Medicaid provider payment suspensions grow in California

California's wide-ranging investigation into Medi-Cal fraud at drug and alcohol treatment centers has led to further payment suspensions, the Los Angeles Times reported.

Altogether, the California Department of Health Care Services (DHCS) has suspended payments to 38 providers that are running 108 different clinics. "We are deeply concerned. We have to put all our resources into fighting fraud in this program," DHCS Director Toby Douglas told the Times.

According to the Times and a separate investigation conducted by CNN and the Center for Investigative Reporting, Medi-Cal, California's Medicaid program, paid $94 million over the past two years to clinics where improper billing was suspected to have occurred.

In one instance, a Los Angeles clinic billed Medi-Cal for treating 179 patients on a day when only 30 were spotted going into the door, CNN/CIR reported.

The number of clinics under investigation is substantially higher than last month, when it was reported the DHCS had suspended payments to 16 providers suspected of committing fraud.

Additionally, some of the providers may have also hired employees who were ineligible to work at the clinics due to prior fraud convictions or a history of being negligent with patients, according to the Times. CNN/CIR reported one instance of a provider being barred from billing Medicaid due to a prior conviction defrauding the federal student loan program. Nonetheless, he collected more than $1 million in payments from Medicaid.

To learn more:
- read the Los Angeles Times article
- here's the CNN/CIR article

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