“We will pursue every health plan and provider that prioritizes profits over patients,” said Acting U.S.
“Health systems and health care providers will be held accountable when they misuse such funds, including funds intended to support Medicaid expansion programs.” Boynton, head of the Justice Department’s Civil Division. “Federal health care funds are not intended to serve as a blank check,” said Principal Deputy Assistant Attorney General Brian M. The United States and California further alleged that the payments were unlawful gifts of public funds in violation of Article IV, section 17 of the California Constitution.Īs a result of the settlements, Gold Coast will pay $17.2 million to the United States Ventura County will pay $29 million to the United States Dignity will pay $10.8 million to the United States and $1.2 million to the State of California and Clinicas will pay $11.25 million to the United States and $1.25 million to the State of California. The United States and California alleged that the payments were not “allowed medical expenses” under Gold Coast’s contract with DHCS were pre-determined amounts that did not reflect the fair market value of any Additional Services provided and/or the Additional Services were duplicative of services already required to be rendered. The three settlements resolve allegations that Gold Coast, Ventura County, Dignity, and Clinicas knowingly submitted or caused the submission of false claims to Medi-Cal for “Additional Services” provided to Adult Expansion Medi-Cal members between Jan. California, in turn, was required to return that amount to the federal government. Pursuant to contracts with California’s Department of Health Care Services (DHCS), if a California COHS did not spend at least 85% of the funds it received for the Adult Expansion population on “allowed medical expenses,” the COHS was required to pay back to the state the difference between 85% and what it actually spent. The federal government fully funded the expansion coverage for the first three years of the program. Pursuant to the ACA, beginning in January 2014, Medi-Cal was expanded to cover the previously uninsured “Adult Expansion” population – adults between the ages of 19 and 64 without dependent children with annual incomes up to 133% of the federal poverty level. (Clinicas), a non-profit health care organization located in Ventura County, have agreed to pay a total of $70.7 million pursuant to three separate settlements to resolve allegations that they violated the federal False Claims Act and the California False Claims Act by submitting or causing the submission of false claims to Medi-Cal related to Medicaid Adult Expansion under the Patient Protection and Affordable Care Act (ACA). For forms and publications, visit the Forms and Publications search tool.Ventura County Medi-Cal Managed Care Commission doing business as Gold Coast Health Plan (Gold Coast), a county organized health system (COHS) that contracts to arrange for the provision of health care services under California’s Medicaid program (Medi-Cal) in Ventura County, California Ventura County, which owns and operates Ventura County Medical Center, an integrated health care system that provides hospital, clinic, and specialty services Dignity Health (Dignity), a not-for-profit hospital system that operates two acute care hospitals in Ventura County and Clinicas del Camino Real Inc. We cannot guarantee the accuracy of this translation and shall not be liable for any inaccurate information or changes in the page layout resulting from the translation application tool.įorms, publications, and all applications, such as your MyFTB account, cannot be translated using this Google™ translation application tool. For a complete listing of the FTB’s official Spanish pages, visit La esta pagina en Espanol (Spanish home page). These pages do not include the Google™ translation application. We translate some pages on the FTB website into Spanish. If you have any questions related to the information contained in the translation, refer to the English version. Any differences created in the translation are not binding on the FTB and have no legal effect for compliance or enforcement purposes. The web pages currently in English on the FTB website are the official and accurate source for tax information and services we provide. Consult with a translator for official business. This Google™ translation feature, provided on the Franchise Tax Board (FTB) website, is for general information only.
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