Kusserow on Compliance: OIG June update highlights

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.

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Copyright © 2015 Strategic Management Services, LLC. Published with permission.