The HHS Office of Inspector General (OIG) provided a monthly update on its activities during June 2015 that included the following:
- A Spring 2015 Semiannual Report to Congress reported $1.8 billion dollars in recoveries during the first half of 2015.
- 243 suspects, including 46 doctors, nurses, and other licensed medical professionals, were charged in the largest criminal healthcare fraud takedown in U.S. history involving about $712 million dollars in false billing.
- A fraud alert warned physicians that commercially unreasonable compensation arrangements may result in liability.
- Medicare Part D continues to be vulnerable to fraud; the OIG identified questionable billing and geographic hotspots that point to such problems.
- Medicare spending for commonly abused opioids has grown faster than spending for all Part D drugs.
- Problems with financial assistance for Health Insurance Marketplace enrollees under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) remain.
- Texas had paid millions of dollars for unallowable Medicaid orthodontic services.
- Some Pennsylvania family child daycare home providers did not always comply with state health/safety requirements.
- CMS was unable to rely on New York qualification rules for home health workers to ensure Medicaid patient safety and quality of care.
- A former assistant administrator at a Texas hospital was imprisoned for 40 years and must repay more than $31 million dollars for his role in a $116 million dollar Medicare scheme.
- A Florida skilled nursing facility (SNF) paid a record $17 million dollars to resolve allegations that it used a sophisticated scheme to pay kickbacks for referrals, a SNF record for violations of the Anti-Kickback Statute (AKS).
- A Washington, D.C., pediatric hospital paid $12.9 million dollars for submitting false cost reports to HHS and Medicaid.
- Nursing home owners, operators, and a manager in California paid $3.8 million dollars for fraud charges.
- Six individuals were charged in North Carolina for a $10 million dollar Medicaid scheme for bogus documents and false claims.
- A Detroit-area neurosurgeon admitted harming patients in an $11 million dollar fraud scheme.
Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.
Connect with Richard Kusserow on Google+ or LinkedIn.
Subscribe to the Kusserow on Compliance Newsletter
Copyright © 2015 Strategic Management Services, LLC. Published with permission.
