$1 Million in UCSD Hospital Billings Probed

UC San Diego Medical Center is suspected of improperly billing the state for at least $1 million in medical care it gave to Mexican children, possibly after UCSD employees helped the parents come to this country and then coached them on how to qualify for free care, a state investigator said Monday.

An investigative report delivered to UCSD in August made the allegations regarding 30 children treated for heart problems at UCSD, said Larry Malm, chief investigator for the Department of Health Services in Southern California.

The number of cases could go as high as 100, Malm said.

The state has asked UCSD for an internal audit of the suspect cases and also asked the institution to halt billing on about $500,000 in care while the inquiry continues, Malm said.

He said the investigation, which began last March, has been marked by missing documents and a pronounced reluctance of UCSD officials to cooperate.

Investigators first arrived at the hospital on Friday, March 23, Malm said. By Monday, documents about a Tijuana clinic where UCSD doctors volunteer were missing from a file, he said.

“I’m surprised that the university did not react in good faith when we contacted them initially,” Malm said. “With any large institutional facility, my experience in the past is that they want to quickly get us out of their hair. And this one didn’t go that way.”

Malm said investigators were given key documents only after obtaining subpoenas and had to wait about two months before they were allowed access to staff members in the pediatric cardiology division.

Malm and UCSD officials met yesterday in San Diego.

In a written statement late Monday afternoon, after the meeting, hospital director Michael R. Stringer said the university had cooperated fully in the investigation from the start.

“The individuals in question have denied any wrongdoing in interview with the state and with my staff,” Stringer said in a written statement. “Without documented proof, we cannot assume that the individuals under scrutiny are guilty of violating institutional policy or state law.

“While we have pursued our own investigation as vigorously as possible . . . we have been hampered by the state’s reluctance to share with us the information that they had gathered,” he added.

This dispute over supporting documents began in August and concluded last Wednesday, when the state handed them over, Malm said. They had been withheld, he said, because investigators wanted to see how thorough a UCSD investigation would be without the aid of the documents.

Leslie Franz, chief spokeswoman for the hospital, said that, with the aid of the documents, UCSD officials hope to complete their investigation within two weeks.

“If there is clear evidence of misconduct on the part of individuals in the division of pediatric cardiology, we will promptly take any necessary action,” Stringer’s statement said.

Employees under investigation include two physicians, Dr. Lilliam M. Valdes-Cruz and Dr. Azucena Murillo, and a secretary, Mercedes A. Alvarado, Malm said.

The billings that concern state investigators were for Mexican children with heart defects who qualified for Medi-Cal or California Children’s Services medical care because their parents were living in this country.

Investigators suspect that the children were first seen in a Tijuana clinic where UCSD doctors volunteer, then given letters for immigration officials certifying that medical care given them at UCSD would be provided without taxpayer expense. The state eventually was billed for the care, however, after the parents established residency here.

Most of the cases were for poor children who might never have had access to such care otherwise. But one case being investigated is that of the infant son of a Mexican cattle rancher who is thought to own many thousands of acres, Malm said.

Malm said the investigation began several months ago after a meeting last February between representatives of the department and immigration officials. One San Diego official in Children’s Services was suspicious about a case at UCSD.

In his statement, Stringer said, it is the funding agency’s responsibility, not the health care provider’s, to determine the eligibility of patients for state funding.

“For any provider to make a special effort to screen Hispanic patients who seek care on the assumption that they are providing misleading information would not only be inappropriate, it would be discriminatory,” Stringer said.