Lompoc Valley Medical Center agrees to $5 million settlement over alleged false claims to Medi-Cal
LOS ANGELES, Calif. – Lompoc Valley Medical Center has agreed to pay $5 million to resolve allegations that it violated the federal False Claims Act and the California False Claims Act by causing the submission of false claims related to Medicaid Adult Expansion under the Patient Protection and Affordable Care Act.
According to the Department of Justice (DOJ), with this and several prior settlements, the United States has recovered $95.5 million in connection with its investigation of healthcare entities in Santa Barbara and San Luis Obispo counties.
“Medi-Cal supports millions of Californians by providing for the critical healthcare they rely on every day,” said California Attorney General Bonta. “When providers misuse Medi-Cal funding, they siphon away much-needed resources from vulnerable, deserving patients. My office always stands ready to partner with the U.S. Department of Justice to hold such perpetrators accountable. The California Department of Justice is committed to protecting the integrity of the Medi-Cal program against those who may seek to abuse it.”
CenCal, Cottage Health System, Sansum Clinic, and Community Health Centers of the Central Coast previously paid $68 million to settle False Claims Act allegations brought by the DOJ.
Dignity Health and Twin Cities Community Hospital and Sierra Vista Regional Medical Center, two subsidiaries of Tenet Healthcare Corporation previously paid $22.5 million to also settle similar False Claims Act allegations.
The settlement agreed to by Lompoc Valley Medical Center (LVMC) resolves allegations the California Health Care District that operates multiple health care centers including a hospital and several clinics knowingly caused the submission of false claims to Medi-Cal while expanding access through the Patient Protection and Affordable Care Act (ACA) detail the DOJ.
The United States and the State of California alleged that LVMC claimed and received payments pursuant to an agreement with CenCal for "Enhanced Services" to Adult Expansion Medi-Cal members between Jan. 1, 2014, and Jun. 30, 2016.
According to the DOJ, those payments were not for "allowed medical expenses" permissible under the contract between California's Department of Health Services (DHCS), were pre-determined amounts that did not reflect the fair market value of any Enhanced Services provided by LVMC, and/or the Enhanced Services were duplicative of services required to be rendered by LVMC.
The United States and the State of California further alleged that the payments above were unlawful gifts of public funds in violation fo the California Constitution relay the DOJ.
“This resolution underscores our steadfast resolve to hold accountable health care providers that seek to undermine the integrity of the Medicaid program,” said U. S. Attorney Martin Estrada. “We will ensure that the nearly $100 million recovered in this case remains in government health care programs, and not in the hands of unscrupulous health care systems and providers.”
This investigation relied on whistleblower provisions within the False Claims Act detail the DOJ. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-447-8477.
