference and exhibition in Las Vegas.

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

OIG noted in one study that hospices inappropriately billed Medicare $268 million dollars in one year for general inpatient care. Visit our website for a podcast on this report.

In companion reports, OIG found that some Florida family childcare homes did not always comply with state health and safety requirements, and some childcare centers in Florida did not always comply with state health and safety licensing requirements.

If you would like to follow OIG on this topic, check out an interactive map on our website that refers to related reports.

OIG found in another review that Vermont's marketplace controls did not always ensure that individuals were enrolled in Affordable Care Act health plans according to federal requirements.

If you would like more information about OIG's body of work on the Affordable Care Act, visit our website for a listing of reports. The list is updated as new reviews are published.

Respironics Incorporated, a Pennsylvania company, is to pay $34.8 million dollars to resolve allegations of kickbacks to durable medical equipment suppliers who bought Respironics sleep apnea masks.

21st Century Oncology, one of the nation's largest providers of radiation oncology, is to pay nearly $34.7 million dollars to settle allegations that it billed for medically unnecessary procedures.

A Louisiana home healthcare company owner and a physician were convicted in a $34.4 million dollar scam. A federal jury found that the doctor falsely certified that patients were eligible for home healthcare and that the company owner fraudulently billed Medicare.

In another home healthcare certification case, this one in Texas, authorities reported that six people, including two doctors, were charged with billing Medicare $13.4 million dollars in false and fraudulent claims.

In Chicago, a marketer was convicted of taking bribes for referrals of elderly patients to a home health business. Eleven defendants have now been convicted in the federal investigation of the Skokie, Illinois-based company.

A Chicago psychiatrist, who at one point was the largest prescriber of Clozapine to Medicaid patients in the United States, was jailed for nine months for taking nearly $600,000 dollars in fees and benefits from pharmaceutical companies for prescribing the drug to thousands of elderly and indigent Medicaid patients. He is also subject to a forfeiture order. While Clozapine has been shown to be effective for treatment-resistant forms of schizophrenia, the anti-psychotic drug has potentially serious side effects, particularly for elderly patients.

An Illinois doctor was convicted of taking kickbacks for referrals to Sacred Heart Hospital in Chicago. Authorities said the physician is the 10th defendant convicted in a multiyear investigation of the now-closed facility.

A Dallas anesthesiologist was convicted in a $10 million dollar false billing scheme. He asserted on one claim that he personally oversaw the delivery of anesthesia when, in fact, he was under anesthesia himself, undergoing surgery.

A New York clinic owner and four medical professionals, arrested in a nationwide healthcare fraud takedown in June, were given long prison terms -- one of them 42 months. Restitution and forfeitures worth millions of dollars were also ordered.

Five defendants pleaded guilty in Houston in a $13 million dollar fraud and kickback scam at several phony clinics.

A North Carolina businessman was sentenced to 20 years in prison and must repay Medicaid nearly $6 million dollars for recruiting beneficiaries, mostly children, for behavioral health services that were billed but not provided. He also had threatened to kill a witness, authorities said.

In separate cases, two Pennsylvania ambulance company workers were each sent to prison for 37 months in a Medicare-patient transport scam. Each defendant was also ordered to repay more than $2 million dollars.

Conrado Lopez, indicted in a multimillion-dollar false claims case, was added to the OIG Most Wanted Fugitives list. Investigators believe he is in the Philippines or the United Arab Emirates.

Former OIG Most Wanted fugitive Ubert Guillermo Rodriguez, who had fled to Cuba, admitted in federal court in Tampa, Florida, that he took part in a $2.5 million dollar durable medical equipment fraud conspiracy.

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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