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Attorney General Lockyer Offers Reward For Reporting Medi-Cal Fraud

Up To $1,000 For Tips Leading To Conviction Of Providers Who File False Claims
Thursday, June 16, 2005
Contact: (415) 703-5837

(SACRAMENTO) – Attorney General Bill Lockyer today launched a crackdown on rip offs of the taxpayer-funded Medi-Cal program, announcing he will offer up to a $1,000 reward for information leading to the conviction of providers of health care services and goods who defraud the system.

"This is a triple crime," said Lockyer. "The money could be used for people who are truly ill and count on Medi-Cal as their only source of health care. Second, people are getting medical procedures they don't need and putting themselves at risk. And taxpayers' money is being wasted at a time when the need is great and dollars are precious."

Medi-Cal fraud is committed by dentists, doctors, medical equipment suppliers and other providers who bill for services or supplies that are unnecessary or not actually performed, as well as those who receive kickbacks for Medi-Cal referrals. For example, in some instances fraudulent providers entice poor and non-English speaking victims to undergo unnecessary medical procedures. As incentives, they offer the patients children's shoes, clothing and other goods the patients otherwise could not afford.

Lockyer's statewide effort involves asking the public to report fraud and then rewarding them for their participation. Rewards can be as high as $1,000 for information leading to the arrest and conviction of providers who defraud the system. With cooperation from the California Department of Health Services (CDHS), more than 6 million Medi-Cal recipients will be contacted and asked to look for and report fraud. The alerts are in English, Spanish, Russian and Vietnamese. In addition, health care providers will receive flyers and posters.

A 2004 CDHS study of Medi-Cal's fee-for-service and dental programs found that 3.57 percent of the total dollars paid by the state involved some type of fraud or payment error.

The new effort targeting providers is part of a larger 10-point plan sponsored by Lockyer in 2004 to better protect Medi-Cal from fraud and abuse. The reward program was enacted through legislation, SB 1360(Brulte and Escutia) which was based on insights gained through Lockyer's prosecution of more than 700 criminal cases of Medi-Cal fraud.

Since becoming Attorney General, Lockyer has made the prosecution of Medi-Cal fraud a top priority. Under his leadership, criminal filings have increased 148 percent and restitution has increased nearly 500 percent. In 2001, Lockyer received a national award from the U.S. Department of Health and Human Services for having the top-performing health care fraud and elder abuse prosecutorial program in the country.

The state's $34 billion Medi-Cal program, the second-largest expenditure in the state budget, underwrites the health care expenses of more than 6 million low-income adults, children and disabled persons in California.

Those wishing to report fraud are urged to call the Attorney General's Bureau of Medi-Cal Fraud & Elder Abuse Hotline at (800) 722-0432 or the Department of Health Services at (800) 822-6222. Tips can also be filed online at www.stopmedicalfraud.ca.gov.

To download the fliers in English, Spanish, Russian or Vietnamese, go to www.stopmedicalfraud.ca.gov.

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