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Transcript for audio podcast:
September 2016 OIG Update

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

https://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).

OIG has issued an investigative advisory and proposed ways to fight fraud and patient harm in Medicaid personal care services. Visit our website to read the advisory.

OIG has also issued an early alert: Incorporating medical device-specific information on Medicare claim forms. Visit our website to read the alert.

Kindred Health Care, the nation's biggest post-acute care provider, paid more than $3 million dollars for failing to comply with a corporate integrity agreement. It is the largest penalty levied for violations of such an agreement.

OIG has proposed a regulation to support Medicaid Fraud Control Units in their battle against fraud and patient abuse. You can read the document on our website or in the Federal Register.

And, speaking of the Federal Register, OIG has issued a competitive challenge there to develop a foundation for an upgraded version of OIG’s sampling tool, called RAT-STATS. The deadline is May 15, 2017. Visit our website or the Federal Register website for details.

Joanne Chiedi, OIG’s principal deputy inspector general, presented the keynote address at the 2016 Annual Training Program of the National Association of Medicaid Fraud Control Units in Omaha.

Gloria Jarmon, Deputy Inspector General for Audit Services, testified before two subcommittees of the House Committee on Energy and Commerce about OIG oversight of health insurance marketplaces. Visit our website to watch or read the testimony.

OIG Special Agent Abhi Dixit brought a field agent’s perspective to Capitol Hill, testifying before the House Ways & Means Committee’s Subcommittee on Oversight about health care fraud investigations. Visit our website to read the testimony. Dixit also appeared on CNBC’s “American Greed” to discuss the case of Dr. Farid Fata, an oncologist who gave cancer drugs to patients who did not need them, part of a multimillion-dollar Medicare fraud scheme. You can watch the episode, “Diagnosis: Blood Money,” on the American Greed website.

OIG’s latest Eye on Oversight, on the Provider Self-Disclosure Protocol, features the largest self-disclosure case in history. Visit our website to watch the video.

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

In one review, OIG raised concerns that a number of hospice patients are not getting the information they need. Hospices must provide complete, accurate information to patients and caregivers to ensure that they can make informed choices. And it’s critical that doctors complete certifications of terminal illness to ensure that beneficiaries receive hospice care.

In another report, OIG recommended that the Centers for Medicare & Medicaid Services address Medicare’s flawed payment system for durable medical equipment infusion drugs. OIG found that CMS continues to make payments for these drugs, which are misaligned with providers’ costs.

Another study showed that nearly a third of Medicaid Fraud Control Unit convictions in fiscal year 2015 involved home care services.

In separate reports, OIG found that two states made incorrect Medicaid electronic health record incentive payments. California made $22 million dollars in incorrect payments to 61 hospitals.

And Washington state made $9.2 million dollars in incorrect payments to 19 hospitals.

OIG found in another report that Vermont did not properly allocate millions of dollars to establishment grants for a health insurance marketplace.

Tenet Healthcare, a major hospital chain, is to pay more than $513 million dollars to resolve criminal charges and civil claims linked to a scheme to defraud the United States and pay kickbacks for patient referrals. Two Tenet subsidiaries have agreed to plead guilty to conspiracy to defraud and paying healthcare kickbacks. “Tenet took advantage of vulnerable pregnant women in clear violation of the law by paying kickbacks in order to bring their referrals to Tenet hospitals,” said Georgia Attorney General Sam Olens.

Vibra Healthcare, which operates in 18 states, is to pay $32.7 million dollars to resolve false claims allegations that it provided medically unneeded services for which it billed Medicare.

North American Health Care, its chairman and a senior vice president together are to pay $30 million dollars to settle allegations of unneeded rehabilitation therapy services.

The United States has sued six Vanguard Healthcare nursing facilities, alleging false claims for nonexistent or grossly substandard services. Vanguard is based in Brentwood, Tennessee, and has 14 long-term-care nursing home providers operating around the country.

OIG Most Wanted fugitive Joel Fuentes, captured in Texas, faces Medicare fraud charges. Investigators believe that he falsely billed more than $3.5 million dollars for infusion-related prescription medications that were not prescribed by doctors or provided, as claimed.

And finally, an invitation to apply for OIG’s Spring Health Care Fraud and Abuse Legal Internship Program. The application deadline is November 18, 2016. Visit our website for details.

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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