OIG reports $35.4 billion in savings, recoveries

Sunday, December 11, 2005

WASHINGTON - The OIG in early December reported $35.4 billion in healthcare savings and expected recoveries for fiscal year 2005--more than doubling its performance from the previous year.

The OIG excluded 3,806 individuals and entities, including DME providers, from federal healthcare programs for fraud and abuse. The OIG, part of the Department of Health and Human Services, outlined its efforts in its semi-annual report to Congress.

Broken down, the $35.4 billion in savings and recoveries represents $32.6 billion in implemented recommendations to put funds to better use, $1.2 billion in audit receivables and $1.6 billion in investigative receivables.

The OIG's DME-related activities included:

* Pennsylvania: Home Health Corporation of America (HHCA) agreed to pay $300,000 and enter into a five-year integrity agreement to resolve its liability under the CMPL provisions applicable to kickbacks. OIG alleged that from February 1997 through May 1998, HHCA made payments in the form of loans, consulting fees and monthly space rental payments to six physicians located in Pennsylvania and Florida in exchange for their referral of Medicare beneficiaries requiring home health services and/or DME provided by HHCA and paid for by the Medicare program.

* Texas: The owner of a DME company was sentenced to 41 months imprisonment and ordered to pay $2.2 million in restitution for healthcare fraud and money laundering. As part of the scheme, the man paid recruiters for locating Medicare patients and paid physicians for fraudulent CMNs and prescriptions for wheelchairs. Though Medicare was billed for motorized wheelchairs, beneficiaries never received wheelchairs or were provided with less expensive scooters.

* Oregon: A DME supplier and its owner were sentenced for charges related to paying business associates to induce Medicare referrals. The company received reimbursements from Medicare for wheelchairs and accessories, hospital beds and enteral nutrition that were not medically necessary. A $2 million settlement agreement was previously reached, resolving their liability for DME that was allegedly not provided or medically necessary, and for allegedly using CMNs that were false, fraudulently obtained or forged.