More resources to fight fraud

first_imgThe FBI seized a $200,000 Rolls-Royce Phantom from one of the suspects. Record restitution One of the most successful anti-fraud programs has been the state Attorney General Office’s Bureau of Medi-Cal Fraud and Elder Abuse. It won a record $274million in court-ordered restitution of money stolen from Medi-Cal, shattering the previous high of $43million. “I believe this is a result of the efforts the bureau has put forward in increasing the number of investigators, special agents, prosecutors and auditors within our bureau,” said Joseph Fendrick, special-agent-in-charge of the bureau. “There has been a concerted effort to aggressively prosecute those who are taking advantage of the system.” City, state and federal agencies are pouring resources into efforts to halt the explosion of health and welfare fraud, officials say. The Program Integrity Group at the Centers for Medicare & Medicaid Services recently opened a field office in Santa Ana to help prevent and prosecute health care fraud. One of only two such offices nationwide, it uses “data mining” technology to target fraudulent Medicare and Medicaid billings. “In the two years since the office has been up and running, we have been able to stop almost $2billion in inappropriate or improper payments from going out the door,” program director Kimberly Brandt said. Last week, the Medicare Fraud Strike Force office in South Florida arrested 38 people on suspicion of defrauding the federal program out of more than $142million. Michael Bowman, spokesman for the state Department of Health Services, said California is making significant strides in identifying and preventing fraud. “The California Department of Health Services has taken an aggressive approach in identifying waste, fraud and abuse in Medi-Cal and is considered a national leader in Medicaid fraud control efforts,” Bowman said. The county’s Health Authority Law Enforcement Task Force helps save taxpayers about $27million a year by investigating Medi-Cal and Medicare fraud and illegal pharmaceuticals. “They are a model for other agencies, not just in the county, but throughout the state and nation,” said Miguel Santana, chief of staff to county Supervisor Gloria Molina, who created the task force in 1998. “What started out as an effort to address … illegal pharmaceuticals has become a major force in combating health care-related fraud and abuses.” More inspections But District Attorney Steve Cooley has been critical of county and state efforts. He wants officials to inspect offices of every medical provider and equipment vendor, performing background and identification checks and ensuring they are providing the services for which they’re being reimbursed. And at Cooley’s request, the Los Angeles County grand jury recommended that the welfare department perform home inspections to ensure recipients are qualified for benefits. “We have taken the grand jury’s recommendation and are developing a pilot program in child care to make visits to the providers to ensure that the participants are receiving the services we are being billed for,” said Philip Browning, who heads the Department of Public Social Services. The department has 189 investigators and supervisors who helped avert $55million in welfare fraud last fiscal year, up from $45million in 2000-01. “I believe we are doing a very credible job of preventing welfare fraud, starting with fingerprinting individuals when they come into our offices (to ensure recipients are not collecting benefits in other jurisdictions),” Browning said. Preventing fraud Shirley Washington, spokeswoman for the Department of Social Services, said the state has established a committee to consider ways to prevent fraud in the program that provides child care to welfare recipients. But Assistant U.S. Attorney Consuelo Woodhead, who coordinates health care fraud prosecutions in Los Angeles, said officials could double the number of investigators and prosecutors combating the problem and still not have enough people to make a significant difference. “To really effectively deal with the problem, we’re going to have to take a multidisciplinary approach where you look at licensing and certification, how claims are processed, as well as strong criminal and civil enforcement after claims are paid,” Woodhead said. “We need to reduce the volume of fraudulent claims in the first place. With all the competing issues that law enforcement has to deal with, we’ll never be able to allocate enough prosecutors and agents to deal with the losses after the fact. “And even if we could, in most cases they wouldn’t be able to get the money back.” [email protected] (213) 974-8985 160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set!last_img read more