California gets $15 million in Medi-Cal fraud settlement from contraceptive company
(The Center Square) – The California Department of Justice (DOJ) and Attorney General Rob Bota, announced a $15 million Medi-Cal fraud settlement on Tuesday.
The three-year investigation by the DOJ of The Pill Company, a Silicon Valley online contraceptives provider, found that Medi-Cal and Medi-Cal managed care plans had been defrauded through the billing, and dispensation of contraceptives “in excess of medical necessity” and through improperly coded telemedicine medical visits. Patients were also provided with products they did not ask for or want.
“The Pill Club unacceptably siphoned off Medi-Cal funding intended to help vulnerable communities access essential healthcare,” Bonta said.
A release by the DOJ stated, “The settlement resolves allegations that the company unlawfully billed California’s Medicaid program, Medi-Cal, millions of dollars in public funds in an allegedly fraudulent scheme that exploited the Affordable Care Act’s (ACA) essential coverage mandate, which ensures that insurance providers, including Medi-Cal, cover contraception.”
“This Agreement is neither an admission of liability by The Pill Club/Favor nor a concession by California that its claims are not well founded,” the Settlement Agreement said. “To avoid the delay, uncertainty, inconvenience, and expense of protracted litigation of the foregoing dispute, and in consideration of the mutual promises and obligations of this Agreement, the Parties agree..”
The DOJ’s Division of Medi-Cal Fraud and Elder Abuse, which “works aggressively to protect residents in nursing homes and other long-term care facilities from abuse or neglect,” and prosecutes those who perpetrate fraud on Medi-Cal, led the investigation.
“I am grateful to the whistleblowers and our investigators who were instrumental in holding The Pill Club accountable. At the California Department of Justice, we fight every day to protect and expand access to healthcare. We will not tolerate companies who attempt to unlawfully enrich themselves at Medi-Cal’s expense,” Bonta said.
California’s Medi-Cal program provides healthcare to residents of limited income and guarantees coverage for contraception.
