California Attorney General files charges in Medi-Cal fraud against the dead

As part of his relentless effort to put the brakes on Medi-Cal fraud (California’s Medicaid program), Attorney General Edmund G. Brown Jr. has filed criminal charges against more than two dozen in-home healthcare workers who "shamelessly bilked" Medi-Cal by billing for services in the names of program recipients who were in fact dead, hospitalized or incarcerated.

This program is easy pickings for fraudsters: under Medi-Cal's In-Home Supportive Services program, workers who perform non-medical services for qualified Medi-Cal recipients may submit timesheets for housekeeping, grocery shopping and meal preparation that are signed by the recipients. In-Home Supportive Services costs the taxpayer $2 billion per years; twice as many Californians received these kinds of services as did in 1999. It was a 2008 audit revealing that many payment requests had been performed for individuals who were dead, in prison, or hospitalized that caused Brown and the California Department of Health Services to initiate an investigation into possible fraud. There is also an investigation to determine the role physicians might have played in this scam.

Today's charges are part of Brown's larger effort to investigate and prosecute those who would defraud Medi-Cal, which receives approximately $20 billion in state funding every year. Over the past two years, Brown has filed legal action against 31 pharmaceutical companies, 7 medical laboratories and dozens of healthcare providers and workers, resulting in criminal charges against 204 individuals and the recovery of $225 million to the state.

The $40 billion Medi-Cal program receives 50 percent of its funding from the state and 50 percent from the federal government.