The Office of Inspector General (OIG) of the Department of Health & Human Services has announced that it expects to recover approximately $6.9 billion in fiscal year 2012. Of this amount, $923.8 million is attributable to audit receivables and $6 billion to investigative receivables. OIG also reported that approximately $8.5 billion has been saved as a result of legislative, regulatory or administrative actions which were taken in connection with the agency’s recommendations. These savings generally relate to monies which are made available for better use through reductions in federal spending. In addition to monetary recoveries and/or savings, OIG excluded 3,131 individuals and entities from participating in federal programs during the 2012 fiscal year. 778 criminal actions were reported against individuals or entities that engaged in crimes against Health & Human Services programs. 367 civil actions, including false claims and unjust enrichment lawsuits, civil monetary penalties settlements, and administrative recoveries related to provider self-disclosure matters were also reported.
Other accomplishments made by OIG for fiscal year 2012 include:
– Efforts by the Medicare Fraud Strike Force resulted in charges being filed against 305 individuals or entities, 181 convictions and $151 million in investigative receivables. The strike force activities involve joint operations by federal, state and local law enforcement agencies and are a key component of the Health Care Fraud Prevention and Enforcement Action Team.
– A nationwide takedown occurred on May 2, 2012 involving $452 million in false billings – the largest amount of Medicare false billings in a single takedown. The operation involved more than 200 OIG special agents, forensic examiners and analysts working in 7 cities and resulted in charges against 107 individuals including doctors, nurses, and other licensed medical professionals who were accused of participating in Medicare fraud schemes.
– GlaxoSmithKline agreed to pay $3 billion to resolve violations relating to its marketing and promotion practices involving several drugs. The settlements were related to charges that GlaxoSmithKline had promoted several drugs for off label uses; paid kickbacks for the prescription of certain drugs, made false and misleading statements about the safety of certain drugs and violated the requirements of the Medicaid drug rebate program. In addition to the monetary payment, GlaxoSmithKline entered into a 5 year Corporate Integrity Agreement with OIG. GlaxoSmithKline entered into separate Medicaid related settlements with a number of states.
– A report titled Questionable Billing by Community Mental Health Centers indicated approximately half of community mental health centers met or exceeded thresholds in 2010. This indicated unusually high Medicare billing for at least one of nine questionable billing characteristics related to partial hospitalization programs which are intense, structured outpatient mental health treatment programs. OIG determined that about 90 percent of the facilities with questionable billings were located in states that did not require community mental health centers to be licensed or certified.
– OIG reported in Medicaid New York State Medicaid Fraud Control Unit: 2011 Onsite Review that the New York Medicaid Fraud Control Unit filed criminal charges against more than 400 defendants, obtained more than 400 convictions and was awarded more than $750 million between fiscal years 2008 and 2010. OIG determined that several of the Unit’s practices were worthy of note including its approach to patient abuse and neglect cases, its use of a list of ongoing investigations to avoid conflict among investigating agencies and its use of technology.
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