Fighting Fraud & Abuse in California's Health Care System

Curbing Medi-Cal Fraud And Elder Abuse

Arrests Six People for Medi-Cal Fraud. Attorney General Edmund G. Brown Jr. announced the arrests of six former employees of New Beginnings Recovery Treatment Center Inc., a Los Angeles-based drug and alcohol rehabilitation center, who "stole tens of thousands of dollars" from Medi-Cal by billing the state for drug treatment sessions that were never performed. ("Brown Arrests Six People for Medi-Cal Fraud," Press Release 3/23/2010)

Former Nursing Home Official Who Kidnapped Alzheimer's Patient and Stole Social Security Checks. Attorney General Edmund G. Brown Jr. announced that California Department of Justice agents arrested a former nursing home administrator, Concepcion "Connie" Pinco Giron, 51, of San Pablo, who "callously stole" more than $50,000 from six of her elderly patients, one of whom she kidnapped and held for nearly a year in order to take her pension and social security checks. ("Brown Arrests Former Nursing Home Official Who Kidnapped Alzheimer's Patient and Stole Social Security Checks," Press Release 3/22/2010)

Recovers $209 Million in Taxpayer Dollars in 2009 Medi-Cal Fraud Cases. Attorney General Edmund G. Brown Jr. announced that last year, his office recovered more than $209 million in "hard-earned taxpayer dollars" and secured 139 criminal convictions by aggressively investigating and prosecuting Medi-Cal fraud cases. ("Brown Recovers $209 Million in Taxpayer Dollars in 2009 Medi-Cal Fraud Cases," Press Release 3/8/2010)

Arrests Former Healthcare Clinic Manager for $2.2 Million Medi-Cal Rip-off. Attorney General Edmund G. Brown Jr. announced that he has filed criminal charges against the former manager of a Mount Shasta-based medical clinic who filed "bogus claims" under Medi-Cal for medical services that were never performed. ("Brown Arrests Former Healthcare Clinic Manager for $2.2 Million Medi-Cal Rip-off," Press Release 10/9/2009)

Criminal Charges Against Former Nursing Home Administrator in Kern Valley Elder Abuse Case. Attorney General Edmund G. Brown Jr. announced that Kern Valley Hospital administrator Pamela Ott was charged on eight felony counts of elder abuse today for allowing staff to forcibly administer psychotropic medications to patients for their own convenience, rather than for their patients' therapeutic interests. These actions are alleged to have resulted in the deaths of three nursing home residents. ("Brown Files Criminal Charges Against Former Nursing Home Administrator in Kern Valley Elder Abuse Case," Press Release 9/8/2009)

Files Criminal Charges Against 25 Individuals who Defrauded Medi-Cal. Attorney General Edmund G. Brown Jr. will today file criminal charges against two dozen in-home healthcare workers who "shamelessly bilked" the program by seeking payment for services to clients who were in fact dead, hospitalized or incarcerated. ("Brown Files Criminal Charges Against 25 Individuals who Defrauded Medi-Cal" Press Release, 5/21/09)

Files Criminal Charges Against Six for Hospice Scam that Defrauded $9 Million from Medicare and Medi-Cal. Attorney General Edmund G. Brown Jr. last night filed criminal charges against six individuals who paid healthy seniors to be admitted to a hospice for the terminally ill and then billed state and federal health care programs for "phantom procedures" never performed. ("Brown Files Criminal Charges Against Six for Hospice Scam that Defrauded $9 Million from Medicare and Medi-Cal" Press Release, 5/5/09)

Sued Seven Labs To Recover Hundreds Of Millions Illegally Diverted From Medi-Cal. Responding to a whistleblower's allegation of “massive Medi-Cal fraud and kickbacks,” Attorney General Brown joined legal action against seven private laboratories to recover hundreds of millions of dollars in illegal overcharges to the state's medical program for the poor. (“Brown Sues to Recover Hundreds of Millions of Dollars Illegally Diverted from Medi-Cal,” Press Release, 3/20/09)

Arrested Sixteen In $2 Million Medi-Cal Pregnancy Fraud. California Attorney General Brown announced the arrest of two physicians, three clinic administrators, and eleven assistants for luring pregnant women to a fake health clinic that fraudulently billed the state's Medi-Cal program for at least $2 million. (“Brown Announces Sixteen Arrests In $2 Million Medi-Cal Pregnancy Fraud,” Press Release, 2/27/08)

Arrested Nursing Home Employees Who Drugged Patients For Staff's Convenience. Attorney General Brown announced the arrests of a nurse, physician, and a pharmacist of a nursing home for “forcibly administering” psychotropic medications for their own convenience, rather than for their patients' therapeutic interests, actions that are alleged to have resulted in the deaths of three residents. (“Brown Announces Arrests of Nursing Home Employees Who Drugged Patients for Staff's Convenience,” Press Release, 2/18/09)

