Published: 2009-12-05 15:49:53
Author: Cheryl Clark | HealthLeaders Media | December 4, 2009
The Office of Inspector General announced Thursday that it saved $20.97 billion for fiscal year 2009 and highlighted six of the cases that led to those recoveries or savings.
"We continue to make significant progress in our fight against fraud, waste, and abuse in [Health and Human Services] programs, particularly Medicaid and Medicare," said Inspector General Daniel R. Levinson. "We're doing this by leveraging our audit, legal, evaluation, and investigative tools, as well as employing the latest in data analysis technology."
The $20.97 billion includes $16.48 billion in implemented recommendationsfor how to put funds to better use, $4 billion in "investigative receivables," and $492 million in audit receivables. Successful cases concluded during the latest six-month period ending Sept. 30 are outlined in a 101-page semi-annual report.
Among the successful cases are:
1. Medicare Fraud Strike Force. Operations by this team lead to sentencing of seven Miami-area residents in a Medicare infusion fraud scheme. They were ordered to pay $19.8 million in restitution and were sentenced to prison terms between 37 and 97 months.
The individuals admitted in their guilty pleas to "manipulating patients' blood samples to generate false medical records, ordering and administering medications to treat conditions that were falsely documented with fraudulent test results, and billing Medicare for services that were medically unnecessary or never provided," according to OIG.
The strike force's investigations, the OIG said, resulted in the filing of charges against 138 individuals or entities, which led to 44 convictions and $40.7 million in investigative receivables.
2. State and local pandemic influenza preparedness. This case involved two reviews.
In the first, the OIG found that although the majority of localities had started planning to distribute and dispense vaccines and antiviral drugs, more needed to be done. "In their preparedness plans, selected localities had not addressed most of the vaccine and antiviral drug distribution and dispensing preparedness items," the OIG found.