Medicare Overseer in California Indicted

A top executive of a firm hired by the federal government to oversee the Medicare program in California was indicted Friday on charges of falsely stating that the firm had reviewed more than 100,000 claims from the elderly and disabled.

A federal grand jury charged Alan L. Snodgrass, 37, a vice president of California Medical Review Inc., with two counts of making false statements in September and October, 1986.

The Health Care Financing Administration hired the firm in 1984 to watch over Medicare in California as part of an effort to crack down on poor patient care and to control costs.

The agency, which is part of the Department of Health and Human Services, extended the firm’s contract in April, even as the criminal investigation was under way.

In addition to the criminal charges announced Friday, the federal government last year joined a civil suit brought by two whistle-blowers who had worked at the company.

Snodgrass is a defendant in the civil suit, as is the firm and the chief executive officer. It was not clear Friday whether the firm or other executives will also face criminal indictment, though Assistant U.S. Atty. Ross W. Nadel said an investigation is continuing.

The two-page indictment accuses Snodgrass of falsely reporting that 107,000 Medicare claims had been reviewed. Snodgrass, then director of review for the firm, also was charged with causing an employee to make false statements.

The indictment does not say how many claims were reviewed.

San Diego defense attorney Michael Lipman said Snodgrass will plead not guilty, adding that “ultimately, in the end, my client will be vindicated.” Snodgrass has been placed on leave pending the outcome of the case.

“There have been no illegal acts committed,” Lipman said. “Dealing with HCFA is a nightmare in and of itself.”

The firm’s president, Dr. Don Gartman, said in a statement Friday that the organization “regrets” the indictment of Snodgrass and “anticipates that he will ultimately be vindicated.” Gartman described Snodgrass as a “diligent and capable employee.”

Gartman said California Medical Review “neither authorized nor engaged in any misconduct or criminal wrongdoing in connection with its Medicare review contract with the federal Health Care Financing Administration.”

Elliott Kramer, regional inspector general for investigations in the Department of Health and Human Service’s San Francisco office, said the case centers on the failure of California Medical Review to review tens of thousands of patient-care records in 1986, potentially “jeopardizing” the well-being of Medicare patients.

“As far as we know, it was an isolated instance,” Kramer said. “We don’t think it is continuing at this point or was done subsequent to the time period involved.”

Kramer added that the next step “depends on what position Mr. Snodgrass and his attorney are going to take as a result of his indictment.”