Dignity Health, False Claims, California 2024
LOS ANGELES – In a shocking display of greed, Dignity Health, a not-for-profit health system that owns and operates three hospitals and one clinic in Santa Barbara and San Luis Obispo counties, has agreed to pay $22.5 million to resolve allegations that they caused the submission of false claims to the Medi-Cal program.
Pursuant to two settlements announced today, Dignity Health, Twin Cities Community Hospital, and Sierra Vista Regional Medical Center have agreed to pay a total of $22.5 million to resolve allegations that they violated federal and California law by causing the submission of false claims to Medi-Cal related to Medicaid Adult Expansion under the Patient Protection and Affordable Care Act (ACA).
According to the allegations, Dignity Health, Twin Cities Community Hospital, and Sierra Vista Regional Medical Center knowingly caused the submission of false claims to Medi-Cal for “Enhanced Services” that Dignity purportedly provided to the Adult Expansion patients of a California county organized health system (COHS) between February 1, 2015 and June 30, 2016, and that Twin Cities and Sierra Vista purportedly provided to such patients between January 1, 2014 and April 30, 2015.
The United States and California alleged that the payments were not “allowed medical expenses” permissible under the contract between the California Department of Health Care Services (DHCS) and the COHS; were pre-determined amounts that did not reflect the fair market value of any Enhanced Services provided; and/or the Enhanced Services were duplicative of services already required to be rendered. The United States and California further alleged that the payments were unlawful gifts of public funds in violation of the California Constitution.
As a result of its settlement, Dignity Health will pay $13.5 million to the United States and $1.5 million to the State of California. Twin Cities Community Hospital and Sierra Vista Regional Medical Center 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.”
“Every day, Medi-Cal provides support for Californians in need of essential healthcare, and when companies take advantage of this system at the expense of patients, they must be held accountable,” said Attorney General Rob Bonta.
Defendant: Dignity Health, Twin Cities Community Hospital, Sierra Vista Regional Medical Center
Criminal Charges: Causing the submission of false claims to Medi-Cal
City and State: Los Angeles, California
Exact Date: Not specified
Sentence or Outcome: Dignity Health will pay $13.5 million to the United States and $1.5 million to the State of California, while Twin Cities Community Hospital and Sierra Vista Regional Medical Center have agreed to pay $6.75 million to the United States and $750,000 to the State of California.
Dollar Amounts: $22.5 million
Key Facts
- State: California
- Category: White Collar Crime
- Source: DOJ Press Release â†â€â€
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