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Metro Digest

Local News in Brief : Doctors Told to Make Individual Claims

September 10, 1988

A Los Angeles judge has ruled that California doctors whose Medi-Cal claims were improperly audited by the state must make individual claims for the millions of dollars in reimbursements owed them.

Superior Court Judge Miriam Vogel ruled that only members of the Union of American Physicians and Dentists, which sued the state Department of Health Services over its auditing methods, can make the claims.

Deputy Atty. Gen. Harlan Van Wye said as much as $31 million may be reimbursed to as many as 2,000 physicians and dentists in private practice.

The doctors' union sued the state, objecting to its practice of auditing about 1% to 2% of patient files and extrapolating the findings to apply to all of a doctor's Medi-Cal claims, billing the doctor for alleged overcharges.

After the union contended that the Health Services Department did not properly adopt the new auditing method, the state on May 15 corrected the error by approving the sampling procedures under the state Administrative Procedures Act. The judge, however, invalidated all state audits conducted before May 15.

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