Four Central Coast healthcare organizations paid $68 million to settle claims of alleged Medi-Cal fraud, the Department of Justice announced June 29, the result of a whistleblower case that originally implicated the organizations.
The department alleged that the organizations violated the False Claims Act and the California False Claims Act by submitting or causing the submission of false claims to Medi-Cal, a California health coverage program generally tailored to those in low-income brackets.
The four organizations are CenCal Health, a nonprofit that contracts with the state to administer Medi-Cal benefits through providers in San Luis Obispo and Santa Barbara counties; Sansum Clinic, a nonprofit outpatient provider in San Luis Obispo and Santa Barbara counties; Cottage Health, a nonprofit hospital network operating in Santa Barbara County; and Community Health Centers of the Central Coast (CHC).
CenCal will pay most of the $68 million — $49.5 million. Cottage will pay $9 million, Sansum $4.5 million, and CHC $3.15 million. A majority of the funds will go to the federal government. The state of California will receive $1.85 million.
Pursuant to the ACA, beginning in January 2014, Medi-Cal was expanded to cover the previously uninsured “Adult Expansion” population – adults between the ages of 19 and 64 without dependent children with annual incomes up to 133% of the federal poverty level. The federal government fully funded the expansion coverage for the first three...
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