Arrested Suspects In $1.34 Million Medicare Fraud Case. Attorney General Brown announced the arrests of two individuals who “hatched a scheme” to file false claims under Medicare for medical services that were never performed. The two defendants -- a husband and wife -- owned and operated Balboa Therapy Center in San Diego. From July 2005 to June 2006, they, along with an accomplice, paid unsuspecting seniors at retirement homes $100 to obtain their insurance information and sign their names on blank medical forms. (“Attorney General Brown Announces Two Arrests in $1.34 Million Medicare Fraud Case,” Press Release, 2/13/09)

Arrested Four Suspects In $1.5 Million Medi-Cal And Medicare Scam. California Attorney General Brown announced the arrest of four suspects involved in a $1.5 million “fake healthcare clinic” scam. The suspects created a health clinic and recruited people to undergo unnecessary medical tests, with the sole purpose of filing false claims with Medi-Cal and Medicare…The suspects operated Scott Medical Center in Burbank and hired two physicians, Dr. Hollander and Dr. Castanon-Hill, to create a front for a physician assistant who falsified records and billed for procedures not actually performed. (“Brown Announces Arrests In Health Care Scam,” Press Release, 10/19/07)

Fighting Prescription Drug Abuse And Fraud

Investigation into Prescription-Drug Ring Linked to Former Child Star Corey Haim. In an ongoing crackdown on prescription-drug fraud and abuse, Attorney General Edmund G. Brown Jr. announced that his office is investigating an "illegal and massive prescription-drug ring" linked to the actor Corey Haim. ("Brown Announces Investigation into Prescription-Drug Ring Linked to Former Child Star Corey Haim," Press Release 3/12/2010)

Real-Time Statewide Prescription Drug-Monitoring System. Continuing his effort to curb prescription-drug abuse, Attorney General Edmund G. Brown Jr. today unveiled a new internet-based prescription-monitoring database that provides physicians, pharmacists and law enforcement officers a powerful technology to stop "drug seekers" from obtaining prescription drugs. ("Brown Unveils Real-Time Statewide Prescription Drug-Monitoring System," Press Release 9/15/2009)

Arrests Five for Conspiring to Fraudulently Obtain Thousands of Dangerous Prescription Pills. Attorney General Edmund G. Brown Jr. today announced that agents from the Bureau of Narcotic Enforcement today arrested five college-age individuals who conspired to fraudulently obtain thousands of "dangerous and potentially lethal" prescription drugs. ("Brown Arrests Five for Conspiring to Fraudulently Obtain Thousands of Dangerous Prescription Pills" Press Release, 4/30/09)

Announced Charges Against Howard K. Stern And Two Physicians For Conspiring To Illegally Furnish Controlled Substances To Anna Nicole Smith. Attorney General Brown announced that three individuals -- Howard K. Stern, Doctor Khristine Eroshevich, and Doctor Sandeep Kapoor – have been charged with conspiring to "repeatedly and excessively" furnish controlled substances to Anna Nicole Smith. Doctor Eroshevich and Doctor Kapoor falsified prescriptions and prescribed unwarranted amounts and combinations of highly addictive medications. Howard K. Stern, Ms. Smith's attorney and confidant, served as a vital link in obtaining, delivering, and administering these prescription drugs to Anna Nicole Smith. (“Brown Discusses Charges Filed Against Howard K. Stern and Two Physicians For Conspiring to Illegally Furnish Controlled Substances to Anna Nicole Smith,” Press Release, 3/13/09); (“Brown Announces Charges Against Howard K. Stern and Two Physicians For Conspiring to Illegally Furnish Controlled Substances to Anna Nicole Smith,” Press Advisory, 3/12/09)

Filed Charges Against Rancho Cucumonga Physician Accused Of Prescription Drug Fraud And Identity Theft. Attorney General Brown announced that charges were filed against Dr. Lisa Barden of Rancho Cucumonga, who broke the law and “wrecked havoc” on the lives of patients whose identities she stole to obtain highly addictive pain killers. The Riverside District Attorney's Office filed 276 felony counts including: commercial burglary, forgery, obtaining a controlled substance by fraud, possession of a controlled substance, insurance fraud and identity theft. Agents recovered from her home multiple prescription pads for 12 different doctors, as well as the personal information of 93 people who are alleged victims of identity theft. (“Attorney General Brown Announces Charges Against Physician Accused of Prescription Drug Fraud,” Press Release, 2/02/09)

