Doj costume claims for the health plan of the Internal Empire carried out fraud with Medi-Cal

From McGruna fenceCalmness

This story was originally published by CalmattersS Register about their ballots.

The health plan of the internal empire reserved $ 320 million that the federal government was to return to the federal government.

IEHP is responsible for the provision of Medi-Cal to 1.6 million people throughout the internal empire-35% of the combined population of Riverside and San Bernardino.

The complaint alleges that IEHP has performed fraud by putting money on medical care for new patients with Medi-Cal for non-medical costs or care for existing patients.

The claim also claims that IEHP has created bonus programs for regional health systems using the money to expand Medi-Cal, and uses federal money as a negotiating chip to negotiate better care rates for people with IEHP insurance.

The agency eventually returned to the federal government $ 30 million back. The complaint charges the final amount of falling $ 320 million.

“Today’s lawsuit against IEHP shows our unwavering commitment to holding responsible insurers who bravely compromise the Medicaid system,” said the Journal of the United States Prosecutor Bill Esayli. “We will take every measure to restore the integrity and accountability of the Medicaid system and to ensure that patient care – not financial profit – is the main focus of our health system.”

The agency’s lawyer, Winston Chan of Gibson, Dunn & Crutcher, wrote in an email that the benefits paid through the program have already been approved by the regulators.

“The allegations are an arrogant attempt at revisionist history, which is not only wrong with the facts and the law, but also especially in the light of the wider attacks of the federal government against the state funding of Medicaid,” he writes.

The Federal Government gave IEHP to expand Medi-Cal from January 1, 2014 to June 30, 2016, according to the case. At least 85% of the funding was intended to pay for the initially high cost of providing health care to the newcomer. Any funding from the program that is not used for these medical expenses must be paid to the federal government, the case said. The complaint alleges that IEHP has cheated by putting the money for non-medical costs or the care of people already covered by Medi-Cal.

“Every MCE dollar that IEHP is incorrectly spent on unacceptable costs – like other patients, consultants or lawyers – was effective in an additional dollar in the IEHP pocket, since IEHP did not have to spend money from its total budget,” the costume said.

The agency has spent $ 50 million on the funds to create a health record system for the IEHP geographical zone, the costume said. Instead of paying the company, the Huron Consulting Group directly with the funds, IEHP administrators pay suppliers who then paid Huron, the complaint said.

The complaint cites an email from former IEHP CEO Bradley Gilbert:

“The funds have to go through the two county hospitals from IEHP in order to be able to receive a loan for them, as medical expenses or dollars return to the country. So we will have to set it up so that IEHP will pay the hospitals and then the money is used for data integration efforts,” the email said.

A June 3, 2015, an email from Gilbert, included in the complaint, discussed the difficulty of spending all the money from the government.

“I will have to allocate hundreds of millions of dollars outside the actual medical expenses,” Gilbert quoted the complaint.

This article was Originally Published on CalMatters and was reissued under Creative Commons Attribution-Noncommercial-Noderivatives License.