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Mar 11, 2021 by |

San Diego and California Whistleblower and Elder Abuse Attorney: State Justice Department Expands Program Against Medi-Cal Fraud and Elder Abuse

ATTORNEY NEWSLETTER

Protecting The State’s Most Vulnerable

Med-Cal Fraud and Elder Abuse Unit Strengthened

California DOJ:  Operation SAFE (Stop Abuse and Fraud of Elders)

Evans Law Firm, Inc. is a plaintiff’s litigation law firm.  We represent individuals here in California who have suffered injury, especially older Californians who have been subjected to elder abuse including financial elder abuse or fraud at the hands of caregivers, insurance agents, trustees, advisors and others.  We also represent individuals who being cases on behalf of the State of California or the federal government for fraud against the government committed by corporations, contractors, manufacturers, service providers and others.  These lawsuits are known as “qui tam” actions and individuals can be rewarded for bringing qui tam cases if the government recovers from the wrongdoer. With senior consumers fraud related to government provided health care (as in Medicare or Medi-Cal) can overlap with elder abuse as we have seen tragically during the COVID-19 pandemic where facilities receiving government aid have in some cases neglected or abused senior patients even though the facilities are paid by the government to provide care If you have credible information of fraud against the government including under Medicare, Medi-Cal or other government programs, or if an older loved one has been the victim of elder abuse in a care facility or at home under the care of an in-home caregiver, call the San Diego and California whistleblower attorneys at Evans Law Firm, Inc. today at (415) 441-8669.

Operation SAFE

California State Attorney General Xavier Becerra (President Biden’s nominee for Secretary of the Department of Health and Human Services) as one of his final official acts announced the expansion of the California Justice Department’s existing program to protect California’s ederly and safeguard the state’s Medicaid program (Medi-Cal). In response to significant increases in Medi-Cal enrollment and the increased need to protect elders and nursing home residents during the COVID-19 pandemic, Attorney General Becerra has directed additional resources toward the California Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse and has elevated the bureau to a full-fledged division, now called the Division of Medi-Cal Fraud and Elder Abuse (DMFEA). DMFEA will continue its mission of investigating and prosecuting fraud committed against the Medi-Cal program as well as physical or financial abuse or neglect of elders and dependents in care facilities statewide. As part of this effort, Attorney General Becerra launched Operation SAFE (Stop Abuse and Fraud of Elders), an initiative aimed at further protecting elders and Californians living in skilled nursing facilities during the pandemic.

34% of COVID-related deaths in California have occurred in nursing homes according to the Los Angeles Times.  Attempts to insulate the elderly from exposure to the coronavirus results in greater isolation for those residents, leaving them more dependent on those facilities to provide appropriate care and more vulnerable to abuse and fraud.  Operation SAFE will conduct unannounced visits to Medi-Cal funded skilled nursing facilities to investigate complaints of abuse and fraud, and will hold accountable those who abuse and neglect the state’s elderly and vulnerable populations. 

Examples[1] of Medi-Cal Fraud

Examples of recent Medi-Cal fraud cases include:

  • $1 Million Settlement with a Post-Acute Rehabilitation CenterDMFEA sreached a $1 million settlement with a post-acute rehabilitation center for alleged violations of the California False Claims Act (Cal. Gov’t Code § 12650 et seq.). The settlement resolves allegations that the center wrongly billed Medi-Cal for patients needing a heightened level of skilled nursing care, known as subacute care, specifically by failing to provide the minimum number of nursing hours for its subacute care unit and assigning subacute patients to non-subacute beds.
  • $18.9 Million Settlement with Large Health Care Provider: DMFEA worked with other State and federal agencies to reach to a large health care network after the health system self-disclosed that it overcharged Medi-Cal for its reimbursement claims for all drugs covered under a State program for a three-year period.
  • $9.5 Million Settlement with Pharmacy: DMFEA worked with other states’ Medicaid Fraud Control Units to reach a $9.5 million settlement with a large national pharmacy chain resolving allegations that the drugstore chain offered incentives to beneficiaries to lure them into its prescription drug program and overcharged Medicare and Medicaid programs in filling the prescriptions.

Contact Us

If you have firsthand knowledge of Medicare or Medi-Cal fraud or have an elderly loved one who has been the victim of any kind of elder abuse here in California, including in a skilled nursing facility, call Ingrid M. Evans and the other San Diego whistleblower and elder abuse attorneys at Evans Law Firm can be reached at (415) 441-8669, or by email to <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>.  Reporting fraud or elder abuse to the authorities is important but also reach out to counsel to pursue all available remedies.  Whether your case is about fraud against the government or the abuse of an older loved one, Ingrid and our other San Diego litigators can help.

[1] Evans Law Firm, Inc. was not involved in any of these cases in any way.

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