On May 21, 2009, the California State Attorney General's Office filed separate criminal cases and charges against two dozen in-home healthcare workers who allegedly defrauded the program by seeking payment for services to clients who were allegedly dead, hospitalized or incarcerated. These cases were filed in Los Angeles County Superior Court.
These named defendants were sent a letter ordering them to surrender to the court in June. If they fail to appear, an arrest warrant will be issued. If convicted, the defendants could face one year in county jail to five years in state prison, depending on whether misdemeanor or felony charges were filed.
Under Medi-Cal's In-Home Supportive Services program, workers perform non-medical services for qualified Medi-Cal recipients. This includes housekeeping, grocery shopping and meal preparation. In-home healthcare workers are required to submit timesheets signed and certified by their clients to receive payment. In 2008, more than 400,000 Californians received in-home healthcare services, twice as many as in 1999. State costs for operating the program are approximately $2 billion per year.
After a 2008 audit revealed that hundreds of payment requests had been submitted for in-home services never performed, the Attorney General's Office and the California Department of Health Care Services launched an investigation into the program, leading to the charges filed and an ongoing investigation into physicians who allegedly facilitate this type of fraud.
It appears that most of the defendants were charged with one count of grand theft and one count of presenting false Medi-Cal claims. Some defendants were charged with misdemeanors and others were charged with felonies. In many of these cases, the alleged fraud was under $5,000.
For example:
■ One Compton man alleged submitted false claims totaling $3,394 for services to his mother who, in fact, was hospitalized and later died.
■ A Los Angeles woman allegedly submitted false claims totaling $1,488 for services to her client who, in fact, had died.
■ A Long Beach woman allegedly submitted false claims totaling $2,953 for services to her mother who, in fact, had died.
■ A Los Angeles man allegedly submitted false claims totaling $6,506 for services to his client who, in fact, had died.
The complaints for all these cases can be reviewed at the following links:
http://ag.ca.gov/cms_attachments/press/pdfs/n1743_allen-jones.pdf
http://ag.ca.gov/cms_attachments/press/pdfs/n1743_lee-rogers.pdf
http://ag.ca.gov/cms_attachments/press/pdfs/n1743_shelmon-woods.pdf
http://ag.ca.gov/cms_attachments/press/pdfs/n1743_allen-jones.pdf
http://ag.ca.gov/cms_attachments/press/pdfs/n1743_lee-rogers.pdf
http://ag.ca.gov/cms_attachments/press/pdfs/n1743_shelmon-woods.pdf
Attorney Comments: There are a couple of notable things about these cases. First, the Attorney General's Office is prosecuting smaller cases, including misdemeanors, and there does not appear to be a threshold amount for prosecution. The Office is apparently taking the position that it wants to be aggressive and tag those individuals with Medi-Cal fraud convictions.
Second, the Office has filed those cases where it appears to be straight out fraud, such as billing for a deceased patient. There are no cases where it is alleged that the services were not necessary.
Third, the real goal here may be to seek the individual defendants' cooperation against physicians who are required to authorize the in-home health care.
Any questions or comments should be directed to: tgreen@greenassoc.com or aschneider@greenassoc.com. Tracy Green is a principal at Green & Associates and Ann Schneider is a senior associate at Green & Associates in Los Angeles, California. They focus their practice on the representation of licensed professionals and businesses in civil, business, administrative and criminal proceedings, with a specialty in health care providers.
