The article focuses on the "medical directors" and the fact that the doctors did not physically examine the patients without understanding that these drug and treatment clinics are not owned by the doctors or health care professionals and that there is no requirement that the patients must be seen by a physician. In fact, the Medi-Cal program does not pay for a physical examination. The reimbursement rates are so low that it would be financially impossible to have a physician see each patient. The program cannot have it both ways -- want physical exams but not pay enough to cover it -- and this reimbursement structure has helped create this problem. The medical directors were not responsible for these clinics and were paid fairly low monthly fees ($1,000 a month). To cast the blame on these physicians is missing the real problems by the owners and managers of these clinics.
Since this series of articles have been published, the Department of Health Care Services has taken action and suspended 73 clinics including 101 additional counseling sites. Not surprisingly, all of the clinics referenced in the article have had their Medi-Cal provider numbers temporarily suspended based on accusations of fraud and abuse.
The Department of Health Care Services has also referred 64 of the clinics to the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse for criminal investigation. This referral will be used to justify the temporary suspensions of the provider numbers. Those clinics will have to address the administrative law issues as well as the criminal investigation.
Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
800 West Sixth Street, Suite 450
Los Angeles, California 90017
213-233-2260
tgreen@greenassoc.com
