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Health entities pay total of $68 million to settle lawsuit Cottage Health, Sansum Clinic, CenCal Health, Community Health Centers of the Central Coast were alleged to have violated false claims acts By DAVE MASON NEWS-PRESS MANAGING EDITOR
Cottage Health, Sansum Clinic, CenCal Health and Community Health Centers of the Central Coast have agreed to pay a total of $68 million to settle a lawsuit over alleged false claims to Medi-Cal. The settlement for the four entities, all of which serve Santa Barbara County, was announced Thursday afternoon by the U.S. Department of Justice, Central District of California. The DOJ said the four healthcare entities were alleged to have violated the False
Claims Act and the California False Claims Act by submitting or causing the submission of false claims to Medi-Cal for “Enhanced Services.” The claims are related to Medicaid Adult Expansion under the Affordable Care Act, aka Obamacare. The DOJ added, “The claims resolved by the settlements are allegations only, and there has been no determination of liability.” Under the settlement, CenCal Health will pay $49.5 million; Cottage, $9 million; Sansum, $4.5 million; and CHC, $3.15 million to the United States. In addition, the state of California will
receive payments totaling $1.85 million. The DOJ said the agreement was executed earlier in June and that a federal judge on late Wednesday unsealed the whistleblower case naming the four entities. Under the Affordable Care Act, MediCal was expanded in January 2014 to cover adults between ages of 19 and 64 without dependent children with annual incomes up to 133% of the federal poverty level. Sansum Clinic participated in the Medi-Cal expansion program designed by CenCal Health, its longtime healthcare partner.
Sansum Clinic issued a statement Thursday saying that it disagreed with the government’s claims but agreed to return $4.5 million of the $7.1 million in payments under the settlement. “Our intention was to participate in a program that, along with CenCal, would allow us to provide for the health care needs of the previously uninsured individuals that were now newly enrolled in Medi-Cal,” said Sansum Clinic CEO Kurt N. Ransohoff. “Sansum disagrees with the government’s claims, and we do not believe it was an overpayment or
that Sansum did anything wrong or inappropriate,” Dr. Ransohoff said in the statement. “However, we decided to settle this matter and return the alleged overpayments instead of engaging in costly, time-consuming litigation that would consume additional health care resources and distract us from our focus on providing high-quality health care to patients, as we have for over 100 years.” The News-Press did not receive statements from the other three entities as of press time. email: dmason@newspress.com
Amtrak resumes Medical treatment not started service after derailment for suspect in NEWS-PRESS EXCLUSIVE
Injuries largely minor in Moorpark collision; Amtrak traveling through Santa Barbara again
courtroom fire Man was declared mentally incompetent to stand trial
By NEIL HARTSTEIN NEWS-PRESS STAFF WRITER
An Amtrak train derailed after a collision Wednesday with a truck in Moorpark.
VENTURA COUNTY FIRE DEPARTMENT PHOTOS
By LIAM HIBBERT NEWS-PRESS CORRESPONDENT
Amtrak service to Santa Barbara resumed Thursday — the day after a train was derailed in Moorpark when it hit an irrigation truck. Sixteen people were injured in the late Wednesday morning crash, but there were no fatalities. The Amtrak Coast Starlight train, headed from Los Angeles to Seattle through Santa Barbara, was derailed after it crashed into a Ventura County Public Works Agency water truck. The Ventura County Fire Department counted 186 passengers on board and reported passengers and employees sustained largely minor injuries. The only critically injured person was the water truck driver. On the lack of serious injuries and casualties, Ventura County Please see TRAIN on A4
RAFAEL MALDONADO / NEWS-PRESS FILE PHOTO
Amtrak service through the Santa Barbara station, above, was interrupted Wednesday after the Moorpark derailment but resumed Thursday.
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A Nipomo man — who was charged with setting a fire inside a Santa Maria courtroom in February but declared mentally incompetent to stand trial more than two months ago — has not yet begun to get the medical treatment a judge ordered him to receive in May, prosecutors said. Instead, the defendant, Eric Wolfgang Spies, 31, remains locked up at the Santa Barbara County Jail on no bail. The court was supposed to hear a review of Mr. Spies’ treatment progress a week ago, on June 22, but that did not happen, according to Deputy District Attorney Austin Ingalls, the prosecutor handling the case. “We did not receive an update as to Mr. Spies’ treatment,” the prosecutor told the NewsPress Tuesday. “Mr. Spies is still housed in Santa Barbara County Jail and is waiting for a spot to become available within the State Hospital. The case was continued to 08/10/2023 for another status check.” San Luis Obispo County Superior Court Judge Michael Duffy ruled April 20 that Mr. Spies was not legally competent to stand trial, which means he is mentally incapable of understanding the charges against them and cannot take part in his own defense. On May 11, Judge Duffy ordered that the defendant be transported to the Department of State Hospitals to receive restoration services in a locked facility. The court also authorized forced medication compliance. The Department of State Hospitals will decide where he receives his treatment. There are numerous locked DHS facilities all over the state, Prosecutor Ingalls told the News-Press previously. “Some of the ones close to us are Atascadero State Hospital and
Coalinga State Hospital.” Mr. Spies’ case is being heard in San Luis Obispo County because a Santa Barbara County judge, without specifying why, declared early on that it would be a conflict of interest for a local judge to preside over his criminal case. The issue arose on March 2, when Mr. Spies’ attorney expressed doubts about his client’s mental competency. Criminal proceedings against Mr. Spies were suspended. Mr. Spies has pleaded not guilty to felony charges of arson and second-degree commercial burglary in connection with the Feb. 18 incident in which he allegedly broke into a Santa Maria courtroom and set a fire, triggering the sprinkler system. Court officials said the combination of flames and water caused extensive damage to furniture, wall paneling, cabinetry, carpeting and court records. They estimated the cost to be about $750,000. Mr. Spies allegedly went to the Santa Maria court complex, ignored a security guard’s order to leave and broke two glass doors to gain entry into the criminal court building. Once inside, he allegedly forced his way into a courtroom, pulling the doors so hard that he broke the wood frames on the top of the doors. Court officials allege he then started a fire on the defense counsel’s chair, which spread to the table and carpet. The fire was so hot that it melted the lights in the ceiling and caused the sprinklers to come on, court officials said. The defendant reportedly told the security guard he had received a notice about an upcoming hearing on a misdemeanor vandalism case and went to the court complex on Feb. 18, a Saturday, to see where he had to show up.
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