Countywide

More than $1 million worth of fraudulent Medi-Cal applications were uncovered in San Diego County as a result of a pilot project that could save taxpayers $15 million annually, county and state officials announced Tuesday.

During the 15-month pilot project, completed in December, tougher screening was used to identify potentially fraudulent claims submitted to the county’s South Bay Income Maintenance Office by applicants seeking to qualify for Medi-Cal, a program that provides health care to low-income families, the elderly and the disabled. Applications that county eligibility officials regarded as suspicious were referred to a state health services investigator for additional scrutiny.

Over the course of the project, 325 fraudulent applications--about 2.3% of the total applications received at the office--were uncovered, county officials said. Most of the fraudulent applications came from people who falsely claimed California residency, while other common fraud patterns included the concealment of private health insurance, failure to disclose income or employment, and false statements about family size.

Kenneth Kizer, director of the California Department of Health Services, praised the San Diego project as an “aggressive, preventive program (that) should send a clear signal to would-be abusers of Medi-Cal that California will not tolerate such irregularities.�

If adopted statewide, the procedures used in San Diego could reduce Medi-Cal payments by about $15 million annually, Kizer said. The screening project has already become a permanent part of all eight local Income Maintenance offices, and is being duplicated in Los Angeles, Ventura and San Bernardino counties, county officials said.