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OIG updates Congress on fraud efforts

OIG updates Congress on fraud efforts Plus: It denies docs safe harbor to provide CPAP

WASHINGTON - The Office of Inspector General (OIG) expects to recover $6.9 billion and exclude 3,131 individuals and entities from participating in federal healthcare programs in fiscal year 2012, according to its Semiannual Report to Congress published Nov. 27.

Of the OIG's recoveries, $924 million were audit receivables and $6 billion were investigative receivables. Of the exclusions, 778 were criminal actions against individuals or entities that engaged in crimes against Health and Human Services (HHS) programs and 367 were civil actions.

In the report, the OIG highlights numerous activities, including:

. A nationwide takedown by the Medicare Fraud Strike Force in May that spanned seven cities and resulted in charges against 107 doctors, nurses and other licensed medical professionals for schemes involving about $452 million in false billing.

. A Medicare scheme in Georgia that resulted in a 12-year sentence for Arthur Manasarian, the operator of Brunswick Medical Supply. Manasarian, who stole the identities of hundreds of Medicare beneficiaries and physicians from multiple states and submitted claims for DME that was never provided, has also been ordered to pay more than $1.8 million in restitution and has been excluded for 20 years.

The OIG also cited previous reports on obstacles to Medicare's collection of identified overpayments and CMS's oversight of ZPIC-related conflicts of interests.

[See also: OIG: CMS not using surety bonds as fraud tools]

[See also: OIG: Conflict of interest among potential ZPICs]

Additionally, the OIG responded to a proposal that it adopt a new safe harbor protecting “remuneration associated with the distribution of DME by physicians for use in the treatment of obstructive sleep apnea and a corresponding waiver of the application of the physician self-referral law.”

The OIG stated: “The arrangements described are subject to abuse and should be evaluated on a case-by-case basis, such as under the advisory opinion process. Development of a physician self-referral law regulatory exception or waiver is beyond OIG's scope of authority.”

[See also: Are docs trying to creep into CPAP biz?]

[See also: 'I know DME providers are not excited about this model']


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