MEDI-CAL SCAMS: Ongoing Probe Turns Up Abuses
An ongoing three-year investigation launched by state and federal agencies into Medi-Cal fraud has turned up "outrageous abuses" that run as high as $1 billion a year, the Sacramento Bee reports. "It's an extraordinarily frustrating and aggravating situation of fraud here in California," said state Controller Kathleen Connell, whose office teamed with the FBI, the U.S. attorney's offices in Los Angeles and San Francisco and the state attorney general's office to form the Medi-Cal task force. Turning up "[l]oopholes in the law ... big enough to allow the theft of millions by just one firm over a few months," the investigators are honing in on abuses such as scams that offer patients free tennis shoes for unnecessary treatments or storefront medical supply firms. The task force has already turned up 12 indictments for fraud, $4 million in seized money and property, and the intervention is estimated to have saved $100 million before fraudulent billings were filed. Connell's task force audited 200 Medi-Cal providers and "uncovered $350 million in fraud and referred 70% of the audited cases for criminal prosecution." But state officials warn that even as the task force and the department crack down, there "are probably more cheaters that haven't been caught, and fraud has become more complex." For instance, some doctors were found to be using a Medi-Cal managed care exemption for complicated patients to run up charges under fee-for-service Medi-Cal (Teichert, 5/24).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.