News Summary
Orange County is investigating allegations of overbilling practices by 360 Clinic, a COVID testing vendor. An internal review raised concerns about duplicate claims and payments covered by other insurance. The audit, initiated after a whistleblower report, showed significant discrepancies in billing. As scrutiny heightens, 360 Clinic denies the allegations. The previous supervisor faces prison time for corruption, adding to the controversy surrounding the clinic and its operations.
Orange County Investigates COVID Testing Overbilling Scandal
In a surprising twist to the COVID testing saga, the Orange County Health Care Agency is calling for a thorough forensic audit after a recent investigation raised serious questions about the billing practices of a COVID testing vendor, 360 Clinic. This company was initially drafted into service to manage drive-through testing and quickly became a household name in the health care landscape of the county.
Internal Review Raises Eyebrows
The internal review, spearheaded by compliance officer Kelly Sabet, unearthed alarming evidence of overbilling by 360 Clinic, which is officially called 360 Health Plan. One of the eye-catching claims from the review indicated that the county had been billed multiple times for the same service. Moreover, it pointed out that claims were submitted for payment even after they had been covered by other insurance companies. This raises the question: how could such discrepancies slip through the cracks?
A Compliance Officer’s Concerns
Reports noted that several health staff members had previously expressed concerns about 360 Clinic’s billing practices. However, under the direction of former Supervisor Andrew Do, they were advised to proceed with payments regardless. Unfortunately for Andrew Do, he now faces serious repercussions after being sentenced to five years in prison for his corruption, having accepted over $550,000 in bribes to fast-track disaster relief funds. His actions only intensify the scrutiny facing the county’s dealings with 360 Clinic.
Whistleblower Reports Kick Off Investigation
The floodgates opened for inquiry when an anonymous report was made to the county’s fraud hotline in August 2024. This set off a compliance probe that meticulously analyzed contracts, invoices, and emails connected to 360 Clinic. The investigation also involved interviews with relevant personnel to go beyond the paperwork and dig into what was genuinely happening behind the scenes.
Evidence of Duplicate Pay Requests
The audit uncovered multiple instances where the county made duplicate payments for the same claims. To illustrate this, one highlighted case involved a claim that was denied for “incorrect insurance.” This claim was then passed on to the county for payment and bizarrely resubmitted to another insurance carrier down the line. Alarmingly, concerns also lingered that 360 Clinic might have billed both the county and the federal government for identical services.
Pressure Mounts on 360 Clinic
Despite the mounting evidence against them, a spokesperson for 360 Clinic dismisses the allegations as baseless, asserting that the internal review contained unsubstantiated claims. However, the county is actively pursuing measures to seek reimbursement from the clinic for any potential overpayments. This shows just how serious the situation has become.
Previous Legal Troubles and Allegations
Adding to the chaos surrounding 360 Clinic, a whistleblower lawsuit was filed last year that accused the company of trying to solicit illegal kickbacks and defraud federal health programs. Compounding the issue, key partners of the company involved have faced their own legal battles and allegations of misconduct. This includes a notable case where a partner pleaded guilty to health care fraud unrelated to the clinic’s services. The entire situation has cast a long shadow over the clinic’s operations.
Plans for Future Investigations
As if this drama were not enough, the scrutiny has even led to the cancellation of a senior center planned by an affiliate of 360 Clinic called 360 PACE, raising further questions about the organization’s integrity. Internal investigations have corroborated findings from previous inquiries, suggesting a deeply rooted problem with oversight in a whopping $5 million contract.
The Way Forward
As the county grapples with the implications of these revelations, officials from CalOptima are also reviewing connections between state health regulators and the individuals behind 360 Clinic. With all eyes on these criticisms, further investigations are likely to unfold as they work to confirm the validity of the accusations against 360 Clinic and its principals.
One thing is for sure: as this story continues to develop, the residents of Orange County will be watching closely to see how these allegations are addressed and what measures will be put in place to prevent such occurrences in the future.
Deeper Dive: News & Info About This Topic
HERE Resources
Unearthing Trouble in Orange County: Former Supervisor’s COVID-19 Contracts
Orange County: A Rising Scandal in Local Government
Orange County Lawsuit Reveals COVID-19 Fund Misuse
Additional Resources
- LAist: Orange County Investigation Finds COVID Double Billing
- Wikipedia: COVID-19 pandemic
- OC Register: OC Health Care Official Calls for Full Audit
- Google Search: Orange County COVID health care audit
- OC Register: Another OC COVID Contractor Accused of Fraud
- Google Scholar: COVID fraud lawsuit Orange County
- LAist: OC Health Officials Allege State Regulator Threatened Board Member
- Encyclopedia Britannica: healthcare fraud
- LAist: Orange County Be Well Health Care Audit Contract
- Google News: Orange County health care scandal
