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2008 Health Care Fraud Report

2008 Health Care Fraud Report

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Published by Mike DeWine
The following is a summary of cases investigated by the Ohio Medicaid Fraud Control Unit during recertification year July 1, 2007 to June 30, 2008.
The following is a summary of cases investigated by the Ohio Medicaid Fraud Control Unit during recertification year July 1, 2007 to June 30, 2008.

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Published by: Mike DeWine on Jul 01, 2009
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02/04/2013

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OHIO MEDICAID FRAUDCONTROL UNIT
 John A. Guthrie, Director 
FY 2008 Annual Report
Health Care Fraud
150 E. Gay St., 17
th
FloorColumbus, OH 43215www.ag.state.oh.us
 
 
Ohio Medicaid Fraud Control Unit 2008 Annual Report Page 2 of 38
Table of Contents
Page
Unit Performance
………………………………………………………………………... 3
Investigations
……………………………………………………………….………….… 4Unit Totals……………………………………………………………….…….….. 4Summary By Case Type……………………………………………………….… 4Summary By Provider Type………………………………………………….…. 5Prosecutions……………………………………………………………….……… 6Civil Settlements………………………………………………………….……23
Case Management System
………………………………………..……….....………... 34
Training 
……………………………………………………………………….………….. 35Professional Development…………………………………………….……….... 35New Agent Training………………………………………………….…...…….. 36Training Projections…………………………………………………….……...... 36
The National Association of Medicaid Fraud Control Units
……………..……….. 37
Ohio MFCU Staff
…………………………………………………………...….….…….. 37
Certification of Drug-Free Workplace
……………………………...………………… 37
Attachment A
: Special Agent Core Training Curriculum
Attachment B
: Inventory of training courses completed
Attachment C
: New Agent Training Curriculum
Attachment D
: Staff Roster
 
Ohio Medicaid Fraud Control Unit 2008 Annual Report Page 3 of 38
Unit Performance
The Ohio Medicaid Fraud Control Unit (OMFCU) continues to aggressivelypursue its investigative responsibilities with respect to criminal and civil offensesagainst the Medicaid program and persons residing in the institutions served by it. Itswell-trained and experienced staff continues to have much success in this regard. As aunit, the OMFCU stands as a significant deterrent to those who would defraud the OhioMedicaid Program or abuse its recipients.During the period July 1, 2007 to June 30, 2008, the OMFCU received six hundredeighty-six (686) complaints of Medicaid fraud and patient abuse or neglect. Of these,four hundred (400) related to allegations of Medicaid fraud and two hundred eighty-six(286) related to allegations of abuse or neglect in Ohio care facilities. The OMFCUopened five hundred forty-nine (549) of these complaints for active investigation, threehundred fifteen (315) relating to Medicaid fraud and two hundred thirty-four (234)relating to patient abuse or neglect. During this period, the OMFCU completed fivehundred eighteen (518) investigations. Of those, two hundred eighty-three (283) relatedto fraud allegations and two hundred thirty-five (235) related to allegations of patientabuse or neglect.During the period July 1, 2007 to June 30, 2008, the OMFCU obtained eighty-seven(87) indictments, bills of information, or complaints. Of these, seventy-six (76)pertained to fraud against the Ohio Medicaid program and eleven (11) involved chargesof patient abuse and neglect in Ohio care facilities. During this same period, theOMFCU obtained convictions against seventy-eight (78) persons and business entities.Of these convictions, sixty-three (63) were in cases involving fraud against the OhioMedicaid Program and fifteen (15) were in cases involving patient abuse or neglect.The OMFCU also completed fifty-two (52) civil settlements during its recertificationperiod. The total value of these criminal restitution orders and civil settlements was$53,908,473.16.The OMFCU has continued to provide information to various groups of healthcare providers, law enforcement agencies, Medicaid advocates, and others around thestate in the form of speeches and workshops. These efforts have proved valuable to theOMFCU, both in terms of the quality of complaints concerning Medicaid fraud andpatient abuse/neglect, and in terms of the timeliness of such complaints. They alsohave served the important function of informing Medicaid providers and caregivers ofthe serious criminal consequences that can result from the mistreatment of thosepersons entrusted to their care, or the submission of fraudulent claims to the OhioMedicaid program.

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