A California health system and three healthcare providers have agreed to pay $68 million to resolve allegations that they violated the False Claims Act and the California False Claims Act by submitting or causing the submission of false claims to Medi-Cal in relation to Medicaid Adult Expansion under the Patient Protection and Affordable Care Act, the Justice Department reported June 29.
Santa Barbara San Luis Obispo Regional Health Authority, doing business as CenCal Health, contracts healthcare services under the state's Medicaid program at Cottage Health System and Sansum Clinic, which both operate in Santa Barbara, and Community Health Centers of the Central Coast, which operates in Santa Barbara and San Luis Obispo.
The settlements resolve allegations that CenCal, Cottage, Sansum and CHC 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.
The U.S. will receive $49.5 million from CenCal, $9 million from Cottage, $4.5 million from Sansum and $3.15 million from CHC. California will also receive $1.85 million.