On December 7, 2022, three health care providers reached two separate settlements to resolve allegations that they violated the federal False Claims Act and the California False Claims Act by causing the submission of false claims to Medi-Cal related to the Medicaid Adult Expansion under the Patient Protection and Affordable Care Act.
Under the ACA, starting in January 2014, Medi-Cal was expanded to cover adults between the ages of 19 and 64 without dependent children with annual incomes up to 133% of the federal poverty level. The expansion coverage was fully funded by the federal government for the first three years. However, if a California county organized health system (COHS) did not spend at least 85% of the funds it received for the Adult Expansion population on “allowed medical expenses,” the COHS was mandated to repay the difference between 85% and what was actually spent.
Dignity Health owns and operates three hospitals and one clinic in California. Tenet Healthcare Corporation subsidiaries Twin Cities Community Hospital and Sierra Vista Regional Medical Center are two acute healthcare facility subsidiaries operating in San Luis Obispo County.
The three providers – Dignity, Twin Cities, and Sierra Vista – allegedly knowingly caused the submission of false claims to Medi-Cal for “Enhanced Services.” Dignity purportedly provided the services to Adult Expansion patients between February 1, 2015, and June 30, 2016. Twin Cities and Sierra Vista allegedly provided the...
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