What Real Medicaid Fraud Looks Like

medicaid fraud
KCBS in Los Angeles

David Gibson, CEO from Reflective Medical, one of the companies that demonstrated their Medicaid fraud detection software to HHSC back in 2010 and 2011, sent TDMR links to a couple of YouTube videos that show the kind of fraud that exists today not only in Texas, but around the country.

California Medi-Cal fraud expose appalling 

The videos are from KCBS in Los Angeles and detail the results of the station’s five month investigation into MediCal fraud in Los Angeles.  The news reports aired back in 1999 and are appalling [UPDATE: the videos were uploaded to YouTube in 2010].

While the reports detail findings relating to fraudulent activities by so-called medical clinics, as one of the USC Medical School experts quoted says, “it is not medicine” and this article is not a hit against the medical profession. Gibson told TDMR that “fraud is not based upon disagreements relating to prior authorization for delivered services as was the case with orthodontists in Texas. Rather, it concentrates in corporate owned business that fraudulently charge for services that are never delivered or intentionally not indicated.”

“Cappers” prowling the streets, giving out kickbacks

The keynote of the criminal scam against the healthcare system is headhunters, or as called in the underworld “cappers”, prowling the streets, soliciting health-insured eligible poor to get unneeded tests or treatment for a kickback.  These individuals go to multiple clinics, even in the same week, without the state being the wiser and shelling out hundreds if not thousands of dollars per visit per clinic.

The state was even paying clinics that don’t exist except for an address.

State agency knew about scams

Worse, California state authorities knew about it but didn’t do anything until the governor made a pledge to take action as a result of KCBS’s shocking investigation.  Even though actions started to be taken against the scammers, apparently it still goes on, per Gibson.

Prepare to be horrified.

Leave a Reply

Your email address will not be published. Required fields are marked *