Medi-Cal Fraud Hurts All Californians
Published: 2010-03-02 18:46:56
Author: KCRA | February 15, 2010
SACRAMENTO, Calif. -- Medi-Cal fraud costs everyone -- legitimate businesses, and patients who need services and taxpayers all pay.
The Department of Health Care Services estimates in 2007, $400 million in claims may have been fraudulent.
"If you have experience and know what you're doing, it's probably not a very hard thing to do," medical biller Laura Zine said.
Zine used to work for a durable medical equipment company billing medical for equipment like wheelchairs. She's seen Medi-Cal fraud firsthand -- a former employer was convicted in federal court for health care fraud.
"I kept stumbling across medical documentation that wasn't matching the equipment that was in the software. I couldn't make the pieces of the puzzle match," Zine said.
Her former boss was convicted of 22 felony counts of cheating Medicare and Medi-Cal out of $170,000 -- but that's just a drop in the fraud bucket.
California pays $12.5 billion in Medi-Cal benefits each year, while many providers and patients follow proper procedures. There are $400 million in claims that have the potential for fraud, according to the department.
"It's very difficult to quantify, there are a number of ways people can defraud the system, there are a number of ways for people to try to get around it," Norman Williams from the Department of Health Care Services said.
Full story
Published: 2010-03-02 18:46:56
Author: KCRA | February 15, 2010
SACRAMENTO, Calif. -- Medi-Cal fraud costs everyone -- legitimate businesses, and patients who need services and taxpayers all pay.
The Department of Health Care Services estimates in 2007, $400 million in claims may have been fraudulent.
"If you have experience and know what you're doing, it's probably not a very hard thing to do," medical biller Laura Zine said.
Zine used to work for a durable medical equipment company billing medical for equipment like wheelchairs. She's seen Medi-Cal fraud firsthand -- a former employer was convicted in federal court for health care fraud.
"I kept stumbling across medical documentation that wasn't matching the equipment that was in the software. I couldn't make the pieces of the puzzle match," Zine said.
Her former boss was convicted of 22 felony counts of cheating Medicare and Medi-Cal out of $170,000 -- but that's just a drop in the fraud bucket.
California pays $12.5 billion in Medi-Cal benefits each year, while many providers and patients follow proper procedures. There are $400 million in claims that have the potential for fraud, according to the department.
"It's very difficult to quantify, there are a number of ways people can defraud the system, there are a number of ways for people to try to get around it," Norman Williams from the Department of Health Care Services said.
Full story