Twenty people arrested in California Medicaid fraud case

Jul 12 2009

Twenty people in California were arrested on Thursday "in a $4.6-million Medi-Cal fraud scheme that law enforcement officials allege used unlicensed individuals to provide in-home nursing care for disabled patients," The Los Angeles Times reports.

"About 75 patients, many of them children with cerebral palsy or developmental disabilities, were treated at home or at school by the unlicensed individuals who stole identities to pose as licensed nurses, according to the United States Attorney's office." Those arrested "are among 42 defendants named in a 41-count indictment," in what United States Attorney Thomas O'Brien calls "the largest single case alleging Medi-Cal fraud ever filed in the state of California" (Abdulrahim, 7/9).

CNN: "Some parents and patients became suspicious of the nurses when they noticed their lack of skills. 'In one case, a "nurse" was unable to replace a tracheotomy tube that had fallen out of a young patient's neck. In another case, an impostor nurse simply fled a medical situation when she apparently was unable to provide assistance,' according to (a) statement. Some of the unlicensed nurses had foreign training, but never passed a U.S.-qualifying nursing exam, the attorney's office said, while others had no medical training at all" (7/9).

In other California news, the state's "budget crisis isn't reason enough to cut $1.1 billion a year in payments to doctors, dentists, pharmacists and other healthcare providers to the needy, a federal appeals court ruled Thursday," The Los Angeles Times reports in a separate story. "A bill passed by the Legislature last year reduced Medi-Cal compensation by 10%, driving away even more providers from the shrinking ranks still taking state patients and endangering their ability to get treatment, a three-judge panel of the U.S. 9th Circuit Court of Appeals said in unanimously upholding an injunction against the cuts. Healthcare providers for the nearly 7 million Californians dependent on state-funded treatment sued the state Department of Health Care Services after the law took effect July 1, 2008." California must now "pay providers the $55.8 million withheld during the few weeks before the court injunction halted the reductions, said H.D. Palmer, deputy director of the state Department of Finance. But the ruling shouldn't affect the $26.3-billion state budget deficit, he said, because the state hadn't counted on the 10 percent savings from the Medi-Cal reimbursement changes" (Williams, 7/10).

Meanwhile, Hispanic Business reports: "Although Hispanics make up a third of California's population, they constitute just 5 percent of the state's pool of physicians, according to a 2008 study by the Center for California Health Workforce Studies."

"Health officials say the shortage is problematic because Hispanic doctors are many times more likely than non-Hispanic doctors to work in areas where healthcare services are lacking. They're also more likely to practice primary care, a branch of medicine that is lagging as medical students flock to the more lucrative specialty fields." But the problem is not likely to change in the near future because "even though the population of Hispanics has exploded in California over the past couple decades, the number of first-year Hispanic medical students during that time has -- somehow -- decreased" (Kuznia, 7/9).