MEDI-CAL: Officials Intensify Fraud War With Search for Phony Clinics
The California Department of Health this week stepped up its ongoing efforts against Medi-Cal fraud, beginning a "door-to-door" inspection of thousands of physician clinics in the Los Angeles area in search of phony operations. In the first hours of action, one team uncovered that three of the four Hollywood Boulevard clinics it examined may have been fraudulent. This latest attempt to root out fraud in the state's medical poverty program continues a federal and state investigation that has uncovered an estimated $1 billion in fraudulent Medi-Cal billings by medical suppliers, laboratories and dental clinics, the Los Angeles Times reports. Investigators are searching for bogus clinics and doctors' offices that bill the program for services never performed, or that provide patients' Medi-Cal numbers to laboratories that then submit fraudulent claims for tests. Many such clinics lack even a business license or a physician on the premises, a health department official said. Investigators estimate that about 10% of all clinics are fraudulent; those found engaging in fraud face possible sanctions ranging from withholding of Medi-Cal payments to criminal prosecution. The state Department of Health started these investigations because they were "[s]haken by the ease with which a local television station was able to find and film clinics falsifying bills to the medical poverty program" (Ellis, Los Angeles Times/Contra Costa Times, 3/9).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.