ORANGE COUNTY: DOJ Investigates Health Care Agency for Possible Billing Fraud
The Department of Justice has been investigating the Orange County Health Care Agency since March, looking into possible fraudulent Medicare billings for mental health programs, the Los Angeles Times reports. Agency Director Michael Schumacher said, "It is about billing practices that have to do with the Medicare charges that were being billed under behavioral health." According to Orange County Supervisor Cynthia Coad, the "problem appears to involve" errors in computer billing codes, where county officials submitted payments using codes for services that did not match Medicare codes. Coad said, "It is serious ... (But) what the doctors were billing was legitimate. It sure could have been caught earlier." In the last two months, federal investigators have questioned current and former employees, and auditors have visited the agency's offices several times in the last six weeks (Warren, 5/2). Tom Uram, who was the agency's director from 1985-1998, said that investigators are looking at billings from the years 1994-1996 (Reed, Orange County Register, 5/2). Ventura County underwent a similar investigation last year, after investigators alleged that the county had submitted Medicare claims with doctors' names, instead of the social workers, psychologists and nurses who actually provided the service, allowing the county to collect a higher reimbursement rate. Last August, the county agreed to repay $15.3 million in Medicare payments. Orange County's situation "is likely to be much smaller," as Orange County does not operate its own hospital, and direct Medicare billings by the county for mental health services are much lower (Los Angeles Times, 5/2).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.