Hospital Says UCI Internal Investigation of Its Doctors Finds No Medi-Cal Fraud

An internal probe of UCI Medical Center doctors suspected of illegally billing Medi-Cal for prescribing research drugs to patients has found “no evidence of fraud or misconduct,” a hospital spokeswoman said Friday.

Karen Young, a UCI Medical Center spokesperson, said the investigation found no evidence to substantiate charges that doctors illegally billed Medi-Cal for research drugs, falsely labeled drugs or kept two sets of medical records to hide the practice from Medi-Cal, which does not pay for research.

Research drugs were prescribed to Medi-Cal patients, Young said, but they were never charged to the Medi-Cal program.

Young did not know what effect, if any, the hospital’s audit will have on a separate investigation of similar charges by the state attorney general’s bureau of Medi-Cal fraud and patient abuse. But a spokesman in the attorney general’s office said that despite the hospital’s findings, the inquiry into alleged Medi-Cal fraud and falsification of records at UCI Medical Center will continue.

“Their results will have no impact at all. We’re still going to proceed with our preliminary investigation,” said Christopher Rodriguez, the attorney general’s investigator in charge.

Complaints that helped launch the hospital’s internal probe were made in February by two UCI psychiatrists and an administrator for the psychiatric department. Letters written by them, copies of which were obtained by The Times, were sent to Dr. William E. Bunney, who later requested the audit, and Dr. Donald B. Summers, the chairman and vice chairman, respectively, of UCI’s department of psychiatry and human behavior.

The letters indicated that ethical and legal concerns about the alleged practices had been raised months earlier. The concern, according to sources, was that the practice of administering the research drug Zacopride to patients would jeopardize Medi-Cal funding for those patients’ treatment.

Andrew Yeilding, director of internal audits, was quoted by Young as saying they interviewed doctors that prescribed the research drug as part of their treatment but that Medi-Cal was never billed for the prescriptions.

“That was all according to standard procedure,” Young said. “(Yeilding) pointed out it would be kind of crazy to do something like that because it could jeopardize the funding.”

The research compounds given to patients allegedly were falsely labeled Haldol, an anti-schizophrenic drug that is approved for use by Medi-Cal, sources had said.

Haldol is a brand name for the drug haloperidol, a tranquilizer used in the treatment of psychotic disorders, severe behavior problems in children, and the short-term treatment of hyperactivity in children, according to the Physician’s Desk Reference on prescription drugs.

But one employee in the psychiatric unit said that last September he noticed an unusual drug, Haldol-R, on a patient’s chart. When asked, he was told it stood for the research drug, Zacopride, and that the hospital staff “had changed the name” on the patient’s records.

Young said a hospital investigator found that “no one falsely labeled anything,” and that the hospital’s performance had conformed with state regulations.

“There weren’t two sets of medical records. There was one set of medical records and one set of research records but Yeilding said the practice conforms with state law,” Young said.

The detail is not minor, because the inquiries come at a time when the financially troubled UCI Medical Center is negotiating a new contract with state Medi-Cal authorities. Hospital officials are seeking higher reimbursement rates for treating Medi-Cal patients to help stem a nearly $12-million deficit the medical center reported for the year ending June 30.

The internal audit is part of a much larger review now being conducted by the hospital, Young said. The larger audit should be completed in two months.