California Whistleblowers’ Law Firm Shines a Spotlight on Medi-Cal Fraud

Readers of this blog know that scammers are routinely bilking the federal Medicare system out of large sums of money, crimes that add up to billions (yes, with a “b”) in losses every year. Health care fraud is not, however, only a federal matter. From small lies to big ones, criminals are also targeting the California Medi-Cal program. Medi-Cal fraud scams cost the state and every taxpayer money and pose a very real threat to the health and welfare of millions of Californians. Fighting these schemes requires the commitment of honest Californians willing to step up to the plate. The Brod Law Firm is proud to be their partner in this fight, representing the interests of the state and the interests of the individual whistleblower as a Medi-Cal fraud whistleblowers’ law firm.

The Medi-Cal System and Medi-Cal Fraud Medi-Cal is California’s Medicaid program, a form of government provided health insurance that covers low-income individuals. Enrollment appears to be growing as coverage expands. While most readers probably know both of those facts, the vastness of the program may still come as a surprise. In November 2014, news site California Healthline reported that approximately 30% of Californians were enrolled in the program, a figure that reflects the addition of more than 2.7 million enrollees in the prior year alone (Note: the site does suggest the figure might fall in the months following the report).

A section of the website for The Office of the Attorney General (“OAG”) for the State of California defines Medi-Cal fraud as “the billing of the Medi-Cal program for services, drugs, or supplies that are unnecessary, not performed, [or] more costly than those actually performed [and] also refers to paying and/or receiving kickbacks for Medi-Cal billing referrals” (formatting changed). The OAG explains that such scams create a financial burden that all Californians feel in the form of increased taxes and rising health insurance premiums while those in need of care may be forced to go without because funds have been stolen from already strained coffers. Per the Office, Medi-Cal fraud also poses a direct threat to public health with scams that involve things like reused syringes, “treatments” carried out by unqualified staff, and unwarranted medical procedures.

One Form of Medi-Cal Fraud Cost $94 Billion Over 5.5 Years Just how big and how costly a problem is Medi-Cal fraud? It’s hard to know for sure exactly how much money is drained from the program by scammers but words like “vast” and “huge” probably underemphasize the extent of Medi-Cal fraud. A state audit released last summer and reviewed in an LA Times article found that, between July 2008 and December 2013, just one type of Medi-Cal fraud scam may have cost the system over $93 billion. The figure represents potentially fraudulent payments made to substance abuse clinics by Medi-Cal’s Drug Treatment Program. Fraud in the substance abuse arena includes blatantly false claims like billing for “patients” who were dead or incarcerated and payments made to unauthorized providers.

A Medi-Cal Fraud Whistleblowers’ Law Firm
As with other forms of health care fraud, whistleblowers are critical to the fight against Medi-Cal fraud. In most cases, particularly in the case of larger scams, at least one honest person sees the fraud occur. This person may be a top-level executive asked to facilitate the scheme, an administrative employee told to ignore discrepancies, a coding specialist directed to enter false data, or even a Medi-Cal beneficiary who notices something incorrect in his/her records. Regardless of position, witnessing fraud can leave an honest individual unsure of the best course of action. This is where we come in. As a Medi-Cal fraud law firm, we partner with witnesses to health care fraud to fight back and ultimately return wrongfully diverted money to the Medi-Cal program. We have a dual commitment to the state and to the individual whistleblower, protecting the witness and fighting the fraud. If money is recovered as a result of your involvement, you may be entitled to a substantial reward. Call to learn more.

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