Fwd: OIG posts 2 reports and news about enforcement actions - 6/6

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From: HHS Office of Inspector General <donotreply@subscriptions.hhs.gov>
Date: Fri, Jun 6, 2014 at 9:03 AM
Subject: OIG posts 2 reports and news about enforcement actions - 6/6
To: iammejtm@gmail.com

Good afternoon from Washington, DC. Today OIG posts 2 reports and news about enforcement actions. As always, you can use the links provided to go directly to the new material.   ------------------------------------------------------------------------------   CMS's Reliance on Illinois Licensure Requirements Could Not Ensure the Quality of Care Provided to Medicaid Hospice Beneficiaries (A-05-12-00028) http://go.usa.gov/8H7j   The Centers for Medicare & Medicaid Services' (CMS) reliance on Illinois licensure requirements could not ensure quality of care and that adequate protection was provided to Medicaid hospice beneficiaries. We determined in most cases that hospices did not meet State hospice licensure requirements related to hospice workers. Of the 120 claims that we sampled, 110 involved direct care provided by unqualified hospice workers. On the basis of these sample results, we estimated that 51,374 of the 56,044 claims covered by our review were associated with unqualified hospice workers.   Of the 110 claims that involved direct care provided by unqualified hospice workers, 93 claims were for room and board only, with Medicare covering the corresponding hospice care service claims. The remaining 17 claims included hospice care services covered by Medicaid. Unqualified hospice workers only affect Medicaid payments for hospice care services, not payments for room and board; therefore, on the basis of our sample results, we estimated that $13.4 million ($8.2 million Federal share) in Medicaid payments for hospice care services included in the claims covered by our review were provided by unqualified hospice workers.   To improve protection provided to Medicaid hospice beneficiaries, we recommended that CMS:   (1) Work with the Illinois Department of Healthcare and Family Services (State agency) and the Illinois Department of Public Health to ensure that hospices meet the State licensure requirements for hospice workers and   (2) Consider working with the State agency to modify the State agency's hospice payment conditions by implementing provisions similar to the State licensure requirements for hospice workers.   CMS concurred with our recommendations.   ------------------------------------------------------------------------------   Average Manufacturer Price Determinations by Selected Drug Manufacturers Generally Were Consistent With Federal Requirements (A-06-13-00014) http://go.usa.gov/8H7V   Under the Medicaid drug rebate program, manufacturers are required to pay rebates in exchange for Medicaid coverage of their drugs. The rebates are based, in part, on average manufacturer prices reported by manufacturers. The methodologies that 20 selected drug manufacturers used to determine average manufacturer prices for drugs reimbursed by Medicaid generally were consistent with Federal requirements.     ------------------------------------------------------------------------------   June 5, 2014; U.S. Attorney; District of New Jersey Board-Certified New Jersey Pediatrician and Internist Sentenced To 20 Months in Prison for Taking Kickbacks http://go.usa.gov/8d3Q   ------------------------------------------------------------------------------   June 5, 2014; U.S. Attorney; Eastern District of Pennsylvania EMT Sentenced For Role in Ambulance Fraud Scheme http://go.usa.gov/8d3Q   ------------------------------------------------------------------------------   June 4, 2014; U.S. Attorney; Eastern District of Texas Nigerian Fugitive Arrested for Health Care Fraud Violations http://go.usa.gov/8d3Q   ------------------------------------------------------------------------------   State Enforcement Actions Updated http://go.usa.gov/8d3e   ------------------------------------------------------------------------------   That's all we have for today. If we can be of any further assistance, please send an Email to public.affairs@oig.hhs.gov   I hope your week has gone well and you are able to enjoy the upcoming weekend.   Marc Wolfson – Office of External Affairs   OIG's privacy policy can be found at http://oig.hhs.gov/notices/privacy-notice.asp Follow us on Twitter: http://twitter.com/OIGatHHS Inquiries? Contact us: Public.Affairs@oig.hhs.gov Manage your OIG subscriptions: update your preferences or unsubscribe Questions about this service? Visit subscriberhelp.govdelivery.com This email was sent to iammejtm@gmail.com using GovDelivery, on behalf of the U.S. Dept. of Health & Human Services · 200 Independence Avenue SW · Washington DC 20201 · 1-877-696-6775

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Jeremy Tobias Matthews