![]() The United States and California alleged that the payments were not “allowed medical expenses” under Gold Coast’s contract with DHCS, were pre-determined amounts that did not reflect the fair market value of any Additional Services provided, and/or the Additional Services were duplicative of services already required to be rendered. The three settlements resolve allegations that Gold Coast, Ventura County, Dignity, and Clinicas knowingly submitted or caused the submission of false claims to Medi-Cal for “Additional Services” provided to Adult Expansion Medi-Cal members between January 1, 2014, and May 31, 2015. California, in turn, was required to return that amount to the federal government. Pursuant to contracts with California’s Department of Health Care Services (DHCS), if a California COHS did not spend at least 85 percent of the funds it received for the Adult Expansion population on “allowed medical expenses,” the COHS was required to pay back to the state the difference between 85 percent and what it actually spent. The federal government fully funded the expansion coverage for the first three years of the program. Pursuant to the ACA, beginning in January 2014, Medi-Cal was expanded to cover the previously uninsured “Adult Expansion” population-adults between the ages of 19 and 64 without dependent children with annual incomes up to 133 percent of the federal poverty level. (Clinicas), a non-profit healthcare organization headquartered in Camarillo. Dignity Health, a San Francisco-based not-for-profit hospital system that operates two acute care hospitals in Ventura County and.Ventura County, which owns and operates Ventura County Medical Center, an integrated health care system that provides hospital, clinic, and specialty services.Ventura County Medi-Cal Managed Care Commission which does business as Gold Coast Health Plan, a county-organized health system (COHS) that contracts to arrange for the provision of health care services under California’s Medicaid program (Medi-Cal) in Ventura County.The parties that entered into the three separate settlement agreements are: ![]() Bilingual English/Spanish is desirable.LOS ANGELES – Ventura County’s organized health system and three medical care providers have agreed to pay a total of $70.7 million to settle allegations that they broke federal and state laws by submitting or causing the submission of false claims to Medi-Cal related to Medicaid Adult Expansion under the Patient Protection and Affordable Care Act (ACA), the Justice Department announced today. Must have a strong sense for accuracy and detail. Working knowledge of general office equipment such as fax, copier, scanner, etc. Proficient in MS Office Word and Excel experience with Power Point and Publisher is desirable. Previous experience working in a Human Resources environment is desirable. Must have a high school diploma, or equivalent and one year of general clerical experience. Liaise with executive and senior administrative assistants to handle requests and queries from senior managers.Act as the point of contact for internal and external clients.Support the Information Systems Department. ![]()
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