To resolve allegations that Lompoc Valley Medical Center knowingly submitted false insurance claims to Medi-Cal—violating the federal False Claims Act and the California False Claims Act—the health care provider agreed to pay $5 million, according to the U.S. Department of Justice.
“Medi-Cal supports millions of Californians by providing for the critical health care they rely on every day,” California Attorney General Bonta said in a statement. “When providers misuse Medi-Cal funding, they siphon away much-needed resources from vulnerable, deserving patients.”
Lompoc Valley Medical Center’s (LVMC) settlement, along with several others on the Central Coast, pertains to false claims being submitted for “enhanced services” as part of Medi-Cal’s Adult Expansion for the previously uninsured adult population. Members of this group are adults between 19 and 64 years old without dependent children and with annual incomes up to 133 percent of the federal poverty level.
“The claims resolved by the settlement are allegations only and there has been no determination of liability,” according to the Department of Justice.
The Department of Justice has now recovered $95.5 million—with CenCal, Cottage Health System, Sansum Clinic, and Community Health Centers of the Central Coast previously paying $68 million in June, and Dignity Health, Twin Cities Community Hospital, and Sierra Vista Medical Center paid $22.5 million in December for similar False Claims Act allegations.
Julio Bordas, CenCal’s former medical director, brought the investigations to light by naming the entities involved in the False Claim Act and California False Claims Act violations. Under the act, a private party can file an action on behalf of the United States and receive a portion of any recovery. Bordas will receive $950,000 from the LMVC settlement and $12.56 million from the $68 million settlement.
The Sun reached out to the U.S. Department of Justice for further comment, but the department’s director of media relations couldn’t be reached before the Sun’s deadline.
LVMC Chief Executive Officer Steve Popkin said in a statement that the health care provider entered into an agreement with CenCal—the Central Coast’s Medi-Cal provider—to provide enhanced services.
“The DOJ contends that CenCal was not permitted to offer those funds to LVMC (and the other health care providers), based upon the contracts between CenCal and the federal and state governments,” Popkin said in the statement. “In the settlement agreement, the DOJ acknowledges that there is not a finding of liability on the part of LVMC and that the settlement is being done to avoid protracted litigation between the state and DOJ.”
Although LVMC “strongly disagrees” with the allegations, the settlement agreement enables LVMC to “put this matter behind us” and focus efforts toward providing health care for Lompoc valley residents, Popkin said.
The Department of Justice recommended filing tips and complaints about health care fraud to the Department of Health and Human Services at (800) 447-8477.
