December 7, 2022

Dignity Health and the Tenet Healthcare hospitals Twin Cities Community Hospital and Sierra Vista Regional Medical Center will pay a total of $22.5 million to resolve allegations that they submitted false claims to Medi-Cal in connection with the ACA’s Medicaid Adult Expansion program.  The defendants, who contracted with Medi-Cal, agreed to provide healthcare services to this newly-insured population and return surplus funds if they did not spend at least 85% of the specified funds on eligible services.  The government alleged that the hospitals falsely billed for “Enhanced Services,” which allowed them to overstate AE spending, including by billing for services that were duplicative of services already required. The settlements resolve claims brought in a whistleblower action by Julio Bordas, who previously served as a Medical Director for CenCal Health, the County Organized Health System through which Medi-Cal contracted with the hospitals. Bordas will receive $3.9 million as his share of the federal recovery.  DOJ; USAO CD Cal; CA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid, Whistleblower Case, Whistleblower Rewards,