Los Angeles Times Examines Health Care Fraud in California
The Los Angeles Times last week examined Medi-Cal fraud, a problem that has cost the program "huge sums" in the past few years despite increased state and federal campaigns to address the problem. Some experts estimate that fraud accounts for about 10% of overall health care expenditures, or about $2.5 billion per year in Medi-Cal costs. Individuals who defraud Medi-Cal often target urban areas of Southern California, which has large numbers of low-income residents and many immigrant communities that are "particularly vulnerable to fraud," the Times reports. Some Medi-Cal fraud cases include:
- Individuals who take the identities and billing numbers of health care providers and use the information to submit fraudulent bills to Medi-Cal and collect millions of dollars;
- Individuals who sell lists of Medi-Cal beneficiary names and identification numbers to health care providers who use the information to submit fraudulent bills to Medi-Cal; and
- Individuals who sell blood from homeless individuals and others to laboratories that bill Medi-Cal for expensive blood tests never approved by physicians or conducted by the labs.
As part of a "crackdown" on health care fraud, the state forced 1,400 medical suppliers to reenroll in Medi-Cal, a move that prompted many fraudulent suppliers to leave the program, the Times reports. The state also visits providers who apply to participate in Medi-Cal and in 2001 imposed a moratorium on new lab applicants. In the past few years, state and federal authorities have filed criminal charges against about 700 individuals and companies accused of Medi-Cal fraud. The Office of the Attorney General and the U.S. attorney's office in Sacramento have won about $100 million in restitution in health care fraud cases, and state health officials estimate that their civil enforcement actions have saved hundreds of millions in additional funds. Collin Wong, executive director of the Bureau of Medi-Cal Fraud in the Office of the Attorney General, said that the state must reduce access to the identities and billing numbers of providers, raise Medi-Cal reimbursement rates to attract "legitimate providers" to the program, "vigorously" monitor Medi-Cal reimbursements and prosecute individuals who defraud the program, the Times reports. "The entrepreneurial spirit of those who commit this kind of fraud is as creative as it is insatiable. If one area of criminal activity is closed to them, they'll migrate to another," Wong said (Reiterman/Ellis, Los Angeles Times, 12/26/02).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.