CA investigators halt Medicaid payments to 16 providers

California regulators have suspended Medicaid payments to 16 unidentified alcohol and drug treatment centers statewide after investigations for potential billing fraud, the Sacramento Bee reported.

According to the Bee, the payment suspensions by the California Department of Health Care Services (DHCS), which oversees the state's Medicaid program, occurred after the agency conducted data mining on provider claims. "We took the complaints and performed some data analytics. That's what led us to the red flags," Bruce Lim, deputy director for audits and investigations at Health Care Services, told the Bee. Those red flags included  billing spikes and other payment anomalies.

Agency officials visited 22 centers earlier this month prior to issuing the suspensions, the DHCS announced. It said it is in the midst of a statewide investigation.

A similar statewide probe is underway in New Mexico. To date, Medicaid payments to 15 providers of mental health services and services to the developmentally disabled have been suspended.

California has about 1,000 drug and alcohol treatment facilities, according to the Bee.

To learn more:
- read the Sacramento Bee article
- check out the DHCS press release (.pdf)

 

Suggested Articles

Presidential candidate Kamala Harris wants to get rid of the tax break drug companies get for DTC ads

Healthcare software company Phreesia closed its first day of trading as a public company Thursday about 40% above its set price.

Growing the biosimilar market could lead to significant healthcare cost savings, according to a new report.