FRESNO, Calif. ( KSEE/KGPE ) – Underreported business income by two former Clinica Sierra Vista executives, among others, has resulted in a nearly $26 million settlement against the medical provider, with ties to the Central Valley.
Additionally, California Attorney General Rob Bonta and U.S. Attorney Phillip A. Talbert announced on Thursday that the healthcare provider, which serves patients in Kern, Fresno, and Inyo counties, submitted false financial documentation and failed to repay overpayments for Medi-Cal and Medicare patients, violating both Federal and California False Claims Acts.
Their offices say Clinica Sierra Vista voluntarily reported its misconduct in a 2019 letter to the U.S. Attorney’s Office for the Eastern District of California and the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse. The letter outlined the wrongdoings following its own internal investigation.
According to court documents, the new Chief Executive Officer of Clinica Sierra Vista claims the company’s founder and former CEO, alongside their former Chief Financial Officer, repeatedly omitted Medi-Cal Managed Care and third-party capitated payments in end-of-year reports. Court documents also support the letter’s claims that the medical facility failed to repay the overpayments it received back to the California Department of Health Care Services, and falsely reported partial payments it had received over a period of seven years. What that means is that Clinica Sierra Vista was able to receive excessive payments from the Medi-Cal program between 2010 and 2017.
As a result, the medical provider must repay a total $25.98 million settlement amount within the next 30 days; the state of California will receive $15.59 million and the federal government will receive $10.39 million.
“When companies take advantage of the Medi-Cal system, they harm patients across California who rely on the program for essential health care services,” said Attorney General Rob Bonta. “I commend the new management at Clinica Sierra Vista for coming forward, and for working with us and our partners to resolve their violations. This settlement will return the money where it belongs: to support California’s Medi-Cal program and the communities it serves. I encourage all providers to conduct regular internal investigations and self-disclose potential violations.”
The California Attorney General’s Office says providers who believe they may have violated the federal or California False Claims Act should follow the HHS-OIG Provider Self Disclosure Protocol, which establishes a process for providers to voluntarily identify, disclose, and resolve instances of potential fraud involving federal health care programs, including Medicaid.
A copy of the settlement agreement is available here . Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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