Announced Statewide Crackdown On Prescription Drug Abuse. California Attorney General Brown announced a crackdown on rampant prescription drug fraud in California, including the top fifty abusers who average more than 100 doctor and pharmacy visits to collect massive quantities of addictive drugs like Valium, Vicodin, and Oxycontin. (“Atty. General Brown Cracks Down on Massive Prescription Drug Abuse,” Press Release, 9/30/08)

Busted Los Angeles County Prescription-Drug Ring. California Attorney General Brown announced the takedown of a drug-trafficking organization believed to be responsible for stealing the identities of local doctors to write false prescriptions for more than 11,000 pills of highly addictive drugs like Oxycontin and Vicodin. (“Attorney General Brown Announces Takedown of Los Angeles County Prescription- Drug Ring,” Press Release, 9/26/08)

Busted Lake Elsinore Doctor For Homicide Following Prescription Drug Fraud Investigation. Following a ten-month investigation, California Department of Justice special agents arrested Dr. Wesley Albert, 78, in Lake Elsinore for writing large quantities of prescription drugs which led to an individual's death in Riverside last year. Dr. Albert routinely prescribed more than 5 times the normal quantity of these drugs, sometimes up to 500 pills per person per month, and pocketed between $50 and $100 cash per prescription. (“State Agents Bust Doctor For Homicide Following Pharmaceutical Investigation,” Press Release, 5/06/08)

Protecting Patients And Fighting Deceptive Drug Marketing

Asks Court to Prevent Michael Jackson's Former Doctor Conrad Murray from Practicing Medicine. Attorney General Edmund G. Brown Jr. announced that his office has filed documents with the Los Angeles Superior Court on behalf of the California Medical Board to ask the court to restrict the medical license of Michael Jackson's former doctor, Conrad Murray, preventing him from practicing medicine in California until the criminal proceedings against him are completed. ("Brown Asks Court to Prevent Michael Jackson's Former Doctor Conrad Murray from Practicing Medicine ," Press Release 3/23/2010)

Subpoenas Health Plans over Claims Denials and Rate Hikes. Attorney General Edmund G. Brown Jr., who has an ongoing investigation into possibly illegal practices by some California health insurers, subpoenaed financial records and other documents from California's seven largest health insurance companies. ("Brown Subpoenas Health Plans over Claims Denials and Rate Hikes," Press Release 2/25/2010)

Wins $37.5 Million for California as Part of Nationwide Settlements with Pfizer over Illegal Kickbacks and Improper Marketing. Attorney General Edmund G. Brown Jr. announced that California will receive $34.8 million as part of a nationwide settlement with Pfizer, Inc., resolving civil and criminal charges that the company paid "illegal kickbacks" and conducted improper marketing campaigns for more than a dozen of its drugs. Under the nationwide agreement, Pfizer will pay a total of $2.3 billion to the federal government and all 50 states. ("Brown Wins $37.5 Million for California as Part of Nationwide Settlements with Pfizer over Illegal Kickbacks and Improper Marketing," Press Release 9/2/2009)

Required Bayer To Launch $20 Million Ad Campaign To Correct Misleading Information About Oral Contraceptive. Attorney General Brown announced an agreement requiring Bayer Corporation to stop a “deceptive ad campaign” regarding an oral contraceptive, “Yaz” and obligating the company to spend $20 million publicly correcting misleading assertions about the product… Bayer claimed the drug could treat symptoms related to premenstrual syndrome (PMS), and acne, in addition to anxiety, tension, irritability, moodiness, fatigue, headaches, and muscle aches. None of these claims have been approved by the Food and Drug Administration (FDA). (“Brown Requires Bayer to Launch $20 Million Ad Campaign to Correct Misleading Information about Oral Contraceptive,” Press Release, 2/09/09)

Joined Lawsuit Against Bush Administration’s Attack On Contraception And Abortion Rights. California Attorney General Brown joined a lawsuit against the United States Department of Health and Human Services (DHHS) to halt the implementation of a Bush Administration “midnight regulation” that could potentially “endanger a woman's right to contraception,” including emergency contraception given to rape victims… Poised to take effect on the day of President-Elect Barack Obama's inauguration, the regulation undercuts state contraception laws and jeopardizes billions of dollars in federal public health money. (“Attorney General Brown Seeks to Block Bush Administration Attack on Contraception and Abortion Rights,” Press Release, 1/15/09)

