NEW DOCUMENTS AND TESTIMONY:
v Suspected
Medicaid Fraud Referrals PDF
(OEI-07-04-00181)
v Testimony
of Lewis Morris, Chief Counsel to the Inspector General, before the U.S. House Oversight and Government Reform Committee,
on Allegations of Waste, Fraud and Abuse in Pharmaceutical Pricing: Financial Impacts on Federal Health Programs PDF
v OIG Releases
Report on Commissioned Corps’ Response to Hurricanes Katrina and Rita: Press Release PDF
v The Commissioned Corps’
Response to Hurricanes Katrina and Rita PDF (OEI-09-06-00030)
NEW REVIEWS & AUDITS:
Medicaid Hospital
v Medicaid Hospital Outlier Payments in Virginia for State Fiscal Years 2001 Through 2003 PDF (A-03-04-00212)
Medicaid Administration
v Virginia Rebase Process Used to Calculate Medicaid Rates for State Fiscal Years 2001 Through
2003 PDF (A-03-05-00205)
Medicaid/State Children’s
Health Insurance Program
v Review of Connecticut’s Title IV-E Adoption Assistance Costs for State Fiscal Years
2002 Through 2004 PDF (A-01-06-02506)
v Review of Title IV-E Training Costs Claimed by Maryland for Calendar Years 1999 Through
2001 PDF (A-03-06-00563)
Other:
Program
Support Center’s Award Process
v Emergency Response to Hurricanes Katrina and Rita: Audit of Program Support Center’s
Award Process for a Contract With Dell Marketing, L.P. PDF (A-03-06-00514)
v Emergency Response to Hurricanes Katrina and Rita: Audit of Program Support Center’s
Award Process for a Contract With Logistics Management Institute PDF (A-03-06-00519)
NEW ADVISORY OPINIONS
v None
NEW CRIMINAL ENFORCEMENT ACTIONS
- UPDATED:
v Practitioners
January 2007
– In Michigan, a dentist was sentenced to 15 months in prison and ordered
to pay $147,000 in restitution and a $50,000 fine for health care fraud. The dentist’s husband was ordered to pay almost
$10,000 for making a false statement. The dentist submitted or caused to submit claims to insurers for services that were
not rendered. The investigation revealed that claims were for services rendered when the dentist was on travel or purportedly
rendered by the former owner of the practice who had been deceased since January 1996. In addition to the fraud scheme, it
was revealed that the dentist, who had been diagnosed with Hepatitis, did not disclose her condition to patients or take certain
precautionary measures when treating patients.
January 2007
– In Arizona, a podiatrist sentenced for theft of Government money was ordered to pay $55,000 in restitution. The podiatrist
provided non-covered routine foot care services to beneficiaries but billed Medicare as of he performed nail avulsions or
debridements.
v Kickbacks - none
v Hospitals, Laboratories, and Clinics –
none
v Physicians and Other Health Care Professionals -
none
v Employee Misconduct - none
v
Durable Medical Equipment
January
2007 – In Idaho, a man was sentenced to 4 months imprisonment,
4 months home confinement and ordered to pay a $5,000 fine for conspiracy. The man, who worked for a DME supplier, orchestrated
a Medicare fraud scheme that included falsifying and forging certificates of medical necessity for oxygen services and supplies.
v Prescription Drug Fraud - none
v Nursing Homes and Home Health - none
v Transportation Fraud – none
v Medicaid Fraud – none
v Other Cases of Interest – none
v Public Health Related
January
2007 – In South Dakota, an attorney was sentenced to 3 months incarceration
and ordered to pay $9,000 in restitution for health care fraud and false claims. The attorney falsely claimed to be part Native
American Indian so she could receive free health care services from the Indian Health Service.
NEW ADMINISTRATIVE ENFORCEMENT
ACTIONS – UPDATED:
v False and Fraudulent Claims - none
v Kickback and Physician Self-Referral - none
v Patient Dumping - none
v Managed Care - none
v Select Agents and Toxins - none
v Overcharging Beneficiaries - none
v Managed Care – none
UPDATED CORPORATE INTEGRITY AGREEMENTS (CIAS),
CERTIFICATION OF COMPLIANCE AGREEMENTS (CCAS) AND SETTLEMENT AGREEMENTS WITH INTEGRITY PROVISIONS
EXCLUSIONS AND REINSTATEMENTS FOR THE MONTH OF JANUARY 2007
