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Brought to you by the Council of the Inspectors General on Integrity and Efficiency
Federal Reports
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Agency Reviewed / Investigated
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Type
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Office of Personnel Management
Audit of EmblemHealth Dental’s 2024 Premium Rate Proposal for the Federal Employees Dental and Vision Insurance Program
David Pugliese, a resident of Palm Beach County, Florida, pleaded guilty on July 28, 2023, in U.S. District Court, Southern District of Florida, to Conspiracy to Commit Health Care Fraud. Pugliese was the manager and registered agent of Capital Advantage Diagnostics, LLC, which was purportedly in the business of performing a variety of laboratory tests for various health care providers.Our investigation found that Pugliese and others submitted false and fraudulent claims to Medicare and Amtrak’s insurance providers for claims that were not medically necessary or for laboratory tests that were never performed. Pugliese solicited beneficiary information and specimens for testing through the use of individual laboratory representatives and paid bribes to these representatives for specimens they provided. As a result of the scheme, Amtrak’s insurance providers were fraudulently billed approximately $315,474. Pugliese will be sentenced at a future date.
Coast Guard instituted controls for P.L. 85-804 extraordinary relief. Specifically, Coast Guard hired a senior review team for an independent status review of the Offshore Patrol Cutter (OPC) program and commissioned independent reviews of the contractor’s business systems. After receiving the contractor’s request for extraordinary relief, Coast Guard created P.L. 85-804 review and re-compete teams to review the contractor’s cost and schedule relief request. In addition, to cover the operational gaps while the contractor built the OPCs, Coast Guard created a service program to extend the useful life of its 270-foot Medium Endurance Cutters.