Dive Brief:

• A managed care company, an integrated health system and two nonprofit health systems in California have agreed to pay a combined $70.7 million to settle allegations of violating the federal False Claims Act, according to a Department of Justice release.
• The organizations, while not admitting liability, allegedly used funds intended for the states’ Medicaid adult expansion program in 2014 and 2015 for services that were duplicative or not allowed to avoid returning unused funds, according to the DOJ release.
• Ventura County Medi-Cal Managed Care Commission, which does business as Gold Coast Health Plan, will pay $17.2 million to the U.S. Ventura County will pay $29 million to the U.S., Dignity will pay $10.8 million to the U.S. and $1.2 million to the state and Clinicas will pay $11.25 million to the U.S. and $1.25 million to the state.

Dive Insight:

The DOJ has recently targeted healthcare fraud related to the COVID-19 pandemic, and in July announced criminal charges against 36 defendants for schemes related to telemedicine, cardiovascular and cancer genetic testing and durable medical equipment adding up to more than $1.2 billion.

The claims settled in California relate to the state’s adult Medicaid population expansion that occurred back in 2014.

Under the Affordable Care Act, California’s Medicaid program was expanded to cover the previously uninsured adult expansion population of adults between the age of 19 to 64 without dependents and with annual...

Read Full Story: https://www.healthcaredive.com/news/california-gold-coast-ventura-dignity-cli...