Since the time I wrote my last post below, describing my experiences at the University of California, people have asked me if I know of any other problems there. Indeed I do. So, over the next few postings, I will describe a few examples of what I believe to be large-scale insurance fraud that I saw, or otherwise know of, at the University of California medical system.
The largest case of which I am aware involved large scale ... umm ... mistaken billing for intern and resident services. I did my medical internship through the University of California, Irvine. I made $29,000 for one year of work, for which I worked approximately 80 to 100 hours / week. The University, however, apparently didn’t bill for my services as if I was making $29,000 / year. Instead, they allegedly billed for the services provided by the interns and residents, as if the services had been provided by attending physicians. (note: I don't know if services I personally performed were billed "incorrectly," just that large numbers of services around the time I was working for UC Irvine were "incorrectly" billed. I assume that some of what I did was billed "in error.") They even billed for attending physicians doing procedures at times when those attendings were documented to have not been in the hospital at all.
In February 2001, after years of appeals, but with new federal DA's on the way after the 2000 federal elections were eventually finalized, the University of California settled those
"erroneous" billing claims (referred to as "routine misbilling of medicare, medicaid, and other federal health care programs") for $22.5 million. (!) The last I read about this, in the LA Times, the whistleblower, from the University of California, Irvine billing department, was still wading through lawsuits and trying to get her life back on track.