MEDI-CAL FRAUD: Connell Brings Proposal to Congress
California Controller Kathleen Connell will appear before Congress to protest a 1999 U.S. District Court ruling that limits her ability to fight fraud against the Medi-Cal program, the Los Angeles Times reports. Previously, Connell's office could freeze Medi-Cal payments to people who make fraudulent claims. But the District Court ruled that the Controller's office lacked the authority to unilaterally freeze payments since the Department of Health Services was the lone agency responsible for the Medi-Cal program. Connell now must send all audits to DHS, which decides if there has been fraud and whether the case should be referred for prosecution. Connell, who said her office's fraud-busting efforts have saved the state more than $547 million, contends that the ruling has caused "months-long delays" in processing cases and that her office "cannot be effective and operate with one arm tied behind [its] back."
Connell will take her complaint to the House Commerce Committee's oversight subcommittee where she has "strong support" from Rep. Christopher Cox (R-Newport Beach). Cox said, "We can make it plain that when it comes to fraud, the state office normally in charge of auditing can exercise authority" over the Medi-Cal program. He added that there are "plenty of bills to which Connell's request can be attached for possible passage this year." But a spokesman for Commerce Committee Chair Thomas Bliley (R-Va.) indicated that action is unlikely this year as relatively little time exists before Congress adjourns. Alan Cates, the head fraud-hunter at DHS, disagrees with Connell's request, saying that DHS is not only doing a good job, but the "rest of the nation is looking at us with great interest." Cates contends that his unit, which has been aided by federal authorities in obtaining 70 convictions, should play the main role in fraud detection, since they focus solely on fraud (Rosenblatt, 7/18).