SOUTHERN CALIFORNIA — The U.S. Department of Justice has filed a lawsuit against Rancho Cucamonga-based Inland Empire Health Plan, alleging the large not-for-profit submitted false claims to California’s Medicaid program.
According to the complaint filed Sept. 17, attorneys representing the federal government claim that IEHP "illegally" spent "hundreds of millions of dollars of surplus [federal] funding in a fraudulent scheme designed to pad its own coffers."
IEHP touts itself as one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid public health plan in the country. Now in its 27th year, IEHP supports more than 1.5 million Riverside and San Bernardino County residents enrolled in Medicaid or IEHP DualChoice (those with both Medi-Cal and Medicare), according to the organization's website.
The federal government's lawsuit stems from alleged misdoings by IEHP that date back a decade to the dawning of Medicaid Expansion.
Beginning in January 2014, Medi-Cal — California's health care program funded by Medicaid — was expanded to cover the previously uninsured. Dubbed “Medi-Cal Expansion,” the program provided health care coverage for very low-income adults of all ages. Medicaid provides health care coverage for the neediest U.S. residents.
The federal government fully funded the expansion program for the first three years, and IEHP received funding to serve its clients.
If IEHP did not spend at least 85% of those funds on "allowed...
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