MORE RESOURCES TO FIGHT FRAUD AGENCIES BATTLE THOSE MILKING HEALTH, WELFARE SYSTEMS.Byline: TROY ANDERSON Staff Writer City, state and federal agencies are pouring resources into efforts to halt the explosion of health and welfare fraud, officials say. The Program Integrity Group at the Centers for Medicare & Medicaid Services recently opened a field office in Santa Ana Santa Ana, city, El Salvador Santa Ana (sän'tä ä`nä), city (1993 pop. 129,873), W El Salvador. It is the second largest city in the country and the commercial and processing center for a sugarcane, coffee, and cattle region. to help prevent and prosecute health care fraud. One of only two such offices nationwide, it uses "data mining" technology to target fraudulent Medicare and Medicaid Medicare and Medicaid U.S. government programs in effect since 1966. Medicare covers most people 65 or older and those with long-term disabilities. Part A, a hospital insurance plan, also pays for home health visits and hospice care. billings. "In the two years since the office has been up and running, we have been able to stop almost $2 billion in inappropriate or improper payments from going out the door," program director Kimberly Brandt said. Last week, the Medicare Fraud Medicare fraud Medifraud Medical practice Any unlawful act which results in the inappropriate billing of Medicare for services by a health care provider–eg, physicians, hospitals and affiliated providers. See Medicare. Strike Force office in South Florida arrested 38 people on suspicion of defrauding the federal program out of more than $142 million. The FBI seized a $200,000 Rolls-Royce Phantom Rolls-Royce has used the Phantom name on many exclusive luxury cars over the past century:
Record restitution One of the most successful anti-fraud programs has been the state Attorney General Office's Bureau of Medi-Cal Fraud and Elder Abuse Elder Abuse Definition Elder abuse is a general term used to describe harmful acts toward an elderly adult, such as physical abuse, sexual abuse, emotional or psychological abuse, financial exploitation, and neglect, including self-neglect. . It won a record $274 million in court-ordered restitution of money stolen from Medi-Cal, shattering the previous high of $43 million. "I believe this is a result of the efforts the bureau has put forward in increasing the number of investigators, special agents, prosecutors and auditors within our bureau," said Joseph Fendrick, special-agent-in-charge of the bureau. "There has been a concerted effort to aggressively prosecute those who are taking advantage of the system." Michael Bowman, spokesman for the state Department of Health Services Department of Health Services may refer to:
"The California Department of Health Services has taken an aggressive approach in identifying waste, fraud and abuse in Medi-Cal and is considered a national leader in Medicaid fraud Medicaid fraud The fraudulent billing of Medicaid by physicians or other health care providers, especially international medical graduates and psychiatrists. See Medicaid. control efforts," Bowman said. The county's Health Authority Law Enforcement Task Force helps save taxpayers about $27 million a year by investigating Medi-Cal and Medicare fraud and illegal pharmaceuticals. "They are a model for other agencies, not just in the county, but throughout the state and nation," said Miguel Santana Miguel Santana (born February 9, 1965) is a former boxer from Puerto Rico. Santana was born in Canovanas. Boxing career Miguel Santana had an award winning amateur boxing career, training alongside a young Jose Antonio Rivera, who is a two division world champion himself. , chief of staff to county Supervisor Gloria Molina Gloria Molina is a member of the Los Angeles County Board of Supervisors, and the current chairwoman of the Los Angeles County Metropolitan Transportation Authority.[1] Molina grew up as one of ten children in the Los Angeles suburb of Pico Rivera, California, U.S. , who created the task force in 1998. "What started out as an effort to address ... illegal pharmaceuticals has become a major force in combating health care-related fraud and abuses." More inspections But District Attorney Steve Cooley Stephen Lawrence ("Steve") Cooley (born May 1, 1947 in Los Angeles, California) is a veteran prosecutor who was elected as Los Angeles County's 36th District Attorney on November 7, 2000. He was sworn in for his second term on December 6, 2004. has been critical of county and state efforts. He wants officials to inspect offices of every medical provider and equipment vendor, performing background and identification checks and ensuring they are providing the services for which they're being reimbursed. And at Cooley's request, the Los Angeles Los Angeles (lôs ăn`jələs, lŏs, ăn`jəlēz'), city (1990 pop. 3,485,398), seat of Los Angeles co., S Calif.; inc. 1850. County grand jury recommended that the welfare department perform home inspections to ensure recipients are qualified for benefits. "We have taken the grand jury's recommendation and are developing a pilot program in child care to make visits to the providers to ensure that the participants are receiving the services we are being billed for," said Philip Browning Philip Brown (born March 26, 1958) is an American actor probably best known for his performances on television. He first played Billy Martin, the son of Doris Day on The Doris Day Show, from 1968-1971. , who heads the Department of Public Social Services social services Noun, pl welfare services provided by local authorities or a state agency for people with particular social needs social services npl → servicios mpl sociales . The department has 189 investigators and supervisors who helped avert $55 million in welfare fraud last fiscal year, up from $45 million in 2000-01. "I believe we are doing a very credible job of preventing welfare fraud, starting with fingerprinting individuals when they come into our offices (to ensure recipients are not collecting benefits in other jurisdictions)," Browning said. Preventing fraud Shirley Washington, spokeswoman for the Department of Social Services, said the state has established a committee to consider ways to prevent fraud in the program that provides child care to welfare recipients. But Assistant U.S. Attorney Consuelo Woodhead, who coordinates health care fraud prosecutions in Los Angeles, said officials could double the number of investigators and prosecutors combating the problem and still not have enough people to make a significant difference. "To really effectively deal with the problem, we're going to have to take a multidisciplinary approach multidisciplinary approach A term referring to the philosophy of converging multiple specialties and/or technologies to establish a diagnosis or effect a therapy where you look at licensing and certification, how claims are processed, as well as strong criminal and civil enforcement after claims are paid," Woodhead said. "We need to reduce the volume of fraudulent claims in the first place. With all the competing issues that law enforcement has to deal with, we'll never be able to allocate enough prosecutors and agents to deal with the losses after the fact. "And even if we could, in most cases they wouldn't be able to get the money back." troy.anderson(at)dailynews.com (213) 974-8985 F.Y.I. The California Department of Justice is offering rewards up to $1,000 for information leading to the conviction of individuals committing Medi-Cal fraud. See www.stopmedicalfraud.ca.gov or call one of the following agencies: Attorney General's Bureau of Medi-Cal Fraud & Elder Abuse: (800)722-0432. U.S. Centers for Medicare & Medicaid Services: (800)633-4223. State Department of Health Services: (800)822-6222. Health Authority Law Enforcement Task Force: (213)989-7039. CAPTION(S): box Box: F.Y.I. (see text) |
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