Dignity Health and others agree to Medi-Cal fraud settlement

August 22, 2022


Ventura County, along with three health care providers operating in its jurisdiction, one of which is Dignity Health, have agreed to pay a combined total of $70.7 million to settle allegations that they broke federal and California laws by submitting false claims to Medi-Cal amid an expansion of the program under Obamacare.

The Patient Protection and Affordable Care Act, or Obamacare, created the Medicaid Adult Expansion program. Medi-Cal, California’s Medicaid program, subsequently expanded to cover previously uninsured adults, ages 19 through 64 without dependent children and who had annual incomes of up to 133 percent of the federal poverty level. The state program launched in Jan. 2014, with the federal government fully funding it for its first three years of existence.

Whistleblowers brought forward allegations that Ventura County and three health care providers submitted false claims to Medi-Cal for services provided to Adult Expansion Medi-Cal members between Jan. 1, 2014 and May 31, 2015. The claims were allegedly for overstated or duplicate services, and the resulting payments constituted unlawful gifts of public funds, according to the United States Department of Justice.

In a settlement announced Thursday, Ventura County, which owns and operates Ventura County Medical Center, an integrated health care system that provides hospital, clinic and specialty services, agreed to pay $29 million to the federal government.

Ventura County Medi-Cal Managed Care Commission, which does business as Gold Coast Health Plan, will pay $17.2 million to the federal government. Gold Coast is a county-organized health system that contracts in order to provide health care services under Medi-Cal in Ventura County.

Dignity Health, a San Francisco-based nonprofit hospital system that operates two acute care hospitals in Ventura County, will pay $10.8 million to the federal government and $1.2 million to the state of California.

Clinicas del Camino Real, a nonprofit healthcare organization headquartered in Camarillo, will pay $11.25 million to the federal government and $1.25 million to the state.

“We will pursue every health plan and provider that prioritizes profits over patients,” Acting United States Attorney Stephanie S. Christensen said in a statement following the settlement announcement. “The money at issue in this case was designated by the federal government to pay for services to treat Medicaid expansion patients, and it never should have been used to pay for services that were already – or, simply never – provided. Medicaid is a taxpayer-funded program that exists to help patients afford health care, and it never should be used to line the pockets of health care providers through fraudulent schemes.”

California Attorney General Rob Bonta also released a statement.

“Medi-Cal props up our communities by providing access to free or affordable healthcare services for millions of Californians and their families. Those who attempt to cheat the system are cheating our communities of essential care,” Bonta said. “I want to express my gratitude to the United States Department of Justice and the United States Attorney’s Office in Los Angeles for their extensive efforts throughout the course of this investigation. The California Department of Justice and our law enforcement partners will continue to hold accountable those who defraud the Medi-Cal program, and protect those it serves.”

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I heard this is why Lagatuta went out of business, leaving thousands without care. Guess they just found him first? Who else is playing the “Bill Medical for extras” game? I don’t think its over!

The fraud did not occur on its own with no human input . Why is there no humans/employees charged with fraud ?? Employees of the medical profession receive kickbacks I.E. commission/ paid vacations etc etc on prescription medication and medical devices they prescribe. Was the commisions/compesation the reason for the fraud ?? Why else would medical employees fraud the system ?? There is alot of cover-up going on and patients and tax payers are paying the cost .When pharmaceutical companies offer incentives to have their medication prescribed ,the patient suffers the physical and mental problems that are associated with those medications plus the addiction. Some patients do enjoy being used as pawns because they sell the medications and medical devices sometimes for thousands of dollars profit each month year round as a side business or to enhance their retirement fund …but it also generates thousands of addicted pharmaceutical drug users …one big ugly circle

Totally agree. The for-profit health care system in the U.S. reeks to high heaven. Americans pay a ludicrous amount for their insurance, whereas every other first world nation—Canada, UK, Australia, and all of Europe have universal care that falls well below the 19% of GDP that Americans pay—France pays only 11% by comparison.

Moreover, the U.S. usually ranks out of the top ten for health outcomes despite paying the most. The passage of Obamacare improved those statistics, but unfortunately, states such as Texas and much of the south denied the Obamacare expansion of Medicaid.

Anyway, until we have universal care, you will have reason to complain and millions of Americans will file for bankruptcy because they can’t pay their medical bills. Thank You, Republicans.

I have friends that live in Europe, French and Italian citizens. They would argue with your assertions. The state run medical plans are fine for routine things they tell me but when you need something serious like bypass surgery, or a hip replacement, you better have private insurance. I don’t argue with you that we pay too much, but universal, publicly paid for healthcare is not sustainable in the United States. And in terms of the quality of the care, why is it that when dictators, and kings,(King Husain of Jordan), need a really specialized high end medical procedure, they always end up in the United States? Places like UCLA, the Cleveland clinic, Johns Hopkins, Stanford, USF, etc. are without equal in terms of the caliber of care they can give. Unfortunately however, to your point, that’s out of reach for most people.

It’s a difficult issue and if the answer was easy it would have been done by now.

Great, now our deductibles and co-pays will go up to pay for it…

Insurance premiums, insurance fraud, insurance premiums, insurance fraud…..INSANITY !