Clinica Sierra Vista OKs $25mil settlement to square up Medi-Cal overpayments

After years of tumult, the Valley chain of nonprofit health clinics came forward that it was overpaid state medical health benefits.

In the news: In order to address the Medi-Cal overpayments, Clinica will be forced to pay nearly $26 million due to finding a fault with a practice back in 2019. This agreement was made after Clinica was caught underreporting Medi-Cal income from the years 2010 to 2017 which increased their government reimbursements received when having no right to do so.

  • According to CEO Dr. Olga Meave, the $26 million will not affect CSV’s daily “operations, patients, or team members” as over the last 3 years the company has been putting money aside for this specific case to be resolved.
  • Steve Schilling, CSV’s founder and CEO during the period of the case, shared that there was not one person benefiting from the Medi-Cal overpayments and that the non profit had worked to keep millions of dollars set aside for the situation that they had to return any overpayments issued. In total, the state will be receiving $15.59 million while giving the remaining $10.39 million to the federal government.
  • This issue occurred from CSV excluding some details about their Medi-Cal payments that had been received in the years from 2010 to 2015. From 2015 to 2017 CSV was found providing false information regarding the amount of Medi-Cal received which ended in a substantial amount of payments being issued from the state that should not have been.

What’s being said: Dr. Olga Meave shared in a statement on Thursday that the non profit has taken extreme measures to prevent an issue such as this from happening ever again and shared how they were doing that.

  • “New leadership is in place at CSV and the organization has taken many steps since 2018 to ensure a reporting error like this does not happen again, including instituting a new compliance program and hiring an external accounting firm to perform annual audits under the rigorous Single Audit Act.”
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