SACRAMENTO (AP) — State auditors have found Medi-Cal, the nation’s largest Medicaid program, was hit with more than $93 million in potentially fraudulent bills by substance abuse clinics across California.
The audit released Tuesday reviewed billing data from July 2008 to December 2013 for Medi-Cal’s Drug Treatment program, which reimburses outpatient rehabilitation clinics, the Los Angeles Times reported.
The state’s Department of Health Care Services and the Department of Alcohol and Drug Programs failed to administer the program “and created opportunities for fraud,” according to the report.
The audit flagged $93.7 million in payments that were “potentially indicative of fraudulent activity.” Red flags included providers billing for treatment on holidays or for more than five days a week. In some cases, multiple beneficiaries were listed as living at the same address.
There were 323 instances — totaling more than $10,000 — in which the state reimbursed providers for services to dead clients. Nearly $1 million in payments went to clinics that were potentially not authorized.
A review led the state health department to cut ties with more than 200 clinics and refer their operators for criminal prosecution, department spokesman Norman Williams told the Sacramento Bee .
The department plans to visit every clinic in the state as part of a sweeping recertification review, Williams said.
“This is a deeply troubling audit,” said Ted Lieu, D-Torrance, who requested the review. “It confirms that there has been widespread fraud in California’s Drug Medi-Cal program, and it’s ongoing.”
The report comes after an investigation by the Center for Investigative Reporting and CNN last year that revealed substance abuse clinics in Los Angeles County were scamming Medi-Cal by billing for patients who didn’t go to the clinics, including some who were dead or in prison.