SLO County Hospitals to pay millions for alleged false billing

December 8, 2022


San Luis Obispo County hospitals agreed to pay portions of a $22.5 million to resolve allegations that they violated federal and state law by submitting false claims to Medi-Cal, federal  prosecutors announced this week.

Dignity Health, which operates three hospitals and one clinic in Santa Barbara and San Luis Obispo counties, entered into  an agreement with the United States and the California to settle allegations of wrongdoing. Twin Cities Community Hospital and Sierra Vista Regional Medical Center, two acute healthcare facility subsidiaries of Tenet Healthcare Corporation, also agreed to pay settlements related to alleged false billing.

In Jan. 2014, Medi-Cal was expanded to cover previously uninsured adults between the ages of 19 and 64 without dependent children and with annual incomes up to 133% of the federal poverty level. The settlements are related to alleged false claims under this program.

The two settlements resolve allegations that Dignity, Twin Cities and Sierra Vista knowingly caused the submission of false claims to Medi-Cal between Feb. 1, 2015 and June 30, 2016, and that Twin Cities and Sierra Vista purportedly made between Jan. 1, 2014 and April 30, 2015.

The United States and California alleged that the payments were not “allowed medical expenses;” were pre-determined amounts that did not reflect the fair market value of services provided; and/or the services were duplicative of services already rendered.

As a result of its settlements, Dignity will pay $13.5 million to the United States and $1.5 million to the State of California. Twin Cities and Sierra Vista have agreed to pay $6.75 million to the United States and $750,000 to the State of California.

“These health care providers siphoned critical Medicaid funding for their own gain instead of using it to provide health care services to patients most in need,” said United States Attorney Martin Estrada. “These major settlements demonstrate our commitment to hold accountable health care providers that seek to exploit the Medicaid program and harm the American taxpayer.”

The whistleblower in this case, Julio Bordas, was the former medical director of the  county organized health system that contracted with Dignity, Twin Cities and Sierra Vista for the provision of health care services under Medi-Cal. For reporting the issue, Bordas will receive $3.9 million as his share of the federal recovery.

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In completely unrelated news, Health Care Costs to rise…

Dignity Health did some undignified things.

Private medicine; private business at its best. Who was responsible for this and who profited and now who is paying for these crimes? The government should run all medical services, there should be NO profit off sick humans. Sadly, lobbyists brainwash people.

The quality of Local health care is already declining… what do they think this settlement will do to it… who is the injured party in a case like this?… the government?… sounds like this could be handled without a monetary penalty…. in the end this will only end up hurting patients…

French Hospital should be on this list. I once went in for a potential hernia. No doctor saw me, I had a quick CT Scan of my abdomen, and they sent me home with the diagnosis of just gas. $13,000 billing, $7,000 towards my deductible, which I negotiated with a collection agency to $4,000. $7,000 of the $13,000 was for the CT scan, the rest for having me wait in a little room and talk to a nurse a couple times.

A CT scan like that should cost well under $1K.

“Dignity…” right.

Been there. It’s called business 101. Poor always suffer to the hands of the greedy rich. Look at the backlash of Obamacare, and that wasn’t even social medicine. Greed is real. End times are near.