{"id":53474,"date":"2023-06-29T20:54:46","date_gmt":"2023-06-30T03:54:46","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=53474"},"modified":"2023-06-29T20:54:46","modified_gmt":"2023-06-30T03:54:46","slug":"three-healthcare-providers-and-others-agree-to-pay-68-million-for-alleged-false-claims-to-medi-cal","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=53474","title":{"rendered":"Three Healthcare Providers and Others Agree to Pay $68 Million for Alleged False Claims to Medi-Cal"},"content":{"rendered":"

LOS ANGELES<\/span><\/strong><\/span><\/p>\n

\"\"A county-organized health system (COHS) that arranges services for Medi-Cal enrollees in Santa Barbara and San Luis Obispo counties and three Central Coast health care providers have agreed to pay a total of $68 million, officials stated.<\/span><\/p>\n

The settlement resolves allegations that they violated the False Claims Act and the California False Claims Act by submitting or causing the submission of false claims to Medi-Cal related to Medicaid Adult Expansion under the Patient Protection and Affordable Care Act (ACA).<\/span><\/p>\n

The four entities that entered into settlement agreements with the United States and the State of California are the following:<\/span><\/p>\n

\"\"
Cottage Hospital, Santa Barbara, California<\/figcaption><\/figure>\n

Santa Barbara San Luis Obispo Regional Health Authority, doing business as CenCal Health, a COHS that contracts to arrange for the provision of health care services under Medi-Cal, which is California\u2019s Medicaid program<\/span><\/p>\n

Cottage Health System, a not-for-profit hospital network operating in Santa Barbara County<\/span><\/p>\n

Sansum Clinic is a non-profit outpatient clinic in Santa Barbara County; and Community Health Centers of the Central Coast (CHC), a non-profit community health center in Santa Barbara and San Luis Obispo counties.<\/span><\/p>\n

The claims resolved by the settlements are allegations only and there has been no determination of liability.<\/span><\/p>\n

\"white<\/p>\n

The settlement agreements were executed earlier this month, and late Wednesday, a federal judge unsealed the \u201cwhistleblower\u201d case naming the entities.<\/span><\/p>\n

Pursuant to the ACA, beginning in January 2014, Medi-Cal was expanded to cover the previously uninsured \u201cAdult Expansion\u201d population \u2013 adults between the ages of 19 and 64 without dependent children with annual incomes up to 133% of the federal poverty level. <\/span><\/p>\n

The federal government fully funded the expansion coverage for the program’s first three years. <\/span><\/p>\n

Under contracts with California\u2019s Department of Health Care Services (DHCS), if CenCal did not spend at least 85% of the funds it received for the Adult Expansion population on \u201callowed medical expenses,\u201d CenCal was required to pay back to the state the difference between 85% and what it actually spent. <\/span><\/p>\n

California, in turn, was required to return that amount to the federal government.<\/span><\/p>\n

\"\"The four settlements resolve allegations that CenCal, Cottage, Sansum, and CHC knowingly submitted or caused the submission of false claims to Medi-Cal for \u201cEnhanced Services\u201d that were purportedly provided to Adult Expansion Medi-Cal members: by Cottage between January 1, 2014 and June 30, 2016; by Sansum and CHC between January 1, 2015 and June 30, 2016; and by certain other healthcare providers between January 1, 2014 and June 30, 2016.<\/span><\/p>\n

The United States and California further alleged that the payments were unlawful gifts of public funds in violation of the California Constitution.<\/span><\/p>\n

As a result of the settlements, CenCal will pay $49.5 million, Cottage will pay $9 million, Sansum will pay $4.5 million, and CHC will pay $3.15 million to the United States. In addition, California will receive payments totaling $1.85 million.<\/span><\/p>\n

\u201cThese historic settlements demonstrate our steadfast efforts to eradicate fraud involving Medicaid Adult Expansion,\u201d said U.S. Attorney Martin Estrada. \u201cHealth care systems and providers are on notice that the False Claims Act provides us with a powerful tool to ensure that taxpayer-funded health care programs are used for patient care, and not for furtive financial gain.\u201d<\/span><\/p>\n

\u201cFederal health care programs are an important resource for millions of Americans to receive medical care,\u201d said Timothy B. DeFrancesca, Special Agent in Charge at the Department of Health and Human Services, Office of Inspector General (HHS-OIG). \u201cHHS-OIG will continue to ensure that federal health care funds are used as intended and protected from fraud, waste, and abuse.\u201d<\/span><\/p>\n

The civil settlements include the resolution of claims brought under the\u00a0qui tam<\/i>\u00a0or whistleblower provisions of the False Claims Act by Julio Bordas, CenCal\u2019s former medical director. <\/span><\/p>\n

Under the act, a private party can file an action on behalf of the United States and receive a portion of any recovery. <\/span><\/p>\n

Dr. Bordas will receive approximately $12.56 million as his share of the federal recovery.<\/span><\/p>\n

The United States\u00a0previously settled similar allegations<\/a>\u00a0against Dignity Health (which operates Arroyo Grande Community Hospital, French Hospital Medical Center in San Luis Obispo, and Marian Regional Medical Center in Santa Maria) and Twin Cities Community Hospital and Sierra Vista Regional Medical Center, two subsidiaries of Tenet Healthcare Corporation, relating to payments they received from CenCal under the Adult Expansion program.<\/span><\/p>\n

The investigation of this matter illustrates the government\u2019s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).<\/span><\/p>\n

\n","protected":false},"excerpt":{"rendered":"

LOS ANGELES A county-organized health system (COHS) that arranges services for Medi-Cal enrollees in Santa Barbara and San Luis Obispo counties and three Central Coast health care providers have agreed to pay…<\/p>\n","protected":false},"author":1,"featured_media":53475,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3255],"tags":[],"class_list":["post-53474","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-federal-court"],"yoast_head":"\nThree Healthcare Providers and Others Agree to Pay $68 Million for Alleged False Claims to Medi-Cal<\/title>\n<meta name=\"description\" content=\"LOS ANGELES A county-organized health system (COHS) that arranges services for Medi-Cal enrollees in Santa Barbara and San Luis Obispo counties and three\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" 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