$15M Penalty For Healthcare Providers Over False Medicaid Billing

$15M Penalty For Healthcare Providers Over False Medicaid Billing

Introduction

Two healthcare providers in Santa Barbara and San Luis Obispo counties, including Dignity Health, have agreed to pay $22.5 million in settlement arrangements to resolve charges that they violated federal and state law by submitting phoney invoices to Medicaid.

Dignity Health agreed to pay the federal government $13.5 million and the state $1.5 million. Marian Regional Medical Center in Santa Maria, as well as French Hospital Medical Center and Arroyo Grande Community Hospital in southern San Luis Obispo County, are all owned and operated by Dignity Health. In both counties, it also runs Pacific Coast, Health Centers.

Tenet Healthcare, which operates Sierra Vista Regional Medical Center in San Luis Obispo and Twin Cities Community Hospital in Templeton, agreed to pay $6.4 million to the federal government and $750,000 to the state in a separate settlement.

According to the US Attorney, these healthcare practitioners diverted crucial Medicaid cash for their personal benefit rather than using it to offer healthcare services to the most vulnerable people. These significant settlements underscore the administration's commitment to holding responsible healthcare providers that attempt to manipulate the Medicaid programme and hurt the American taxpayer. They were among many Central Coast healthcare businesses accused of filing false claims by a whistleblower.

The charges were made against the Santa Barbara/San Luis Obispo Regional Health Authority, also known as CenCal Health, which is in charge of managing the Medi-Cal programme in Santa Barbara and San Luis Obispo counties (Medicaid in California is called Medi-Cal).

Dignity Health provides a variety of services in line with a pre-existing programme and agreement. Dignity Health filed full monthly reconciliation statements and annual reports to CenCal Health under the programme and was paid in compliance with the agreements, the firm said in a statement. As a result, Dignity Health got fair market value compensation from CenCal for services actually given to this vulnerable group, and the organisation argues that all payments were handled lawfully.

Dignity Health reached a settlement deal with the federal government and the state of California to handle the case without the expense of litigation and without admitting any responsibility.

The charges concerned the Patient Protection and Affordable Care Act's Medicaid Adult Expansion (ACA). The two settlements resolve charges that healthcare providers filed false Medi-Cal claims for "Enhanced Services" given by Dignity Health to certain CenCal patients between Feb. 1, 2015, and June 30, 2016, and by Twin Cities and Sierra Vista between Jan. 1, 2014, and April 30, 2015.

The payments were not "authorised medical costs," according to the contract between the California Department of Health Care Services and the county-organized health system, CenCal Health in this case.

They also claimed that the charges had problems such as not reflecting the fair market value of any Enhanced Services offered or duplicating previously necessary services.

According to US officials, the legal settlements address allegations made under federal whistleblower statutes by the former medical director of CenCal Health, which contracted with Dignity, Twin Cities, and Sierra Vista for the provision of Medi-Cal health care services.

The legislation allows anybody to file an action on behalf of the United States and get a percentage of any recovery. According to the US Attorney's Office, the former medical director of CenCal Health would earn $3.9 million as his portion of the government recovery. Santa Barbara County achieved a Medi-Cal billing settlement with the Department of Justice in October.