Section 12528 Of Article 2. General Powers And Duties From California Government Code >> Division 3. >> Title 2. >> Part 2. >> Chapter 6. >> Article 2.
12528
. (a) There is in the Office of the Attorney General the
Bureau of Medi-Cal Fraud, which shall implement Sections 1903(a)(6),
1903(b)(3), and 1903(g) of the federal Social Security Act, as
amended by the federal Medicare-Medicaid Anti-Fraud and Abuse
Amendments ( Public Law 95-124), and is authorized to conduct a
statewide program for investigating and prosecuting, and referring
for prosecution, violations of all applicable laws pertaining to
fraud in the administration of the Medi-Cal program, the provision of
medical assistance or medical supplies, or the activities of
providers of medical assistance or medical suppliers under the
Medi-Cal plan. The investigation of fraud by beneficiaries of the
Medi-Cal program is the responsibility of the Audits and
Investigations Branch of the State Department of Health Services.
(b) The bureau shall also review complaints alleging abuse or
neglect of patients in health care facilities receiving payments
under the Medi-Cal plan and may review complaints of the
misappropriation of patient's private funds in such facilities and
complaints of discriminatory treatment of Medi-Cal beneficiaries by
such facilities.
(1) If the initial review indicates substantial potential for
criminal prosecution, the bureau shall investigate the complaint or
refer it to an appropriate criminal investigative or prosecutive
authority.
(2) If the initial review does not indicate a substantial
potential for criminal prosecution, the bureau shall inform the
referring agency of its determination and may, if appropriate, refer
the complaint to the State Department of Health Services.
(c) Local law enforcement and prosecution agencies shall have
concurrent jurisdiction with the bureau to investigate and prosecute
violations of law referred to in this section.
(d) If the bureau, in carrying out its duties and responsibilities
under subdivisions (a) and (b), discovers that overpayments have
been made to a health care facility or other provider of medical
assistance or medical supplies under the Medi-Cal plan, the bureau
shall either attempt to collect the overpayment or refer the matter
to the State Department of Health Services for collection.
(e) Where a prosecuting authority other than the bureau elects to
prosecute a case reported to the bureau, the bureau shall, upon
request of that prosecuting authority, ensure that those responsible
for the prosecutive decision and the preparation of the case for
trial have the opportunity to participate in the investigation from
its inception and will provide all necessary assistance to the
prosecuting authority throughout all resulting prosecutions.
(f) The bureau shall make available to federal investigators or
prosecutors all information in its possession concerning fraud in the
provision or administration of medical assistance under the Medi-Cal
plan and shall cooperate with such officials in coordinating any
federal and state investigations or prosecutions involving the same
suspects or allegations.
(g) The bureau shall safeguard the privacy rights of all
individuals and shall provide safeguards to prevent the misuse of
information under its control, and all agencies which are required to
report complaints alleging abuse or neglect of patients shall
maintain the confidentiality of those reports until such time as the
report becomes a matter of public record.
(h) The bureau shall offer training programs to local law
enforcement and prosecutorial personnel in investigating and
prosecuting crimes against elders and dependent adults, and to the
State Department of Health Services, the State Department of Social
Services, the county adult protective services agencies and to the
Long-Term Care Ombudsman in evaluating and documenting criminal abuse
against elders and dependent adults.
(i) The state Long-Term Care Ombudsman, the Licensing and
Certification Division in the Department of Health Services, and the
Statistical Services Bureau in the State Department of Social
Services shall report to the bureau all instances of abuse and
neglect of elders and dependent adults, as defined in Section 15610
of the Welfare and Institutions Code, which come to their attention.
(j) The bureau shall collect information on a statewide basis
regarding cases of abuse and neglect of patients in health facilities
receiving payments from the Medi-Cal program for the primary purpose
of analyzing the information it collects and disseminating its
conclusions to local law enforcement agencies and to regulatory and
licensing authorities.
(k) For purposes of this section, "bureau" means the Bureau of
Medi-Cal Fraud in the Office of the Attorney General.