An audit completed by the Department of Health and Human Services’ Office of Inspector General (OIG) has uncovered that a number of pharmacies and other healthcare providers are illegally using Medicare beneficiaries’ data.
Full Answer
How does OIG protect Medicare beneficiaries from hospice abuse?
Some Medicare beneficiaries were seriously harmed when hospices provided poor care or failed to take action in cases of abuse. OIG made several recommendations in both reports to strengthen safeguards to protect Medicare hospice beneficiaries from harm and to ensure hospices are held accountable for deficiencies in their programs.
What does OIG stand for?
Meanwhile, also in July, the HHS Office of Inspector General (OIG) released findings from a Medicare audit of a San Mateo, California-based home health and hospice provider.
What is the DOJ’s case against Home Health Executives all about?
In a July 2 announcement, DOJ alleged that, from April 2016 until March 2017, the home health execs were involved in a scheme to defraud Origin Bank, Peoples Bank and Louisiana National Bank (LNB) by fraudulently obtaining money and credits from the institutions.
What is the Medicare fraud strike force?
Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 federal districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion.
What are some of the ways providers abuse Medicare?
Some examples include: A provider that bills Medicare for services or supplies they never gave you, like charging you for a visit you never had, or a back brace you never got. A provider that charges Medicare twice for a service or item that you only got once.
What is the key law that makes it illegal to submit a falsified bill to Medicare?
False Claims Act [31 U.S.C. The civil FCA protects the Government from being overcharged or sold shoddy goods or services. It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.
Which of the following are potential penalties for physicians and other healthcare providers who violate the False Claims Act?
Financial penalties to the person or organization includes recovery of three times the amount of the false claim(s), plus an additional penalty of $5,500.00 to $11,000.00 per claim. Violation of the MMFCA constitutes a felony punishable by imprisonment, or a fine of $50,000 or less, or both, for each violation.
What are examples of penalties that a healthcare provider could be subject to under the False Claims Act?
Health care providers and their employees can be subject to civil monetary penalties of $5,500 to $11,000 for EACH false claim submitted. They can be required to pay three times the amount of damages sustained by the United States government, and they may also be excluded from participation in Medicare and Medicaid.
What is the OIG?
The OIG is the “premier” law enforcement agency for investigating health care fraud. Its primary mission is to protect beneficiaries and federal health programs, including Medicare and Medicaid, TRICARE, and the VA. To accomplish this, the OIG works closely with various law enforcement agencies at both the state and federal level ...
What are the outcomes of the OIG?
Though there are varying types of outcomes imposed by the OIG and other federal agencies, the most general include: Dismissals / no criminal or civil liability; No criminal liability, but civil settlements over civil monetary penalties and recoupment;
What is the formal aspect of OIG?
The more formal aspects of OIG investigations are those in which the OIG takes steps to request more information. These fact-finding missions are conducted with a great deal of precision and a tremendous amount of foresight – OIG agents know what they’re looking for, and they know how to get it.
What is the purpose of keeping investigations civil?
Keep investigations civil, meaning no criminal investigations or charges; Maintain confidentiality and protect clients from reputational harm; Engage in early intervention strategies, good faith efforts, and other channels of communication to secure resolutions as early as possible; and.
Does a subpoena indicate a health care fraud case?
That’s because early contact from the OIG, whether through a subpoena or less-formal means of information gathering, does not necessarily indicate whether a health care fraud case will be civil or criminal. While the underlying facts do play a role in that, so do the steps you take when making a response plan.
Is an OIG investigation good or bad?
Though overly simplified, the outcome of an OIG investigation can generally be good (meaning you’ll still have a future in health care) or very bad (meaning criminal convictions).
How many strike forces are there in Medicare?
The Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 federal districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion.
Who owned a sham pharmacy in New York?
Peter Khaim, 41, and Arkadiy Khaimov, 38, both of Forest Hills, New York, who owned and controlled several New York pharmacies and sham pharmacy wholesaling companies, were charged in a superseding indictment for their participation in an alleged $45 million health care fraud, wire fraud, and money laundering scheme.
What is the OIG report?
First, on May 11, the OIG released a report on “care and oversight deficiencies” around numerous homicides at a medical center in Clarksburg, West Virginia.
Who complained about Dr. Patel?
Hoffman and her nursing colleagues complained about Patel. But their concerns went unheeded and their professional futures were jeopardized. Desperate, Hoffman contacted a journalist who Googled Patel. According to the book, the reporter found that “his problematic history dated all the way back to 1981.
How many patients did Reta Mays kill?
The OIG investigated the actions of a nursing assistant, Reta Mays, who allegedly killed seven patients by deliberately administering them insulin. According to the report, Mays said, “she administered insulin to patients she believed were suffering so that they could pass ’gently,’ and because she had a lot of stress and chaos in her personal ...
Is serial murder a patient safety orphan?
Yorker,, Professor Emerita of Nursing and Criminal Justice & Criminalistics at Cal State University, Los Angeles, bluntly state that serial murder in healthcare is a “patient safety orphan.”. In their study of this phenomenon, Kizer and Yorker found that serial murders have been reported in 21 countries ...
How much is the HMA penalty?
Under the terms of the NPA, HMA will pay a $35 million monetary penalty. Under the terms of the NPA, HMA and CHS, the current parent company, agreed to cooperate with the investigation, report allegations or evidence of violations of Federal health care offenses, and ensure that their compliance and ethics program satisfies the requirements ...
Is Carlisle HMA guilty of fraud?
In addition, an HMA subsidiary, Carlisle HMA, LLC, formerly doing business as Carlisle Regional Medical Center, has agreed to plead guilty to one count of conspiracy to commit health care fraud. The plea agreement remains subject to acceptance by the court.
What Is The OIG?
- The HHS-OIG is the “premier” law enforcement agency for investigating health care fraud. Its primary mission is to protect beneficiaries and federal health programs, including Medicare and Medicaid, TRICARE, and the VA. To accomplish this, the OIG works closely with various law enforcement agencies at both the state and federal level (including the...
How OIG Investigations Begin
- OIG Investigations can begin to take form following a number of “red flags” and enforcement efforts involving various agencies. The most common ways they begin include: 1. Audits in which analysts identify unusual patterns or billing practices (i.e. double billing, up-coding, unbundling, billing for services not rendered, etc.); 2. Qui-tam lawsuits initiated by whistleblowers with insid…
OIG Requests For Information
- The more formal aspects of OIG investigations are those in which the OIG takes steps to request more information. These fact-finding missions are conducted with a great deal of precision and a tremendous amount of foresight – OIG agents know what they’re looking for, and they know how to get it. Without an experienced health care fraud attorney by your side, even if you believe you’r…
Responding to An OIG Investigation: Strategies
- It is an unfortunate fact that providers and suppliers who go without legal representation often end up ensnared in criminal cases involving health care fraud allegations. One of the most important things you can do upon any notification that you’re under investigation, or might be, is to speak immediately with an attorney knowledgeable in health care laws and fraud defense. The i…
The Outcome of An OIG Investigation
- Though overly simplified, the outcome of an OIG investigation can generally be good (meaning you’ll still have a future in health care) or very bad (meaning criminal convictions). From full case dismissals to prison sentences, the resolution of any health care fraud investigation will always depend on the underlying issues and allegations, and the steps you take in response. Though th…