Medi-Cal Clinics Recruit Long-Term Care Patients To Boost Billings

Some rehabilitation clinics that receive funding from the Drug Medi-Cal Treatment Program have been using money and other incentives to recruit board-and-care residents in order to bill the program for more services, the Center for Investigative Reporting reports.

Medi-Cal is California's Medicaid program (Evans/Jewett, Center for Investigative Reporting, 12/10).

Background

In July, an investigation by CIR and CNN found that $94 million has been awarded over the past two years through the Drug Medi-Cal program to 56 clinics in Southern California that have engaged in fraudulent activities.

The $94 million represents half of all public funding for the Drug Medi-Cal program (California Healthline, 11/25).

The investigation prompted state and local officials to launch their own probes, resulting in the suspension of Medi-Cal payments to 177 clinics.

Details of Recent Investigation

Some clinics have begun recruiting board-and-care residents who previously visited clinics that now are closed or suspended from the Drug Medi-Cal program, according to more recent CIR report.

The report was based on:

• A review of government records; and
• Interviews with former clinic employees.

CIR reports that the demand for clients who qualify for the Drug Medi-Cal program has "created a competitive market in which clinics bribe residents to attend counseling and pay kickbacks to home operators."

CIR compiled a partial list of 21 clinics that have engaged in such practices. Those clinics received $25 million collectively from the Drug Medi-Cal program during the last fiscal year. Many of the clinics had previously been cited for signs of fraud or questionable billing practices, according to CIR.

Some clinics have been billing the program for patients who:

• Do not meet requirements because they have not been diagnosed with an addiction within the past 12 months; and
• Did not actually attend counseling sessions.

Jeffery Wilkins, past president of the California Society of Addiction Medicine, said such individuals "don't need those very important Medi-Cal dollars, which should be (available) to people who are really trapped by drugs."

State's Reaction

In a statement to CIR, the California Department of Health Care Services said it is "concerned about allegations of providers targeting board-and-care clients."

The statement said the department is "working on numerous levels to ensure that (Drug Medi-Cal) services are provided only to those who qualify for treatment" (Center for Investigative Reporting, 12/10).