California county, three health systems pay $70.7 million for Medicaid fraud

The health system operated by Ventura County, California, and three health care providers will pay $70.7 million to settle allegations they defrauded California’s expanded Medicaid program.

The U.S. Department of Justice (DOJ) and the California Attorney General’s Office announced the settlement for false claims from January 2014 to May 2015. The time coincides with California’s expansion of its Medicaid program, known as Medi-Cal, to cover previously uninsured adults with incomes up to 133% of the federal poverty level.

That expansion was allowed under the federal Affordable Care Act and was reimbursed by the federal government for the first three years. If county organized health systems (COHSs) did not spend at least 85% of the money they received on allowed medical expenses, they were required to reimburse the state of California, which would return the money to the federal government, according to DOJ.

The settlement resolves allegations that the county and three health care systems knowingly submitted false claims to Medi-Cal for allowable expenses, according to DOJ. The billed services were duplicative of those already provided, and some services were never provided, Acting U.S. Attorney Stephanie S. Christensen said in a news release.

Source: California county, three health systems pay $70.7 million for Medicaid fraud / Medical Economics

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