加州总检察长 Bonta 宣布103名居家护理员被控重罪：涉骗 Medi-Cal 超450万美元、涉及全州17县
加利福尼亚州总检察长 Rob Bonta 10月22日在洛杉矶县 Los Angeles 宣布，全州针对居家支持服务（IHSS）欺诈的执法已对103名 IHSS 护理员提出重罪指控，指控他们骗取 Medi-Cal 超过450万美元，涉案会员分布在全州17个县。
加州司法部称，被指控的手法是：护理员在会员住院于急症医院或专业护理机构、相关费用已由 Medi-Cal 支付的同一时段，仍向 Medi-Cal 申报居家护理工时。加州司法部与负责管理 Medi-Cal 的加州医疗保健服务部合作，通过数据分析与理赔审查梳理线索，司法部的数据挖掘审计员、特工与调查员调查了从 Butte County 到 San Diego County 的护理员。涉案会员所在的17个县为 Butte、Contra Costa、Fresno、Kern、Lake、Los Angeles、Napa、Orange、Riverside、Sacramento、San Bernardino、San Diego、San Joaquin、Santa Clara、Solano、Sonoma 与 Tulare。
IHSS 由 Medi-Cal 出资，每年服务超过90万名老年人与残障人士，让受益人留在家中而非进入长期护理机构；州政府称，这种居家模式经联邦批准，与护理机构照护相比每人每年约可节省10万美元公共开支。Bonta 说，IHSS 让父母能够照顾成年残障子女、让老年人能在家养老，是全州家庭的重要生命线，州政府要保护这条生命线；被指控的欺诈只占加州300亿美元 IHSS 预算的一小部分，但任何对 Medi-Cal 的滥用都会危及最弱势居民的资金。
负责此案的加州司法部 Medi-Cal 欺诈与老人虐待司在联邦财政年度2027年的经费中，75%来自美国卫生与公众服务部的拨款8,588万余美元，其余25%、2,862万余美元由加州出资。公众可通过该司投诉专线（800）722-0432举报疑似 IHSS 欺诈。司法部同时说明，刑事指控仅为指控，每名被告在被证明有罪之前均推定无罪。
California Attorney General Bonta Announces Felony Charges Against 103 IHSS Providers: Over $4.5 Million in Alleged Medi-Cal Fraud Across 17 Counties
California Attorney General Rob Bonta announced in Los Angeles, Los Angeles County, California, on October 22 that a statewide enforcement effort against fraud in the In-Home Supportive Services (IHSS) program has resulted in felony charges against 103 IHSS providers, who allegedly defrauded Medi-Cal out of over $4.5 million, with affected members living in 17 counties across the state.
According to the California Department of Justice, the alleged scheme involved providers billing Medi-Cal for care hours during periods when the member was admitted to an acute care hospital or skilled nursing facility that was also paid for by Medi-Cal. The state Department of Justice worked with the Department of Health Care Services, which administers Medi-Cal, reviewing referrals generated through data analytics and claims review; DOJ data mining auditors, special agents and special investigators investigated providers from Butte County to San Diego County. The members lived in 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.
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 long-term nursing facilities. The state says the federally approved home-based model reduces public spending by approximately $100,000 per person annually compared with nursing facility care. Bonta said IHSS enables parents to care for adult children with disabilities and allows elderly individuals to age in place, calling it a vital lifeline for families across the state that his office is protecting; he said the alleged fraud represents a small fraction of California's $30 billion IHSS budget, but any abuse of Medi-Cal jeopardizes funding for the state's most vulnerable residents.
The Division of Medi-Cal Fraud and Elder Abuse, which handled the effort, receives 75 percent of its funding from the U.S. Department of Health and Human Services, totaling $85,882,152 for federal fiscal year 2027, with the remaining 25 percent, $28,627,384, funded by the State of California. Suspected IHSS fraud can be reported to the division's complaint line at (800) 722-0432. The Department of Justice notes that the charges are only allegations, and every defendant is presumed innocent until proven guilty.
来源：GSM·美国（原文链接）
图片来源：Los Angeles 市政厅（资料图，加州总检察长此次全州执法结果在 Los Angeles 宣布）。照片：Busition，CC BY 4.0，经 Wikimedia Commons
