{"id":53962,"date":"2023-08-30T20:06:15","date_gmt":"2023-08-31T03:06:15","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=53962"},"modified":"2023-08-30T20:06:15","modified_gmt":"2023-08-31T03:06:15","slug":"calif-health-care-provider-agrees-to-pay-5-million-for-alleged-false-claims-to-medicaid","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=53962","title":{"rendered":"Calif. Health Care Provider Agrees to Pay $5 Million for Alleged False Claims to Medicaid"},"content":{"rendered":"

LOS ANGELES\u00a0<\/strong><\/span><\/p>\n

\"blackLompoc Valley Medical Center (LVMC), a California healthcare district that operates multiple healthcare providers, including a hospital and several clinics, has agreed to pay $5 million to resolve allegations that it violated the federal False Claims Act and the California False Claims Ac<\/span><\/p>\n

They allegedly caused 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

With this and several prior settlements, the United States has now recovered $95.5 million in connection with this investigation of entities in Santa Barbara and San Luis Obispo counties. CenCal, Cottage Health System, Sansum Clinic, and Community Health Centers of the Central Coast previously paid $68 million<\/a>, and Dignity Health and Twin Cities Community Hospital and Sierra Vista Regional Medical Center, two subsidiaries of Tenet Healthcare Corporation\u00a0previously paid $22.5 million<\/a>, to settle similar False Claims Act allegations.<\/span><\/p>\n

There has been no determination of liability, according to officials.<\/span><\/p>\n

\"\"Beginning in January 2014, officials stated that 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), Santa Barbara San Luis Obispo Regional Health Authority, doing business as CenCal Health (CenCal), arranged for the provision of health care services as a county-organized health system under California\u2019s Medicaid program (Medi-Cal) in Santa Barbara and San Luis Obispo counties by contracting with providers such as LVMC to provide health care services to Medi-Cal patients. <\/span><\/p>\n

\"\"Under its contractual arrangement with DHCS, CenCal received funding to serve the Adult Expansion population. <\/span><\/p>\n

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 settlement resolves allegations that LVMC knowingly caused the submission of false claims to Medi-Cal pursuant to agreements executed by LVMC with CenCal for \u201cEnhanced Services\u201d that LVMC purportedly provided to Adult Expansion Medi-Cal members between January 1, 2014 and June 30, 2016. <\/span><\/p>\n

\"gavel,The United States and California alleged that LVMC claimed and received payments pursuant to those agreements that were not for \u201callowed medical expenses\u201d permissible under the contract between DHCS and CenCal, were pre-determined amounts that did not reflect the fair market value of any Enhanced Services provided by LVMC, and\/or the Enhanced Services were duplicative of services already required to be rendered by LVMC. <\/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

\u201cThis resolution underscores our steadfast resolve to hold accountable health care providers that seek to undermine the integrity of the Medicaid program,\u201d said U.S. Attorney Martin Estrada. \u201cWe will ensure that the nearly $100 million recovered in this case remains in government health care programs, and not in the hands of unscrupulous health care systems and providers.\u201d<\/span><\/p>\n

\u201cThe Medicaid program provides critical health care services to those most in need,\u201d said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department\u2019s Civil Division. \u201cWe will hold providers accountable when they knowingly divert Medicaid funds from their intended purpose.\u201d<\/span><\/p>\n

\u201cFederal health care programs are intended to ensure that millions of Americans have access to high quality, medically necessary care,\u201d said Special Agent in Charge Timothy B. DeFrancesca of the Department of Health and Human Services Office of Inspector General (HHS-OIG). \u201cProtecting federal health care funds from fraud, waste, and abuse is at the center of HHS-OIG\u2019s mission, and we are committed to ensuring that these valuable resources are available to patients as intended.\u201d<\/span><\/p>\n

\u201cMedi-Cal supports millions of Californians by providing for the critical healthcare they rely on every day,\u201d said California Attorney General Bonta. \u201cWhen providers misuse Medi-Cal funding, they siphon away much-needed resources from vulnerable, deserving patients.”<\/span><\/p>\n

The civil settlement includes the resolution of claims brought under the\u00a0qui tam,<\/i>\u00a0or \u201cwhistleblower,\u201d 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. \u00a0<\/span><\/p>\n

Dr. Bordas will receive approximately $950,000 as his share of the federal recovery from the LVMC settlement.<\/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. <\/span><\/p>\n

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

Assistant U.S. Attorney Jack D. Ross of the Civil Fraud Section and Justice Department Trial Attorneys Mary Beth Hickcox-Howard and Tiffany L. Ho of the Civil Division\u2019s Commercial Litigation Branch, Fraud Section handled this case.<\/span><\/p>\n

\n

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LOS ANGELES\u00a0 Lompoc Valley Medical Center (LVMC), a California healthcare district that operates multiple healthcare providers, including a hospital and several clinics, has agreed to pay $5 million to resolve allegations that…<\/p>\n","protected":false},"author":1,"featured_media":53963,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-53962","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"yoast_head":"\nCalif. 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