The involved organizations include Gold Cost Health Plan, a COHS that contracts to arrange healthcare services under Medi-Cal in Ventura County; Ventura County, which owns and operates the integrated healthcare system Ventura County Medical Center; Dignity Health, a not-for-profit hospital system operating two acute care hospitals in Ventura County; and Clinicas del Camino Real Inc., a nonprofit healthcare organization in Ventura County.

California expanded Medicaid under the Affordable Care Act in January 2014. This extended Medi-Cal coverage to adults between 19 and 64 with incomes up to 133 percent of the federal poverty level.

The federal government funded the program’s expansion for the first three years. Per contracts with California’s Department of Health Care Services (DHCS), California county organization health systems were required to spend at least 85 percent of the federal funds on “allowed medical expenses” for its adult expansion population.

If a county organized health system did not spend at least 85 percent of the funds, it was required to pay the state the difference between 85 percent and what it spent. The state would then have to return that amount to the federal government.

Three separate settlements have been reached to resolve allegations that Gold Cost, Ventura County, Dignity Health, and Clinicas submitted false claims to Medi-Cal for additional services provided to adult expansion members between January 1, 2014, and May 31, 2015.

According to...

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