Attorney General Lockyer Receives Federal Award for Combating Medi-Cal Fraud, Elder Abuse

(SACRAMENTO) – Attorney General Bill Lockyer's Bureau of Medi-Cal Fraud and Elder Abuse has received special recognition from the U.S. Department of Health and Human Services, Office of Inspector General, for being the nation's premiere state prosecutorial agency in the battle against health care fraud and elder abuse.

"Combating elder abuse and Medi-Cal fraud is one of my highest priorities," Lockyer said today, "so I am extremely honored that the U.S. Department of Health and Human Services has recognized the outstanding performance of my Bureau of Medi-Cal Fraud and Elder Abuse."

The prestigious national award was presented by Inspector General Janet Rehnquist and Deputy Secretary Claude Allen Monday in Washington, D.C. The Inspector General's Office said Lockyer's Bureau of Medi-Cal Fraud and Elder Abuse "demonstrated exceptional ability to detect, investigate and prosecute Medicaid provider fraud and patient abuse" and their efforts "represent the highest yearly conviction rate of any state Medicaid Fraud Control Unit in the nation."

Upon becoming Attorney General in 1999, Lockyer reinvigorated the Bureau by both expanding its total staff by over 50% – including a doubling of its elder abuse prosecution program – and directing it to aggressively pursue Medi-Cal fraud and elder abuse in California. Lockyer also launched Operation Guardians, a multi-agency task force which in its first year of surprise inspections of nursing homes triggered improvements in the quality of care and living conditions at the 50 facilities it visited.

The Attorney General's first-year efforts yielded a 36 percent increase in the number of Medi-Cal fraud cases filed from the previous year, an 86 percent increase in convictions and a five-fold increase in the funds recovered for the state's health care program for needy Californians. In his second year, criminal filings increased from 88 criminal cases prosecuted in FY 1998/99 to 151 cases in FY 2000/01.

In Lockyer's battle against poor performing nursing homes, criminal enforcement actions increased from an anemic 1 in FY 1993/94 to 86 in FY 2000/01. Lockyer also holds the distinction of being the state's first Attorney General to prosecute nursing home owners for abuse, neglect and poor quality of care.

Lockyer further commented, "There is no group more committed to protecting the state's $25 billion Medi-Cal program – and the approximately one out of every six Californians who depend on it for their health care needs – than the dedicated men and women of the Bureau of Medi-Cal Fraud and Elder Abuse."

Summary of Medi-Cal fraud and Elder Abuse prosecutions by the Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse:

MEDI-CAL FRAUD (Criminal Prosecutions) 1
93/94 94/95 95/96 96/97 97/98 98/99 99/00 00/01
Referrals Received 306 450 266 788 1020 923 832 556
Complaints Filed 41 29 32 40 53 88 120 151
Convictions 44 28 21 31 50 45 84 79
Acquittals 0 1 1 0 0 2 1 0
Restitution $852,286 $645,420 $2,725,777 $3,191,228 $3,602,696 $5,464,936 $27,221,692 $9,099,922

ELDER ABUSE (Criminal and Civil Prosecutions)
93/94 94/95 95/96 96/97 97/98 98/99 99/00 00/01
Referrals Received 477 563 869 862 1088 1024 1389 1517
Criminal Complaints Filed 1 2 4 17 24 54 40 2 86
Criminal Convictions 2 3 0 8 22 26 22 33
Acquittals 0 0 0 1 0 1 1 2
Civil Complaints Filed 0 0 0 0 0 0 0 2 3
Civil Judgments 0 0 0 0 0 0 0 0
Civil Dismissals 0 0 0 0 0 0 0 0
Restitution and Penalties $0 $0 $0 $0 $3,508 $62,905 $14,193 $40,663

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1 These statistics do not include results stemming from the BMFEA's aid to other law enforcement agencies.
2 Includes State of California's first-ever criminal prosecution of a skilled nursing facility (SNF) and its owner.
3 Includes State of California's first-ever civil lawsuit against a nursing home chain and its corporate owner.