Commentary: Responding to Fraud in the Medi-Cal Program

Recently, a report on CNN exposed millions of dollars worth of fraud in the drug Medi-Cal program, which is the state’s Medicaid payment system for substance abuse treatment. False billing for non-existent patients and a variety of other frauds have cast the entire substance abuse treatment system in a very negative light. Combine this with a report by the California State Senate published in April entitled, “Suspect Treatment”, which highlighted the gross lack of oversight of the regulation of the substance abuse counseling profession by the state, and it has been a very difficult few months for treatment providers. In response to this news, the California Association of Alcohol & Drug Abuse Counselors (CAADAC) is supporting actions to investigate and hold accountable businesses and individuals participating in these fraudulent activities.

CAADAC is the largest AODA counselor certification organization in California. CAADAC’s certification board, the California Certification Board for Alcohol and Drug Abuse Counselors (CCBADC), adheres to the highest standards of quality and professionalism in the AODA treatment field. CAADAC has an interest, and a stake, in raising the standards of professionalism for substance abuse counselors who work in both treatment and prevention. Recently, CAADAC has partnered with with the California Association of Addiction Recovery Resources (CAARR) to draft new regulations to address continuing concerns. CAARR is a non-profit membership organization that serves as the principal voice for social model recovery programs throughout California.

While the lack of oversight in this instance is disturbing at the very least, it is a direct reflection of the lack of resources afforded to the regulation of the substance abuse counseling profession. The recent elimination of the Department of Alcohol and Drug Programs is just one example. With the expansion of the Medi-Cal benefit for addiction treatment (under the Affordable Care Act) set to occur in less than five months, oversight of the quality and efficacy of addiction treatment urgently needs to be addressed.

CAADAC and CAARR are striving to create a Uniform Code of Conduct, which addresses fraudulent behavior in the profession, and are assisting in forming disciplinary guidelines to encourage effective policies to respond to breaches in ethical behavior. Both organizations are supportive of new legislation in the California Legislature, Senate Bill 570, sponsored by Mark Desaulnier. This legislation will require background checks for all substance abuse counselors entering the profession, including screening for financial crimes. It is scheduled to be heard today by the Health Committee of the State Assembly.

Andrew D. Kessler is IC&RC’s Federal Policy Liaison and Founder of Slingshot Solutions, LLC.

2 Responses to Commentary: Responding to Fraud in the Medi-Cal Program

  1. Roxanne Baker | August 13, 2013 at 2:21 pm

    Here is one form of Fraud in the Drug Medi-cal system. The Title 9,which is the State regulations for methadone treatment states each patient must have 50 minutes of counseling each month. The Title 22,which is the Drug Medi-cal Regulations for California states that “Providers Can Charge up to 222 minutes a month. What it does NOT say is Cash Paying patients must do 50 minutes and Drug Medi-cal Patients must go each week. YET in every program in California cash paying patients are maybe doing 50 minutes a month,and you can bet every drug medi-cal patient is going 4 x’s a month. Yes,I get it that each patient is different and may require more counseling. I want to ask ALL the Providers in CA to check their Stats and they will find what I say to be true.

    Rokki

    • Gonzalo Gonzalez | August 22, 2013 at 1:42 am

      Roxanne, you are a Godsend. I hope more people stand up for what is right and expose these schemes! It is a shame that it took an investigation from CNN in order to finally get this ball rolling.

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