Los Angeles Times Examines Medi-Cal Fraud for Adult Incontinence Products

The Los Angeles Times on Tuesday examined how fraud related to Medi-Cal coverage of adult incontinence products "helps to illustrate why controlling spending for health care remains such a challenge." According to the Times, state health officials contend that "they have worked long and hard over the years to stamp out the fraud without unduly restricting access to incontinence products that give patients comfort, security and skin protection -- or unduly hurting honest providers." Medi-Cal has paid more than $1.4 billion for adult incontinence supplies since mid-1986. In the early 1990s, Medi-Cal officials instituted a $165-per-month limit on the cost of incontinence products for each beneficiary to stop providers from overcharging the program for such products. However, it was an "open secret" among providers that Medi-Cal's computer system had "a gaping flaw" that allowed multiple providers to charge the monthly limit for the same beneficiary, the Times reports. Medi-Cal officials did not complete corrections to address the problem until February 2003 because they said that they did not want "to put honest retailers at too much financial risk" if another retailer claimed the reimbursement for the beneficiary, according to the Times. Stan Rosenstein, deputy director for medical care services for the Department of Health Services, said, "We do put providers at risk now ... to prevent fraud," adding, "We decided that honest providers could come back and get it approved after a denial." However, people in the medical supply industry say that businesses are now overcharging Medi-Cal for other supplies (Reiterman, Los Angeles Times, 3/23).