Medical group Clinica Sierra Vista to pay $26M settlement over false claims in California

A health care provider that operates in central California has agreed to pay nearly $26 million for under-reporting income in order to defraud the state’s Medi-Cal program.

In a new release Thursday, California Attorney General Rob Bonta and U.S. Attorney Phillip A. Talbert said former executives with Clinica Sierra Vista — including its founder and former CEO, and former CFO —knowingly violated state and federal False Claim Acts in order to receive excessive payments from Medi-Cal.

The provider, which has several clinics is Fresno, will pay $15.59 million to the state and $10.39 to the federal government.

“When companies take advantage of the Medi-Cal system, they harm patients across California who rely on the program for essential health care services,” Bonta said in the release.

“This settlement will return the money where it belongs: to support California’s Medi-Cal program and the communities it serves.”

According to the settlement, the violations happened over a period of seven years beginning in 2010, during which time the executives submitted false information in annual reconciliation reports “by omitting Medi-Cal Managed Care and third-party capitated payments it had received in each fiscal year” and by including “some, but not all, Medi-Cal Managed Care and third party payments it had received.”

The violations were discovered after they were reported voluntarily in 2019 after an internal investigation by the provider’s new management.

The U.S. Department of Health and Human Services Office of Inspector General has a Self Disclosure Protocol that allows providers like Clinica Sierra Vista to come forward if they believe they have violated the False Claims Act, according to Special Agent in Charge Steven J. Ryan.

“Providers who defraud government health care funds, such as Medi-Cal, for illegitimate financial gain, prevent valuable taxpayer dollars from being used for their intended purpose,” he said.

The settlement does not release Clinica Sierra Vista from any criminal liability, though it is unclear whether criminal charges have been or will be filed.

A message to Attorney General Bonta’s office was not immediately returned Thursday.