Three California healthcare providers are among four organizations that have agreed to pay a total of $68 million to resolve allegations that they violated the False Claims Act.
The four organizations that entered into settlement agreements are:
- Santa Barbara San Luis Obispo Regional Health Authority, a county organized health system doing business as CenCal Health
- Cottage Health System, a nonprofit hospital network based in Santa Barbara
- Sansum Clinic, a nonprofit outpatient clinic in Santa Barbara
- Community Health Centers of the Central Coast, a nonprofit community health center based in Santa Maria
The settlements resolve allegations that CenCal, Cottage, Sansum and CHC violated the 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.
Medi-Cal was expanded in 2014 to cover the previously uninsured "Adult Expansion" population — those between ages of 19 and 64 without dependent children with annual incomes up to 133% of the federal poverty level. The federal government funded the expansion coverage for the first three years of the program.
The U.S. and California alleged that the organizations knowingly submitted or caused the submission of false claims to Medi-Cal for "Enhanced Services" that were purportedly provided to Adult Expansion Medi-Cal members.
CenCal will pay $49.5 million, Cottage will pay $9 million, Sansum will pay $4.5 million, and CHC will pay $3.15 million to the United States. In addition, California will receive payments totaling $1.85 million.