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Transcript for audio podcast:
October 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).

On October 15, OIG celebrated its 40th anniversary. OIG is charged with overseeing nearly $1 trillion dollars in Department of Health and Human Services spending, which represents about a quarter of every federal dollar spent.

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

In separate reports, OIG recommended an examination of quality of care delivered at Indian Health Service hospitals to help meet longstanding challenges. OIG also urged more monitoring of those hospitals to ensure quality of care.

OIG found in one report that the Centers for Medicare & Medicaid Services generally prevented improper payments for incarcerated beneficiaries, but in some cases it did not.

In one review, OIG found that Medicare improperly paid $9.3 million dollars for services for 481 unlawfully present beneficiaries for 2013 and 2014. OIG recommended that the Centers for Medicare & Medicaid Services recoup the money.

In another review, OIG found that hundreds of millions of dollars in Medicare payments for chiropractic services did not comply with requirements.

Visit our website to listen to a podcast on the report.

Life Care Centers of America and its owner have agreed to pay $145 million dollars to resolve allegations that they violated the False Claims Act by knowingly causing skilled nursing facilities to submit false claims to Medicare and TRICARE for rehabilitation therapy that was not reasonable, necessary or skilled. Life Care also entered into a corporate integrity agreement with OIG that requires an independent review organization to annually assess the medical necessity and appropriateness of therapy services billed to Medicare.

Two psychologists admitted taking part in a fraudulent testing scheme that preyed on nursing home residents in the Southeastern United States. The $25 million dollar scam included administering a large number of tests that were not needed and repeatedly testing the same nursing home patients though some were incapacitated and could not meaningfully participate in the testing.

Omnicare, the nation's largest nursing home pharmacy, agreed to pay more than $28 million dollars to resolve allegations that it solicited and received kickbacks from Abbott Laboratories in exchange for promoting the

A former CEO of two nonprofit health clinics for the poor and homeless in Alabama was imprisoned for 18 years for funneling millions in grant money to private companies. OIG Special Agent in Charge Derrick Jackson said, "This is one of the most outrageous fraud cases I have seen."

A former Philadelphia doctor was imprisoned for 30 years for running a "pill mill" and distributing oxycodone resulting in a death; he is also to repay more than $342,000 dollars.

The owner of a New Orleans medical service company and a doctor who served as the company's medical director were sentenced to prison for their involvement in a $34 million dollar Medicare fraud scheme. Evidence presented at trial showed that the vast majority of patients did not require home healthcare services.

Three members of the military were indicted on charges of paying kickbacks to TRICARE beneficiaries to obtain prescriptions for compounded medications. If convicted, each faces a maximum penalty of five years in federal prison on each of 10 counts.

OIG Most Wanted fugitive Adrian Basanta was captured at Miami International Airport. He was charged in a $12.5 million dollar Medicare Part D fraud scam involving at least 42 individuals and 12 pharmacies.

OIG's latest Eye on Oversight, on personal care services, looks at major vulnerabilities in the program. Visit our website to watch the video.

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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