Government
Jun. 25, 2002
$73 Million Medicaid Whistle-Blower Suit Settles
LOS ANGELES - Federal prosecutors have obtained a $73.3 million settlement in a whistle-blower lawsuit that accused the state of California and Los Angeles County of submitting false claims to Medicaid.
Neither the state nor county government admitted fault as part of the settlement, Principal Deputy County Counsel Anita Lee said. The county's share of the settlement was $6.8 million, Lee said.
Gurubanda Singh Khalsa, an employee of the county Department of Mental Health, will receive $1.4 million under the whistle-blower provisions of the False Claims Act. He remains a county mental health employee, Lee said.
The U.S. attorney's office alleged that the state and county governments falsely billed the federal Medicaid program for services for adolescents who did not meet the federal income guidelines.
Medicaid is a federal-state health insurance program that covers 36 million low-income and needy people.
The California teens, who qualified for health benefits under the state's looser Medi-Cal guidelines, received services for drug and alcohol abuse, family planning, sexual assault treatment, sexually transmitted diseases and mental health problems.
"It is the county's belief that, although these children were not federally eligible, it did not act in a false or fraudulent way - it was a misapplication of rules," Lee said. "The county had no reason to think they weren't eligible."
The U.S. Department of Justice investigated and made false-claims accusations against several other California counties in the action, which was filed under seal in the U.S. District Court for the Northern District in late 1999.
"The Department of Justice places a high priority on ensuring that the United States is not billed for health care services that do not legally qualify for federal reimbursement," Assistant Attorney General Robert McCallum Jr. said.
The settlement releases the state and counties from liability for claims arising between October 1989 and October 1999. No other false claims have been asserted, county officials said last week.
The billing conflict arose over a state policy that allows adolescents to obtain certain types of health care without their parents' consent, Lee said.
Although federal guidelines require minors to submit their own income and that of their parents' to qualify for Medicaid, the state can qualify teens on their own income alone.
In some of those cases, the county inappropriately charged the federal government for 50 percent of the costs, she said.
The settlement will not worsen the county's severe health care budget shortfall because the Board of Supervisors reserved settlement funds about two years ago when the county had a budget surplus, Lee said.
Gina Keating
For reprint rights or to order a copy of your photo:
Email
Jeremy_Ellis@dailyjournal.com
for prices.
Direct dial: 213-229-5424
Send a letter to the editor:
Email: letters@dailyjournal.com