Corporate Compliance

CA authorities take down largest Medi-Cal fraud scheme in state history

Compliance Monitor, July 15, 2009

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On July 9, California authorities arrested 20 individuals believed to be involved in a Medicaid fraud scheme that defrauded the Medi-Cal program of allegedly $4.6 million, according to a Department of Justice (DOJ) release.
 
The most recent arrests bring the total number of defendants connected to the scheme to 42. The DOJ alleges that the 42 defendants and two others conspired to bill the Medi-Cal program for in-home nursing services provided by unlicensed individuals.
 
The alleged organizer of the ring, Priscilla Villabroza, pleaded guilty to five counts of healthcare fraud last year and admitted that she and others hired unlicensed professionals to provide in-home nursing services to Medi-Cal beneficiaries, many of them children with cerebral palsy or developmental disabilities. Villabroza then billed the program, claiming the unlicensed nurses were licensed vocational nurses (LVNs). Villabroza allegedly instructed the unlicensed nurse defendants, some of whom had no medical training, to lie to parents and claim they were LVNs.
 
According to the DOJ, patients complained about the nurses’ inability to provide care. In one instance, a nurse fled a medical situation, presumably because she was in over her head and unable to administer the proper care.



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