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Transcript for audio podcast:
July 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).

The owner of more than 30 Miami-area care facilities, a hospital administrator and a physician's assistant were charged in an alleged billion-dollar healthcare fraud and money laundering scheme. Authorities said the scheme involved bogus services, kickbacks, money laundering and obstruction of justice. They also said that addicted patients -- encouraged to come to the care facilities for drugs -- were put at risk, and others were subjected to unneeded treatment - often against their will. OIG said it used advanced data analysis and forensic accounting to uncover the scope of the scheme, which authorities characterized as the largest in Medicare Strike Force history in terms of loss amount charged.

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

In one report, OIG found that an estimated 29% of Medicare beneficiaries in rehabilitation hospitals experienced adverse or temporary harm events. Physicians attributed much of the preventable harm to substandard treatment, errors, and inadequate monitoring. OIG recommended raising awareness of patient safety issues in rehab hospitals.

In another review, OIG found that stronger oversight is needed to protect the Child Care and Development Fund Block Grant Program and the children it serves. OIG found $311 million dollars in improper payments in 2015; for every $1 million dollars lost, 200 children could have had care for a year. Visit our website to see the report, a fact sheet, a photo gallery and an interactive map.

In another study, OIG found fault with Massachusetts' reporting of reasonable suspicions of abuse or neglect and other critical incidents involving developmentally disabled Medicaid recipients in group homes. OIG recommended, among other things, that staff members be trained on how to identify and report such incidents.

A New Jersey laboratory at the center of a long-running $100 million dollar test-referral scheme, entered a guilty plea and must forfeit all of its assets. The investigation resulted in 41 guilty pleas - 27 of them from doctors. Authorities said it is believed to be the largest physician bribery case ever prosecuted.

Elsewhere in New Jersey, a couple and their diagnostic imaging companies are to pay more than $7.75 million dollars in a civil Medicare case involving falsified reports and the failure to properly supervise tests. Sentencing in a related criminal case is scheduled for August.

A scheme that used bogus records and unqualified staff to defraud Medicare of $7 million dollars put the owner of a New Jersey home health agency behind bars for 54 months.

Acclarent, a Johnson & Johnson subsidiary, has agreed to pay $18 million dollars to settle allegations of false claims linked to the marketing of a medical device for a use that was not approved by the Food and Drug Administration. Separately, two former Acclarent executives were convicted of distributing adulterated and misbranded medical devices. A jury convicted the men on 10 misdemeanor fraud counts and acquitted them on 14 felony fraud counts.

Columbia University in New York is to pay $9.5 million dollars to settle a civil fraud lawsuit linked to National Institutes of Health research grants. Columbia allegedly sought and received excessive cost recoveries tied to the grants.

A Minnesota-based provider is to pay $18 million dollars to resolve allegations that it filed claims for ineligible hospice patients.

A Minneapolis medical device firm, Cardiovascular Systems, is to pay $8 million dollars to resolve allegations that it paid doctors to encourage them to use its products.

Drayer Physical Therapy, which operates in 15 states, is to pay $7 million dollars, authorities said, to settle allegations of false claims to federal healthcare programs.

A Philadelphia doctor was found guilty of running a "pill mill" and causing a death through the illegal distribution of drugs.

A Florida physician who falsely diagnosed hundreds of patients in a scheme to increase payments from Medicare was sent to prison for nearly four years and must repay more than $2 million dollars.

A Texas nurse was convicted in an $8 million dollar home health false billing scheme, which included false records created to support care that wasn't rendered. Medicare got the bill, authorities said, but beneficiaries did not get home health care, and many didn't even qualify for it.

A Houston doctor who, for a fee, fraudulently certified patients for home health care was jailed for more than five years and must repay more than $900,000 dollars.

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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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201