The Drug Medi-Cal program has been under a lot of scrutiny since 2013 when it was the subject of investigative reporting. In 2014, significant changes and audits were made. Many facilities were closed. However, it seems that there are still criminal filings coming out of those past audits.
On March 29, 2018, two executives at a South Los Angeles company that offered
alcohol and drug abuse treatment services were indicted on federal
charges that allege they defrauded the Medi-Cal program from 2009 to 2015 by submitting bills
seeking more than $2 million for services that did not qualify for
reimbursement or simply were never provided. An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed innocent until and unless proven guilty in court.
The owner and executive director of The New You Center (TNYC) Mesbel Mohamoud and her mother-in-law and co-founder and program director, Erlinda Abella, were taken into custody on April 3, 2018 since they were named in the indictment charging both with 21 counts
of health care fraud and two counts of aggravated identity theft for conduct from 2009 through 2015. TNYC had contracts to provide medically necessary substance abuse treatment services through the Drug Medi-Cal program to adults and teenagers in Los Angeles County.
The indictment alleges that TNYC submitted false and fraudulent bills for
counseling sessions that were not conducted at all, were not conducted at authorized
locations, or did not comply with Drug Medi-Cal regulations regarding the
length of sessions or the number of patients. Furthermore, Mohamoud and Abella
allegedly caused TNYC to bill for clients who did not have a substance abuse
problem, to falsify documents related to services supposedly provided to
clients, and to forge client signatures on documents such as sign-in sheets.
According to court filings, the charges in the indictment primarily relate to services provided to girls
residing at Dimondale Adolescent Care Facility group homes in Lancaster, Long
Beach and Carson, facilities where TNYC was not authorized to provide
counseling. The indictment alleges that TNYC submitted over $2 million in false and
fraudulent claims for group and individual substance abuse counseling services
and was paid more than $1.8 million based on these bills.
This case was investigated by the Federal Bureau of Investigation and the
California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse.
Attorney Commentary: These billings go back 9 years but where the acts are alleged as a continuing act, the statute of limitation does not begin to run until the last act. The delay in prosecuting makes these cases more difficult to defend since usually the businesses are closed and the records may not be available and witnesses are not available. In addition, these programs were administered by the County and Los Angeles County allegedly had issues in monitoring during that time period.
Generally, the prosecutors will focus on false signatures, missing signatures and anything that serves as an indicia of fraud. One of the issues is what does it take for a minor to have a "substance abuse problem?" The State and County were using these programs to provide drug counseling treatment at an early age since a middle age or high school student using drugs or alcohol or getting into legal or school problems due to them has a problem that can lay groundwork for a life of addiction. By alleging that the locations were not "authorized" the prosecution is seeking to disallow all the billings.
The identity theft allegations are often added for billing where services not provided and it provides the government leverage during plea negotiations since an identity theft conviction has a mandatory two-year term.
Posted by Tracy Green, Esq.
