[MM Curator Summary]: If it walks like a duck..
For the second time in two years, California health officials are suspending all Medicaid payments to federally qualified health center Borrego Health for “continued and unresolved inappropriate billings,” the San Diego Union-Tribune reported Aug. 30.
The California Department of Health Care Services’ decision comes after state and federal authorities launched a criminal investigation into millions of dollars of alleged improper billings, excessive salaries and above-market rent payments at Borrego Spring-based Borrego Health, according to the report. It also comes after Borrego Community Healthcare Foundation sued several past board members, executives and contractors over allegations of racketeering, fraud, nepotism, excessive compensation and self-dealing.
Borrego Health’s Medicaid reimbursements were first suspended in December 2020 after state and federal agents raided Borrego Health locations, seizing computers, taking medical records and interviewing employees.
Regulators agreed to reinstate Medicaid reimbursements for medical services in early 2021, but not for dental work, which remains the focus of the criminal investigation, according to the report. The reinstatement came after Borrego Health agreed to an independent monitor and other conditions.
In an Aug. 19 letter obtained by the San Diego Union-Tribune, state health officials said they would withdraw all Medicaid reimbursements by Sept. 29 because of Borrego Health’s alleged failure to meet its settlement obligations.
A Borrego Health spokesperson told the San Diego Union-Tribune the decision was unwarranted and unexpected and will “significantly and abruptly reduce access to care for thousands of at-risk Californians.”
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