Calif. Insurer Agrees To Pay Record Settlement Over Medicaid Payments


Topics: States, Medicaid

Aug 24, 2012

A health plan in California has agreed to pay a record $320 million settlement over allegations it was overpaid by the state’s Medicaid program. Also in the news, a California hospital chain will pay $16.5 million to settle with the California Medicaid program and Medicare after a patient “kickback” investigation.

Los Angeles Times: Health Plan Pays Record Settlement
A Long Beach health plan agreed to pay $320 million to resolve allegations that it was overpaid by the state’s Medi-Cal program going back to 1985, government officials said. Federal officials called the settlement from SCAN Health Plan the largest of its kind from a single provider in Medi-Cal, the state’s Medicaid program for the poor and disabled (Terhune, 8/24).

California Watch: Health Plan Pays Largest-Ever Settlement To Medi-Cal Authorities
State and federal authorities announced the largest-ever Medi-Cal overpayment settlement today, recouping $327 million after a Long Beach-based HMO drew excess payments for years. The SCAN Health Plan, which provides care to 127,000 Medicare Advantage clients in California, settled claims that it was overpaid and did not provide required financial documents to the state’s Department of Health Care Services, limiting reviewers’ ability to notice irregularities (Jewett, 8/23).

Los Angeles Times: Hospital Chain accused Of Kickback Scheme To Pay $16.5 Million
A Los Angeles-based hospital chain has agreed to pay the government $16.5 million to settle allegations that its subsidiaries paid illegal kickbacks for patients recruited from among the homeless and provided them unnecessary services in an attempt to defraud Medicare and Medi-Cal, according to court documents (Zavis, 8/24).

CNN: Hospital Chain To Pay $16.5 Million In Kickback Case Involving The Homeless
A California-based hospital chain has agreed to pay $16.5 million to settle allegations that its hospitals were involved in a kickback scheme in which homeless people were taken to hospitals for sometimes unneeded treatment, and government programs were billed for the work, authorities said Thursday. Los Angeles Doctor’s Hospital, Inc., agreed to plead guilty to conspiring to defraud Medicare and Medi-Cal through the payment of illegal kickbacks to “marketers” who recruited people to act as patients, the U.S. attorney for central California said in a news release. LADH is a subsidiary of Pacific Health Corp., which has entered into a deferred prosecution agreement with federal authorities (Watkins, 8/24).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

US residents with employer-based private healt...

US residents with employer-based private health insurance, with self insurance, with Medicare or Medicaid or military health care and uninsured in Million; U.S. Census bureau: Income, Poverty, and Health Insurance Coverage in the United States: 2007 (Photo credit: Wikipedia)

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