Committee hears dueling tales of anti-fraud efforts

Witnesses told members of the House Commerce Oversight and Investigations Subcommittee July 18 that fraudulent medical equipment providers may have ripped off California’s Med-Cal program to the tune of $1 billion over the last few years, despite an aggressive effort by federal law enforcement officials to root out fraud and abuse.

Worse yet, California medical equipment dealer Ruben Assatourian told the subcommittee that seasoned Medicare criminals are now expanding their targets. He says that adult day programs, an increasingly popular state-subsidized option for family members who want to avoid placing parents in institutionalized care, are fast becoming "the next jackpot" for career criminals.

Federal Bureau of Investigation Deputy Assistant Director Thomas Kubic countered that California has implemented numerous measures including a moratorium on termination clauses, expanded inspections and background checks, and a moratorium on durable medical equipment providers that should serve as a model for other states. He also pointed to some 300 investigations still under way in that state.

General Accounting Office Associate Director Leslie Aronovitz argued that the Health Care Financing Administration and state Medicaid programs should improve coordination of their joint efforts in this area. Specifically, she says the administration must know a lot more about ongoing state activities. An aide to Subcommittee Chairman Fred Upton (R-MI) said it is uncertain whether any legislation will emerge to address those areas.