On August 30, the U.S. Department of Justice (DOJ) announced a $5 million settlement with Lompoc Valley Medical Center (LVMC), a California health care provider, over allegations that the company violated the False Claims Act (FCA).
The DOJ alleged that LVMC submitted false claims to California’s Medicaid program (Medi-Cal) related to Medicaid Adult Expansion under the Patient Protection and Affordable Care Act (ACA).
This is the most recent in a string of settlements related to the alleged misconduct. “This settlement brings the United States’ total recovery in the matter to $95.5 million,” the DOJ reports.
“The Medicaid program provides critical health care services to those most in need,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will hold providers accountable when they knowingly divert Medicaid funds from their intended purpose.”
The case stems from a qui tam whistleblower case filed against LVMC by CenCal’s former medical director Julio Bordas. Qui tam claims enable private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery. Bordas will receive approximately $950,000 as his share of the federal recovery. Bordas previously received a qui tam whistleblower award of $12.56 million in a related settlement announced in June.
“This resolution underscores our steadfast resolve to hold accountable health care providers that seek to undermine the integrity of the Medicaid program,” said U.S. Attorney Martin Estrada for the Central District of California. “We will ensure that the nearly $100 million recovered in this case remains in government health care programs, and not in the hands of unscrupulous health care systems and providers.”
On July 25, a bipartisan group of senators introduced the False Claims Amendments Act of 2023, which address a few technical loopholes undermining the success of the FCA. The bill is widely supported by whistleblower advocates.
“The False Claims Act is America’s number one fraud-fighting law,” said whistleblower attorney Stephen M. Kohn. “These amendments are urgently needed to ensure that whistleblowers can continue to play their key role in protecting taxpayers from corporate criminals.”
Further Reading:
Bipartisan Legislation Unveiled to Strengthen False Claims Act