MEDI-CAL: Fraud Buster Is a Determined Investigator
The man who once sold extra food stamps for cash and traded his Medi-Cal stickers for an air conditioner, now uncovers Medi-Cal scams as the Gov. Gray Davis-appointed head of the new antifraud unit within the Department of Health Services. J. Alan Cates said his own scam wasn't major, but it taught him "how people approach Medi-Cal and welfare recipients." He added, "Fraudsters are like magicians. It's a game trying to expose them. It's fun. But sometimes they hurt people. That's why I take them out." The San Diego Union- Tribune reports that Cates began working as an auditor under Gov. Jerry Brown and then moved on to working under then Controller Davis, where he revealed a scam involving fake medical suppliers who billed Medi-Cal for adult diapers. During that case, Cates devised a new plan, convincing Davis to stop payment to the companies instead of paying the bills for years while the investigation proceeded, as had been done in the past. Cates also came up with a faster audit, one that focused on fraud instead of compliance with all state regulations. But Cates' involvement in cases where he helped the FBI secure 78 indictments involving about $38 million, drew him the ire of now Controller Kathleen Connell. Frustrated by the state Department of Justice's failure to prosecute the cases he investigated, Cates turned to the FBI, which opened an investigation of its own and secured an indictment. John Chen, acting chief of the fraud division, wrote Cates a memo in June 1998, informing him that he had gone against procedure by providing unsolicited reports and papers to the U.S. Attorney's Office. In July, Cates received his new job from Davis. And Cates has done all this while having polio. Jim Ferguson, Cates' supervisor through much of his work for the state said, "His polio has never stopped him from doing everything he wants to do. You have to admire his gumption and courage. He's a determined individual." FBI Special Agent James Wedick, who has worked with Cates, called him a "very conscientious auditor who has a passion for uncovering fraud" (Ainsworth, 1/4).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.