California County Organized Health System and Three Health Care Providers Agree to Pay $70.7 Million for Alleged False Claims to California’s Medicaid Program

Ventura County Medi-Cal Managed Care Commission doing business as Gold Coast Health Plan (Gold Coast), a county organized health system (COHS) that contracts to arrange for the provision of health care services under California’s Medicaid program (Medi-Cal) in Ventura County, California; Ventura County, which owns and operates Ventura County Medical Center, an integrated health care system that provides hospital, clinic, and specialty services; Dignity Health (Dignity), a not-for-profit hospital system that operates two acute care hospitals in Ventura County; and Clinicas del Camino Real Inc. (Clinicas), a non-profit health care organization located in Ventura County, have agreed to pay a total of $70.7 million pursuant to three separate settlements to resolve allegations that they violated the federal 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 under the Patient Protection and Affordable Care Act (ACA).

Effective August 11, 2022, the United States of America, acting through the United States Department of Justice and on behalf of the Office of Inspector General of the Department of Health and Human Services (HHS-OIG), and Clinicas del Camino Real, Inc. (Clinicas), among others, entered into a settlement agreement to resolve allegations that Clinicas violated the federal False Claims Act and the California False Claims Act through a fraud scheme involving Medicaid Adult Expansion under the Patient Protection and Affordable Care Act.

Although Clinicas entered into a health care fraud settlement with the United States, it refused to agree to compliance-related oversight with HHS-OIG through a CIA. Therefore, as part of the Settlement Agreement, OIG reserved the right to exclude Clinicas for the alleged conduct and will place Clinicas on a list of providers who refused to enter into CIAs. OIG’s list is designed to promote transparency by identifying those providers who refuse oversight.

Read more on www.justice.gov

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