Recovered Millions For Medi-Cal Program From Eli Lilly Following Deceptive Drug Marketing. Attorney General Brown announced that California will recover $112 million for its Medi-Cal program as part of a national settlement with Eli Lilly and Company for the unlawful off-label marketing of its anti-psychotic drug Zyprexa, which the company aggressively marketed for such unapproved uses such as treatment for depression, anxiety, irritability, disrupted sleep, nausea and gambling… In October 2008, the California Attorney General entered a settlement with Eli Lilly over the Zyprexa marketing campaign. In his original complaint, Attorney General Brown alleged that Eli Lilly engaged in unfair and deceptive practices when it marketed Zyprexa for off-label uses and failed to adequately disclose the drug's potential side effects (including diabetes and hyperglycemia) to healthcare providers. Under this settlement, Eli Lilly agreed to change its marketing practices and to cease promotion of its off-label uses. (“Attorney General Brown Announces California Will Recover $112 Million for Medi-Cal Program from Eli Lilly Settlement,” Press Release, 1/15/09); (“Attorney General Brown Announces $62 Million Multi-State Settlement with Eli Lilly,” Press Release, 10/07/08)

Joined Agreement Forcing Airborne To Stop Marketing Its Products As A Cure For The Common Cold. California Attorney General Brown joined with 32 other state attorneys general in announcing a landmark $7 million settlement with Airborne, Inc. that forces the company to stop advertisements that “dramatically misrepresented” its dietary supplements as cold remedies. (“Attorney General Brown Joins Agreement Forcing Airborne to Stop Marketing its Products as a Cure for the Common Cold,” Press Release, 12/16/08)

Announced $58 Million Merck Settlement To Change Deceptive TV Drug Advertisements. California Attorney General Brown announced a “groundbreaking settlement” with Merck & Co. which requires the pharmaceutical manufacturer to obtain Federal Drug Administration approval before running any television drug advertisements for new pain medications. The settlement resolves 30 state lawsuits challenging Merck's marketing practices for Vioxx, a non-sterodial anti-inflammatory drug used to treat symptoms of arthritis as well as chronic and acute pain. (“$58 Million Merck Settlement To Change Deceptive TV Drug Advertisements,” Press Release, 5/20/08)

Announced $8 Million, Multi-State Settlement with Bayer Corporation to Resolve Safety Risk Disclosure Of Cholesterol Drug. Attorney General Jerry Brown announced an $8 million, 30-state settlement with Bayer Corporation that will resolve an enforcement action initiated because of Bayer's failure to adequately disclose safety risks associated with the use of Baycol, a drug used to lower cholesterol that was pulled from the market in August 2001. (“Attorney General Brown Announces $8 Million, Multi-State Settlement with Bayer Corporation to Resolve Safety Risk Disclosure of Cholesterol Drug,” Press Release, 1/23/07)

Curbing Prescription Drug Price Inflation And Illegal Industry Collusion

$22.5 Million Settlement Against Pharmaceutical Companies that Blocked Generic Drugs. Attorney General Edmund G. Brown Jr. and 23 other state attorneys general announced a $22.5 million settlement with pharmaceutical giants Abbott and Fournier after the companies "illegally blocked" cheaper generic substitutes for the cholesterol-reducing drug Tricor. ("California and 23 States Reach $22.5 Million Settlement Against Pharmaceutical Companies that Blocked Generic Drugs," Press Release 1/7/2010)

Announced $23 Million Drug Price Settlement With Bristol Myers-Squibb. Attorney General Brown announced that California will receive $23 million of a $515 million nationwide settlement with Bristol-Myers Squibb. The settlement resolves allegations that the company reported “grossly inflated” drug wholesale prices to California's Medicaid program in an effort to maintain its market share of prescription drugs. (“Brown Announces $23 Million Drug Price Settlement With Bristol Myers-Squibb,” Press Release, 7/15/08)

Sued Abbott And Fournier for Blocking Generic Cholesterol Drug. California Attorney General Brown sued Abbott Laboratories and French drug company Fournier for devising “an elaborate scheme” to block less expensive generic versions of TriCor, a drug that controls cholesterol. (“Brown Sues Abbott And Fournier for Blocking Generic Cholesterol Drug,” Press Release, 3/18/08)

Settled Antitrust Lawsuit Against Barr Pharmaceuticals. California Attorney General Brown settled an antitrust lawsuit that charged Barr Pharmaceuticals with taking $20 million for keeping off the market a cheaper, generic version of the oral contraceptive Ovcon. (“Brown Settles Antitrust Lawsuit Against Barr Pharmaceuticals,” Press Release, 2/25/08)

Announced Multi-Million Dollar Settlement With Prescription Management Company That Profited By Tricking Doctors Into Changing Patient Prescriptions. California Attorney General Brown announced a multi-million dollar settlement with Caremark, resolving allegations that the prescription management company tricked doctors into switching patients to different brand name drugs in exchange for secret rebates from drug manufacturers… Under the settlement, Caremark must reimburse patients for any out-of-pocket expenses related to drug changes and inform patients if switching drugs will increase copayments. (“Brown Settles Lawsuit Against Major Drug Prescription Company,” Press Release, 2/14/08)