OIG Saves American Taxpayer's Money by Cracking down on Fraud

The Office of Inspector General (OIG) of the Department of Health and Human Services continually strives to eliminate fraud, waste, and abuse in HHS programs on every front and follows up on all matters involving fraud, waste and mismanagement in any Health and Human Services programs. In the fiscal year 2004, OIG reported savings to the American taxpayer of almost $30 billion! Fraud and abuse cases OIG investigated and resolved involved the following HHS programs:

Ø Medicare Part-A
Ø Medicare Part-B
Ø Child Support Enforcement
Ø National Institute Of Health
Ø Indian Health Service
Ø Food and Drug Administration
Ø Center for Disease Control
Ø Substance Abuse and Mental Health Services Administration
Ø Health Resources and Services Administration
Ø Aid to Children and Families
Ø All Other HHS agencies or related programs


OIG maintains a hotline which offers a confidential means for reporting fraud and publishes summaries of resolved fraud and abuse cases on their web site throughout the year. The following are a few exples of the types of complaints that OIG investigated and persued:
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In Maine, a registered nurse was sentenced to 18 months in jail with all but 45 days suspended for theft of drugs. While working at a hospital emergency room, the woman stole morphine on at least three occasions.
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In New York, a billing clerk was ordered to pay $2,100 in restitution for health care fraud. The billing clerk systematically upcoded claims. These claims had already been upcoded by nurses who routinely treated patients without any physician involvement, but coded the services as though a physician had rendered them.
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In New York, a physician and his nurse were sentenced for their involvement in a scheme to defraud the Government. The physician was sentenced to three years and 10 months incarceration and ordered to pay $227,000 in restitution. The physician was previously convicted during a jury trial for health care fraud, conspiracy to distribute and dispense controlled substances, illegal distribution and dispensation of controlled substances, and aiding and abetting. The nurse was sentenced to 6 months home confinement for health care fraud and conspiracy to illegally distribute Schedule II controlled substances. The physician submitted claims to Medicare indicating he had treated the patients and performed the service directly, when actually, a nurse treated the patients. To facilitate this scheme, the physician provided presigned prescription pads for her and other nurses to prescribe narcotic drugs to patients.
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In New York, three subjects were sentenced for their roles in a scheme to defraud the Government and private insurers. A podiatrist was sentenced for submitting claims for services that were either upcoded, not rendered, or were medically unnecessary. Also sentenced were two billing clerks who at the direction of the office manager, submitted claims that they knew were fraudulent.
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In New York, after entering a guilty plea, a psychiatrist was sentenced to a conditional discharge for his submission of false filings. The man agreed to repay $502,000 in restitution to Medicare and Medicaid for billing for office consultations and medication dispensing when no consultations actually took place.
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In Indiana a doctor was sentenced to 7 years incarceration, with 3 years suspended, for his scheme involving intimidating Medicaid beneficiaries. The doctor, who was previously found guilty during a 4-day jury trial, intimidated Medicaid recipients by telling them they would lose their benefits if they did not make cash payments.
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In Michigan a dentist was sentenced to 1 year and 1 day incarceration and ordered to pay $743,000 in restitution and fines for mail fraud. The man billed insurers for services not performed and for upcoded dental services.
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In Illinois a doctor and her employee were sentenced for their role in submitting false claims. The doctor was sentenced to 5 months incarceration and ordered to pay $70,000 in restitution; the employee was ordered to pay $7,500 in restitution. Claims submitted were for psychiatric services provided when the doctor was absent from the office and/or were actually provided by the employee, who has never been licensed to practice medicine.
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In Virginia a physician was sentenced to 18 months incarceration and ordered to pay a $10,000 fine and $191,000 in restitution for health care fraud. From approximately January 2000 through October 2003, the physician submitted upcoded claims to Medicare and to a private insurer. In addition, claims submitted reflected comprehensive office visits that did not occur at all, or were for dates of service when the patient was only provided a prescription refill. The investigation began in July 2003 when the private insurer found that the physician’s billings were much higher than the average medical provider in the area. Shortly after the investigation began, a fire occurred at the physician’s medical office, which was determined to be a case of arson. Although a grand jury returned an indictment charging the physician with arson in connection with the fire, the Government dismissed the charge in exchange for his guilty plea to health care fraud.
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In California, a doctor was sentenced for health care fraud and was required to surrender his medical license for billing Medicare and private insurers for diagnostic studies that never occurred. The doctor may not reapply for a 5-year period.



Read more about OIC Criminal Actions!