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Some Tri-Counties health care providers reach $68 million settlement with feds over Med-Cal payment issue

Federal prosecutors say agencies failed to meet payment guidelines for program, and kept money which should have been refunded.

Federal prosecutors say they’ve reached a $68 million settlement with four health care agencies on the Central and South Coasts over some false Medi-Cal claims.

Investigators say the issue was with an expansion of the Medi-Cal program. In 2014, it added eligibility for low income adults between 19-64 without kids. There was a catch.

CenCal Health, which provides Medi-Cal services for hundreds of thousands of people in Santa Barbara County, had to use at least 85% of each federal dollar it received on allowed medical expenses, or refund the difference.

Prosecutors say Cen Cal, Cottage Health System, Sansum Clinic, and Community Health Center of the Central Coast failed to comply with the federal funding rules. The prosecutors say the settlement calls for CenCal to pay nearly $50 million, with the other three agencies kicking in a combined total of around $16 million.

Lance Orozco has been News Director of KCLU since 2001, providing award-winning coverage of some of the biggest news events in the region, including the Thomas and Woolsey brush fires, the deadly Montecito debris flow, the Borderline Bar and Grill attack, and Ronald Reagan's funeral.