MediCal scams

Marta Russell ap888 at lafn.org
Thu Dec 30 16:24:54 PST 1999


When Pete Wilson was governor, his tactic to control rising MediCal costs was to cut the budget - and harm the poor needing medical services. Now we find out that some CA government officials had been tipped off during his administration that there were big scammers (not individuals who cheat the system but capitalist business owners) ripping off the state program but no one did nothing about it. The newspapers report that the FBI and Gov. Davis are the ones responsible for bringing this to light now.

The GAO estimates that10% of MediCal monies go to this type of fraud. Seems that whenever public health care budgets are attacked by the right (like Armey and Gramm) as being too large, this would be a good line of defense. A pox on all the pro-business politicians who aren't adequately regulating white collar crime.

Marta


>From the San Francisco Chronicle 12-30:
LA Times Sacramento: Another multi-million dollar Medi-Cal scam based in Southern Callif. has been uncovered, this one involving stolen doctor and patient records, state Attorney General Bill Lockyer announced yesterday. The newest revelations to shake the troubled Calif. medical program for the poor and apparently unrelated to the federal state probe of false billings for medical supplies, which FBI officials estimate may eventually cost taxpayers more than $1 billion when it is finally unraveled. That giant rip-off of the Calif. Medi-Cal system, centered in Armenian immigrant neighborhoods of Los Angeles, is one of the largest frauds against a state in American history, federal investigators said. This time, in a sophisticated scheme that Lockyer's state investigators first suspected in July but are only now beginning to fully grasp, information from medical records is believed to have been stolen from hospital and clinic files. In some cases, hospital and even government employees are suspected of taking bribes to provide patients lists to the fraud ring, investigators said. The information was used to set up phony medical operations of ghost doctors and phantom patients. In one case, the criminals even used a cardboard computer to make an office look real, Lockyer said. Those fake doctors' offices then billed Medi-Cal for services never rendered that Lockyer would only estimate in the "millions of dollars." "It's a continuing investigation," he said. "When you get deeper into it, it appears to get larger and larger." So far, at least 20 doctors' names have been confirmed stolen by what is thought to be a tight-knit crime ring, and l"we've only scratched the surface," said Collin Wong, the new director of Lockyer's Bureau of Medi-Cal Fraud and Elder Abuse. Wong declined to otherwise characterize the ring's members, saying he did not want to harm the investigation. Typically, the attorney general waits to disclose details of

investigations until after it has issued indictments - an action that in this case may still be weeks or even months away. But Wong said the office decided to warn hospitals and doctors yesterday because it has so far been unable to halt the operation completely and did not want to risk losing millions of dollars more. Locyer and Gov. Gray Davis have been pursuing Medi-Cal crimes amid criticism that their predecessors ignored the abuses. State Controller Kathleen Connell's office reported yesterday that her auditors had first uncovered examples of similar schemes iln 1997, but no action was taken until after the new administration too office last January. Much of the fraud has been centered in Southern Calif., Wong said, and another state official confirmed that most of it has occurred in Los Angeles. Wong said there appear to be no links to the earlier fraud revealed in Nov., which involved dozens of fake medical equipment companies stealing Medi-Cal funds by taking payment for crutches, adult diapers and other medications that were never delivered to patients. Calif. receives about $9 billion annually in federal Medicaid money, which is matched in Calilf. by about $9 billion, benefiting 5 million poor and disabled Medi-Cal patients. The U.S. General Accounting Office estimates that nationwide about 10 percnt of that money - $1.8 billion in Calilf. is lost to fraud. S.F. Chronicle 12-30



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