Efforts by the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) could result in the recovery of some $4 billion in misspent Medicare, Medicaid, and other health and human services funds.
The work is outlined in the Fall 2022 Semiannual Report to Congress, which provides an overview of the watchdog agency’s activities for the reporting period comprising the last half of fiscal year 2022 from April 1 through September 30, 2022.
Of the anticipated $4 billion in savings, more than $1 billion is expected to be returned based on program audit findings, and approximately $3 billion is expected to be returned based on investigative work.
OIG reported 710 criminal enforcement actions against individuals or entities that engaged in crimes that affected HHS programs. The agency also reported 736 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalty settlements, and administrative recoveries related to provider self-disclosure matters. The agency also excluded 2,332 individuals and entities from participating in federal healthcare programs.
Among some of the agency’s efforts:
- OIG identified 1,714 providers out of approximately 742,000 whose billing for telehealth services during the first year of the COVID-19 pandemic posed a high risk to Medicare.
- OIG partnered other agencies on Medicare Fraud Strike Force Teams. Strike Force efforts resulted in the filing of charges against 100 individuals or entities, 98 criminal actions, and more than $248.2 million in investigative receivables.
OIG also outlined some of the cases it resolved including:
COVID – MorseLife Health System Inc. agreed to pay $1.75 million to resolve its potential liability under the False Claims Act for facilitating COVID-19 vaccinations for hundreds of individuals ineligible to participate in the CDC Pharmacy Partnership for Long-Term Care Program, a program specifically designed to vaccinate long-term care facility residents and staff when doses of COVID-19 vaccine were in limited supply at the beginning of the CDC COVID-19 Vaccination Program.
HOME HEALTH – Carter Healthcare agreed to pay $7,175,000 to resolve allegations that it violated the False Claims Act by submitting claims to Medicare for medically unnecessary home health therapy services to Medicare beneficiaries in Florida, and it also agreed to pay $22,948,004 to resolve allegations that it submitted claims to Medicare in violation of the anti-kickback statute by paying physicians remuneration under the guise of medical directorships in order to induce referrals of home health patients in Oklahoma.
HOSPITAL – Providence Health & Services Washington agreed to pay $22,690,458 to resolve allegations that it fraudulently billed Medicare, Medicaid, and other federal healthcare programs for medically unnecessary neurosurgery procedures.
PHARMACIES – Aleah Mohammed was sentenced to 6.5 years in prison for carrying out multiple schemes to defraud health care programs, including obtaining more than $6.5 million from Medicare Part D plans and Medicaid drug plans.
KICKBACKS – Jae Lee, the CEO of Northwest Physicians Laboratory was sentenced to serve 24 months in prison and ordered to pay $7.6 million in restitution for conspiracy to solicit kickbacks from medical testing laboratories in exchange for referring government testing business to the laboratories.
TELEMARKETING – Marc Sporn was sentenced to 14 years in prison for healthcare
and wire fraud resulting in a loss of more than $20 million to Medicare, and for evading
WIRE FRAUD – Marty Johnson was sentenced to 60 months in prison, followed by one year of supervised release, and Keesha Dinkins was sentenced to 24 months in prison, followed by one year of supervised release, in connection with a healthcare fraud and wire fraud scheme. In addition, Marty Johnson and Keesha Dinkins were ordered to jointly pay restitution in the amount of $3.5 million.
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