Clip files / Local news from the states
Clip files / Local news from the states
This column features selected short items about state health care policy.
State worker accused of Medi-Cal bribes is first to be implicated in FBI probe
SACRAMENTO, CA—The first state worker to be implicated in the FBI’s investigation of Medi-Cal fraud was accused in early April of accepting bribes from doctors who submitted false billings to the program.
U.S. Attorney Paul Seave filed bribery charges against Mildred V. Jackson, 51, a veteran state worker who was in charge of processing applications from doctors seeking to enroll in the program.
Ms. Jackson, an office technician in the Department of Health Services, was accused of accepting $1,000 bribes on six occasions in return for expediting applications so doctors would not have to wait the normal 30 days before submitting claims. Medi-Cal provides medical services for the poor.
Assistant U.S. Attorney Daniel Lindhardt said Ms. Jackson’s actions allowed the doctors to file false claims much sooner than they could have if she had followed normal procedures.
Mr. Linhardt said several other government employees are under investigation and he expects to file charges in those cases in the next few months. During the last year, the U.S. Attorney’s Office has filed criminal charges against more than 90 people as part of its probe of fraud in the $18-billion Medi-Cal program.
Nearly all the cases have been centered in Los Angeles, where medical equipment providers, pharmacies and blood laboratories have been accused of submitting hundreds of millions of dollars in false claims.
In most instances, they were accused of billing for supplies or services that were never provided. FBI officials expect to uncover more than $1 billion in fraudulent billings by the time the investigation is completed.
—Los Angeles Times, April 5
California to begin nursing home crackdown through surprise inspections, enforcing laws
LOS ANGELES—In a move to prevent abuse and neglect of California’s elderly, officials announced in late March the creation of a multi-agency effort to conduct surprise inspections in the state’s 1,500 nursing homes.
Named "Operation Guardians," the program will first target Los Angeles, where the General Accounting Office and congressional investigators recently reported serious problems. The investigation will later expand to San Francisco and San Diego.
Inspections, which supplement routine checks every 15 months, will focus on nursing homes with the worst records, state Attorney General Bill Lockyer and City Attorney James K. Hahn said. Felonies, misdemeanors and civil citations will be vigorously enforced, officials said. Nearly one-third of California nursing homes caring for Medicare/Medicaid patients were cited for serious care violations, according to a 1998 General Accounting Office report that reviewed federal and state data from 1995 through 1998.
A congressional report issued last November found less than 3% of the 439 nursing homes serving 34,000 Los Angeles County residents were in full or substantial compliance with federal standards during the most recent annual inspections. Almost one in five nursing homes had violations that caused actual harm to residents or placed them at risk of death or serious injury.
—Los Angeles Times, March 28
State HMOs could force public hospitals, clinics to close or reduce services
WASHINGTON, DC—Public hospitals and clinics serving the poor are cutting back on services and struggling to survive as they lose patients to HMOs and take on more of the uninsured, said a panel of health experts that recommended spending $2.5 billion during the next five years to keep the facilities afloat.
Many public facilities or safety net providers, which are legally obligated to provide care to people who cannot afford it, started losing money when states began converting Medicaid to managed care to cut costs, inviting health maintenance organizations and other private providers to compete for patients. Medicaid is the biggest source of revenue for many safety net providers and though estimates vary, more than 8 million Americans get basic health care from these providers.
Some hospitals and clinics have joined managed care groups to compete, but reimbursement rates for Medicaid patients under those plans are sometimes less than what it costs to provide care, according to an Institute of Medicine report.
Most safety net providers have been able to survive by cobbling together grants, the report said. Federal officials said more needs to be done to stabilize the safety net.
A $25 million pilot program for consortiums of safety net providers aims to improve coordination of care for the uninsured, said Claude Earle Fox, MD, head of the Health Resources and Services Administration at the Department of Health and Human Services, which commissioned the report. The Clinton administration has asked Congress for $1 billion to expand the program during the next five years.
—Los Angeles Times, March 31
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