Oig Outlook 2014 - Deputy ig for investigations, gary cantrell

[ Music ] Turning now to our law enforcement efforts, Gary Cantrell is our top cop in health care, leading our Office of Investigations with some 500 special agents across the country. Welcome, Gary. I know that I can't ask you who will be investigated in the year ahead, so just start with a quick look back at what your investigative work accomplished last year. Last year, our investigations resulted in outstanding outcomes. We had a record number of criminal convictions. We had a record number of civil actions, resulting in almost 5 billion dollars in investigative receivables. Well, with fewer resources now, does data-driven enforcement play a bigger role? We continue to use data to operate more efficiently and effectively. First of all, we've used it to allocate our resources in areas where we've seen fraud hotspots. So, this is illustrated by our Medicare Fraud Strike Force, as they're located in nine cities throughout the country. So, we work with our law enforcement partners, basing our operations in fraud hotspots, and we've found that that's been a very effective tool. And we also use data every day in the course of our investigations to shift through these cases, which can be very complex, much more quickly and efficiently. So give us a sense of what kinds of trends you're following. Well, we've seen some major trends, fraud trends, related to prescription drugs. And not only in the area of pain medication abuse, which we've seen over the last several years, but we're also seeing fraud schemes related to just pure financial greed, interest in stealing money from the government: billing for drugs that aren't necessary, that are expensive and never even dispensing them. So, this is both a concern for patient harm, where there's been abuse of these pain medications, and also a financial risk for the government. Well, take us behind closed doors to home health and personal care services. What kinds of schemes are you seeing there? Home-based services are another area where we see a lot of fraud. Unfortunately, many patients are home-bound and they need to have care provided to them in their homes. All too often, services are not being provided. The necessary services are never delivered. And in some cases, it's delivered, but it's not necessary. So, the patients aren't actually home-bound and shouldn't be receiving services in the home. That's done sometimes by paying kickbacks to induce individuals to participate in these schemes. Well, you've touched on patient harm, but we say so much about dollars saved or dollars lost. Talk a little bit more about patient harm. Give us an example. Yeah. Unfortunately, many of our investigations -- it's not just a financial crime. Patients are being put in harm's way. The most egregious example that we've seen in the last year was a radiology tech, working in a hospital to divert drugs for his own abuse, was taking necessary pain medications from the patients, using the syringe, and then it was being re-used to provide saline solution to patients who needed pain medication. All the while, he was infected with Hepatitis C, infecting over 40 patients in multiple states, throughout the country. Twenty of those patients were Medicare patients, and three of them were Medicaid patients. When we identify cases like this where our patients are being put in harm's way, we will pursue these aggressively and take action swiftly. That is a really shocking example. Since the Affordable Care Act is so much in the spotlight, what kinds of concerns do you have on the enforcement side there? Well, we're monitoring for fraud schemes related to the Affordable Care Act. And right now, we're trying to educate consumers to ensure that they're not the victims of these fraud schemes. Identity theft is certainly something we're concerned about and we're watching for. And we will also pursue any allegations of fraud relating to Affordable Care Act or consumer fraud very aggressively. Gary, thanks for sharing some of the trends that you're seeing and what your enforcement priorities look like for 2014. Thank you.