News Summary
An internal investigation has revealed significant fraudulent billing practices by 360 Clinic, the COVID-19 testing partner for Orange County. Double and triple billing for services under a county contract raised concerns over oversight, leading to questions about more than $3 million in taxpayer funds. The probe, initiated by a tip, also highlighted missing payments and mismanagement. Calls for a forensic audit and repayment from the clinic are being recommended as various agencies continue to scrutinize the findings.
Santa Ana, California – An internal investigation has uncovered significant fraudulent billing practices by 360 Clinic, Orange County’s COVID-19 testing partner. The clinic was found to have double and triple billed for services under a county contract, leading to questions about the oversight of the lucrative agreement that generated over $3 million in taxpayer funds.
The investigation, spearheaded by Kelly Sabet, the county’s chief compliance officer, was prompted by a tip received through the Orange County Fraud Hotline. It revealed that 360 Clinic had issued a payment of $523,650 to the county that had surprisingly gone missing for more than three years. The county claims they never received the payment, while 360 Clinic insists it was delivered. The investigation noted a conspicuous lack of documentation supporting the existence of the missing check.
360 Clinic’s billing practices came under scrutiny when high-level county staff raised concerns about the clinic submitting the same claims multiple times to the county and receiving multiple payments for them. During their substantial testing operations throughout 2020 and 2021, 360 Clinic not only billed the county but also received payouts from private insurance and federal reimbursements, accumulating substantial taxpayer funds.
More than just billing mismanagement, the investigation brought to light the actions of former Supervisor Andrew Do, who overrode staff concerns and authorized payments to 360 Clinic for claims that had been denied by private insurers due to suspected overbilling. Andrew Do is currently serving a five-year prison sentence following a felony bribery charge linked to kickbacks from other county contractors.
In light of the findings, Sabet concluded that the county should seek repayment from 360 Clinic for the allegedly obtained funds and recommended a comprehensive forensic audit of the contract. The results of the investigation have since been forwarded to county counsel and the internal audit department for further action.
A spokesperson for 360 Clinic asserted that they were unaware of the investigation until approached by a local media outlet, downplaying the serious allegations as unsubstantiated. However, the investigation’s outcomes and the involvement of multiple regulatory agencies indicate this matter is far from resolved.
Throughout the contract, 360 Clinic periodically submitted lists of “uncollectible claims”, yet their patterns involved filing multiple claims for the same services, leading to significant concern among oversight officials. Blue Shield of California confirmed that numerous claims were denied due to either exceeding fee arrangements or insufficient information regarding medical necessity.
An internal memo revealed that staff within the county failed to adequately report potential issues regarding fraud, waste, or abuse linked to 360 Clinic. This lapse in reporting has led to broader questions about the oversight of the county’s agreement with the clinic and whether appropriate measures were implemented to protect taxpayer funds.
In a related development, Hang Nguyen, a state health regulator, pressed board members to back a health center initiative associated with 360 Clinic despite ongoing issues concerning its billing practices. This push faced increasing scrutiny from various stakeholders leading to a whistleblower lawsuit against 360 Health Plan, which has drawn attention from CalOptima’s board of directors.
In recent actions, CalOptima officials voted to rescind their support for the health center linked to 360 Clinic because of mounting concerns regarding the clinic’s business methods. Multiple regulatory agencies are now reviewing the investigation’s findings, resulting in substantial delays for projects connected to 360 Clinic and its affiliates.
Deeper Dive: News & Info About This Topic
HERE Resources
Investigation into COVID-19 Contracts in Orange County
Orange County Investigates Health Contract Fraud Allegations
CalOptima Health Board Member Faces Scrutiny Over Healthcare Center Endorsement
Additional Resources
- LAist: Orange County Investigation Finds COVID Double Billing
- Wikipedia: Fraud
- OC Register: Another OC COVID Contractor Accused of Fraud Scheme
- Encyclopedia Britannica: Malpractice
- LA Times: 360 Clinic Teams Up with Golden West College for COVID-19 Testing
- Google News: COVID-19 Fraud Schemes
- LA Times: 360 Clinic Expands Efforts to Combat COVID-19
- Google Search: COVID Fraud Investigation
