OIG dog and pony show

WASHINGTON - Buoyed by the Medicare Fraud Strike Force, the Office of Inspector General (OIG) told Congress in its semiannual report last week that it expected recoveries of about $3.4 billion for the first half of fiscal year 2011.

Strike Force efforts, alone, resulted in the filing of charges against 213 individuals or entities, 107 convictions and $63.9 million in investigative receivables, according to the report.

"Our partnership with other law enforcement entities as part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) continues to produce significant results, particularly in its Strike Force actions," wrote Inspector General Daniel Levinson. "This past February, Strike Force teams engaged in an unprecedented health care fraud takedown. Teams across the country arrested more than 100 defendants in 9 cities for their alleged participation in Medicare fraud schemes involving more than $225 million in false billing."

One of the listed highlights in the report: Investigations into claims for home blood-glucose tests strips and lancets. The OIG estimated that about $169.7 million could have been saved in calendar year 2007 had tools been in place at the Medicare administrative contractors to review claims that exceed utilization guidelines.

Other mentions of durable medical equipment in the report include:

* Oliver Nkuku, a manager for K.O. Medical, and Callistus Edozie, a delivery employee at K.O. Medical, were sentenced to 120 months and 41 months of incarceration, respectively, and ordered to pay $453,112 and $80,000 in restitution, jointly and severally, for their roles in a DME fraud scheme related to power wheelchairs and other DME that were medically unnecessary and improperly billed as catastrophe-related in connections with Gulf Coast hurricanes.

* Dr. Howard Grant, Obisike Nwankwo, John Lachman, Michael Obasi, Basil Kalu and Darnell Willis were sentenced to anywhere from 21 to 70 months of incarceration for their roles in a DME fraud scheme at Onward Medical Supplies. Restitution was ordered jointly and severally among the defendants in excess of $1.3 million. Evidence presented at the trial showed that from 2003 to 2009, Onward billed Medicare for fraudulent DME, including power wheelchairs and orthotic devices. Under the scheme, Grant ratified prescriptions for medical unnecessary DME, Lachman created fraudulent patient files and paid kickbacks to recruiters, and Nwankwo delivered DME to beneficiaries who had no medical need for the equipment.

Go here to read the whole report.