Federal Reports

An Amtrak Customer Service Representative in Salinas, California, was terminated from employment on April 5, 2019, following an administrative hearing for violating company policies. Our investigation found that the Customer Service Representative manually adjusted ticket prices for the benefit and financial gain of family members and then lied to his supervisor when questioned about it.

John Mckoy pleaded guilty in U.S. District Court, Eastern District of Pennsylvania, on June 14, 2019, to multiple health care fraud charges related to involvement in a scheme to defraud a health care benefit plan, which provided coverage to Amtrak employees and their dependents. McKoy was the owner and operator of several neighborhood health care facilities, including Mt. Pleasant Medical Management, Inc. and Harris Medical Management, Inc. Between November 2004 and October 2007, McKoy submitted, and caused to be submitted, hundreds of false and fraudulent claims to United Health Care Corporation totaling more than $321,000 for services purportedly rendered to predominately Amtrak patients who were never seen or treated for those services. McKoy’s fraud caused Amtrak a loss of approximately $291,000.This joint investigation was conducted with the U.S. Postal Inspection Service, Department of Labor OIG and the Federal Bureau of Investigation.

A previous OIG report found that, in 2009 and 2010, Delaware did not comply with Federal requirements to report all Medicaid overpayment collections. The report had five recommendations that were still unimplemented as of June 30, 2017.Our objective was to determine whether Delaware implemented recommendations from our previous review and is in compliance with Federal requirements for reporting Medicaid overpayments.

This report fulfills for 2019 the annual reporting mandate from the Patient Protection and Affordable Care Act (ACA). The ACA requires OIG to conduct a study of the extent to which formularies used by Medicare Part D plans include drugs commonly used by full benefit dual eligible individuals (i.e., individuals who are eligible for both Medicare and full Medicaid benefits). These individuals generally get drug coverage through Medicare Part D. Pursuant to the ACA, OIG must annually issue a report with recommendations as appropriate. This is the ninth report that OIG has produced to meet this mandate.

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