MEDI-CAL: Despite Prosecutions, Fraud Continues
Despite more than 200 arrests and several high profile prosecutions, the number of Medi-Cal fraud cases continues unabated, the Los Angeles Times reports. "I don't see it slowing down yet. The fraudsters are out there continually retooling and designing new schemes to try and thwart our efforts," James Wedick, head of the FBI's corruption squad in Sacramento, said. In 1998, the FBI began an investigation that led to charges against 108 people and 63 convictions. Gov. Gray Davis (D) has expanded the state's antifraud efforts and has proposed adding $4 million to the state attorney general's office to hire more investigators and lawyers to fight against Medi-Cal fraud. The governor also has thrown his support behind a measure which establishes stricter guidelines for billing procedures and brings state health care fraud crimes in line with federal statutes. The bill would empower the attorney general to convene a state grand jury to review Medi-Cal abuse cases and would increase sentences for fraud convictions. But even as lawmakers increase their efforts against Medi-Cal fraud, criminals are finding new ways to submit false claims to the state program. J. Alan Cates, head of Davis' Medi-Cal Fraud Prevention Bureau, said that as officials cracked down on fraudulent medical supply shops, the same areas "now appear to be inundated with equally suspect pharmacies," which can also sell medical supplies. State officials cite other areas of the Medi-Cal program where fraud may be more prevalent than previously suspected. "We're still finding a lot of problems with unsubstantiated claims," Tom Marshall, a spokesman for State Controller Kathleen Connell, said (Tamaki, 5/30).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.