California Attorney General Rob Bonta announced that 103 felony cases were filed against In-Home Supportive Services (IHSS) providers for allegedly defrauding the Medi-Cal program out of more than $4.5 million. The California Department of Justice, in partnership with the state Department of Health Care Services, investigated providers from Butte County to San Diego County.
The alleged fraud involved providers claiming to have delivered care while members were admitted to hospitals or skilled nursing facilities also paid for by Medi-Cal. The investigation used data analytics and claims review to develop leads.
IHSS, funded through Medi-Cal, serves over 900,000 seniors and individuals with disabilities annually, allowing beneficiaries to remain in their homes rather than entering nursing facilities. According to the state, home-based care reduces public spending by approximately $100,000 per person annually compared to nursing facility care.
Bonta said the charged providers represent a small fraction of the IHSS caseload and that the enforcement action demonstrates California has systems to hold bad actors accountable. "Any abuse of Medi-Cal jeopardizes funding for our most vulnerable residents," he said.
The charged providers came from Butte, Contra Costa, Fresno, Kern, Lake, Los Angeles, Napa, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Santa Clara, Solano, Sonoma, and Tulare counties.