Attorney General Lockyer Announces Record-Shattering $274.4 Million in Court-Ordered Recoveries in Medi-Cal Fraud Cases

Fiscal 2005-06 Performance Continues Unprecedented, Eight-Year Enforcement Record

Wednesday, August 16, 2006
Contact: (415) 703-5837, agpressoffice@doj.ca.gov

(SACRAMENTO) – Attorney General Bill Lockyer today announced the state Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse (BMFEA) in fiscal 2005-06 won a record-shattering $274.4 million in court-ordered recoveries of funds ripped off from the Medi-Cal program, continuing the BMFEA’s unmatched enforcement record during Lockyer’s tenure.

“Every dollar stolen from Medi-Cal is a dollar not available to provide health care for California’s neediest families and most vulnerable children,” said Lockyer. “Taxpayers deserve our best efforts track down and hold accountable those who rip off this crucial program. I have made anti-fraud enforcement a top priority. We have made remarkable progress, but we won’t rest on our laurels.”

The $274.4 million obtained in fiscal 2005-06 bested the previous high of $78.1 million – also obtained under Lockyer in fiscal 2003-04 – by $196.3 million. The latest data on court-ordered recoveries highlights a trend under Lockyer that has seen BMFEA recoup taxpayer money at rates unprecedented in the enforcement program’s 28-year history.

Since Lockyer became Attorney General in 1999, the BMFEA has obtained court-ordered recoveries totaling $503.2 million in Medi-Cal fraud cases. That figure dwarfs by 629 percent the $69 million secured over the prior eight fiscal years. The $274.4 million figure for fiscal 2005-06 is only $23.4 million less than the court-ordered recoveries secured during the previous 15 fiscal years combined ($297.8 million).

Criminal filings and convictions also have increased substantially under Lockyer, compared to the previous eight years. From fiscal 1998-99 through fiscal 2005-06, criminal filings went up 116 percent, from 438 to 944, while convictions increased 74 percent, from 369 to 643.

The BMFEA investigates and takes enforcement action against health care providers and others who defraud Medi-Cal by overbilling, billing for non-existent or unneeded services or products, or pay or receive kickbacks for referrals. Money recovered by BMFEA reimburses the Medi-Cal program and helps fund the BMFEA’s ongoing enforcement efforts. The BMFEA currently has an annual operating budget of $29 million.

Depending on the type of case, some money recovered in Medi-Cal fraud actions also can go to whistleblowers, to the state general fund, or to state or county special funds to be used solely to finance consumer protection programs.

Along with fighting Medi-Cal fraud, Lockyer has made a top priority of protecting senior citizens from abuse. He has more than doubled the size of the elder abuse unit, and the enforcement data show the augmentation has worked. Compared to the previous eight fiscal years, elder abuse criminal filings have increased 797 percent, convictions have risen 469 percent, and restitution to victims has gone up 1,369 percent.

Additionally, under Lockyer, the elder abuse unit filed the state’s first-ever civil and criminal enforcement actions against nursing home chains (Beverly Enterprises, Inc., Sun Healthcare and Pleasant Care). Those actions secured system-wide, court-enforceable care improvements for senior citizens. To further help prevent and correct substandard care, the elder abuse unit leads “Operation Guardians,” a multi-agency task force that conducts surprise inspections of California’s 1,300 nursing homes.

Under Lockyer, combined court-ordered recoveries in Medi-Cal fraud and elder abuse enforcement actions totaled $512.1 million through fiscal 2005-06. That’s $433.2 million more than the $78.9 million obtained during the previous 20 years put together.

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