O.C.-Based Health Care Organization Agrees to Pay Over $31.5 Million to Settle Claims It Overbilled Medicaid for Prescription Medication
LOS ANGELES – Memorial Health Services, a Fountain Valley-based non-profit health care organization, has agreed to pay more than $31.5 million to resolve allegations that it overbilled Medicaid for prescription medication purchased and reimbursed under a federal drug pricing program, the Justice Department announced today.
The settlement agreement is the result of a voluntary disclosure made in October 2019 by Memorial Health, which under the name MemorialCare Health System operates Long Beach Memorial Medical Center, Miller Children's and Women's Hospital, and Orange Coast Memorial Medical Center.
After an internal audit, Memorial Health determined that its hospitals and pharmacies overbilled the United States and California, which jointly fund Medicaid – known in California as Medi-Cal – a program that helps lower-income people with their medical costs.
According to the settlement agreement, from December 2016 to October 2019, Memorial Health improperly charged higher “usual and customary” costs, rather than lower “actual acquisition costs,” as required under the 340B Drug Pricing Program. This federal program requires drug manufacturers to provide outpatient medication to eligible health care organizations at significantly reduced prices.
The overbilling allegedly resulted from Memorial Health billing for its usual costs following a federal court’s temporary stay of the implementation of the California law requiring 340B providers to bill Medi-Cal at actual acquisition cost rates. But once a court lifted the temporary ban, Memorial Health failed to implement actual acquisition cost pricing.
“Hospitals and pharmacies that participate in the 340B Program are expected to provide low-priced drugs to vulnerable patients without overcharging the federal or state government,” said United States Attorney Nick Hanna. “While we commend Memorial Health for making a voluntary disclosure of its overbilling, we expect health care entities that participate in the 340B Program to do so fairly, honestly and in full compliance with the law.”
“Today’s settlement was the result of Memorial Health coming forward, doing the right thing, and alerting the authorities of their error,” said California Attorney General Xavier Becerra. “The money from the settlement will go back where it belongs: to California’s residents, particularly low-income families and children who rely on Medi-Cal for their healthcare coverage.”
Memorial Health ultimately overbilled the United States and California $21,021,786 and the $31.5 million settlement represents 1.5 times the alleged overbilling, the agreement states. Memorial Health has agreed to pay the United States $12,613,071.60 and California $18,919,607.40 to resolve the allegations, bringing the total settlement amount to $31,532,679.
After making its voluntary disclosure, Memorial Health cooperated with the federal and state authorities’ investigation.
The settlement was negotiated by Assistant United States Attorneys John E. Lee and Abraham C. Meltzer of the Civil Fraud Section, along with the U.S. Department of Health and Human Service’s Office of Inspector General and the California Department of Justice.
The settled claims are allegations only, and Memorial Health has not admitted any wrongdoing.