Medicare Compliance & Reimbursement

HHS watchdog sniffs out 258 criminal actions in the first half of FY 2005.

Providers, watch out: This year's recoveries prove that the HHS Office of Inspector General is getting better at catching providers and suppliers who intend to defraud Medicare.

The OIG's semiannual report to Congress for the first half of fiscal year 2005, released June 13, revealed $15.6 billion in implemented recommendations and other actions.

The OIG netted $266 million in audit receivables and $1.1 billion in investigative receivables, the report says. This all totaled nearly $17 billion in reported savings and anticipated recoveries, just for the first half of FY 2005. OIG Hits Century Mark In Civil Actions The OIG excluded 1,695 individuals and entities for fraud or abuse and pursued 258 criminal actions against individuals or entities who committed crimes against the programs.

The OIG also pursued 105 civil actions, including False Claims Act cases, unjust enrichment lawsuits, civil monetary penalties law settlements and other administrative recoveries from provider self-disclosure instances, the report notes. Big Busts Include Gambro, Schering-Plough Some of the larger fraud recoveries during this reporting period included Gambro Healthcare, Inc.'s $350 million penalties and fines for allegedly defrauding Medicaid, Medicare and TRICARE, and Schering-Plough Corporation's $345.5 million settlement for purportedly illegally pricing its drug Claritin and paying kickbacks to keep Claritin on an HMO's formulary.

 To read the OIG's report, go to http://www.oig.hhs.gov/publications/docs/semiannual/2005/SemiannualSpring05.pdf.