Gold Coast (aka Ventura County Medi-Cal Managed Care Commission) to pay $17.2 million to U.S. and California; providers that received allegedly illegal payments - Ventura County Medical Center, Dignity Health, and Clinicas del Camino Real Inc. - will pay an additional $53.5 million

The law firm of Lieff Cabraser Heimann & Bernstein, LLP announces a $70.7 million settlement of a False Claims Act whistleblower lawsuit against Gold Coast Health Plan and certain "favored" medical providers in California, in which Relators alleged that the defendants knowingly misused Medi-Cal funds they received in 2014 and 2015 for newly-enrolled adult Medi-Cal patients under the Affordable Care Act.

"Blowing the whistle on those defrauding the government is critically important," stated Lieff Cabraser partner Robert J. Nelson, who represented the whistleblowers in the case, "and often requires extreme courage and commitment, especially as here, where it took seven years from the time of the original whistleblowing to the achievement of these substantial, meaningful settlements."

Under "medical loss ratio" rules, Gold Coast was required to return to the government a certain percentage of monies that it did not ultimately use on health care for this Adult Expansion population. This mechanism allowed the government to adequately fund care for this newly-insured population knowing that any excess amounts would be returned. Instead of returning the funds to the government, relators alleged...

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