{"id":2488695,"date":"2025-09-19T14:21:02","date_gmt":"2025-09-19T18:21:02","guid":{"rendered":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/doj-sues-health-plan-that-got-almost-3-5-billion-from-feds\/"},"modified":"2025-09-19T14:24:29","modified_gmt":"2025-09-19T18:24:29","slug":"doj-sues-health-plan-that-got-almost-3-5-billion-from-feds","status":"publish","type":"post","link":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/doj-sues-health-plan-that-got-almost-3-5-billion-from-feds\/","title":{"rendered":"DOJ sues health plan that got almost $3.5 billion from Feds"},"content":{"rendered":"<aside class=\"mashsb-container mashsb-main mashsb-stretched\"><div class=\"mashsb-box\"><div class=\"mashsb-count mash-medium\" style=\"float:left\"><div class=\"counts mashsbcount\">22<\/div><span class=\"mashsb-sharetext\">SHARES<\/span><\/div><div class=\"mashsb-buttons\"><a class=\"mashicon-facebook mash-medium mash-nomargin mashsb-noshadow\" href=\"https:\/\/www.facebook.com\/sharer.php?u=https%3A%2F%2Fwww.conservativenewsdaily.net%2Fbreaking-news%2Fdoj-sues-health-plan-that-got-almost-3-5-billion-from-feds%2F\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Facebook<\/span><\/a><a class=\"mashicon-twitter mash-medium mash-nomargin mashsb-noshadow\" href=\"https:\/\/twitter.com\/intent\/tweet?text=&amp;url=https:\/\/www.conservativenewsdaily.net\/breaking-news\/?p=2488695&amp;via=ConservNewsDly\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Twitter<\/span><\/a><a class=\"mashicon-subscribe mash-medium mash-nomargin mashsb-noshadow\" href=\"#\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Subscribe<\/span><\/a><div class=\"onoffswitch2 mash-medium mashsb-noshadow\" style=\"display:none\"><\/div><\/div>\n            <\/div>\n                <div style=\"clear:both\"><\/div><\/aside>\n            <!-- Share buttons by mashshare.net - Version: 4.0.47--><p>The U.S. Attorney&#8217;s Office for the Central District of California has filed a lawsuit against Inland Empire Health Plan (IEHP), accusing it of violating the False Claims Act. IEHP, which received nearly $3.5 billion in federal funding under the Affordable care Act to cover newly eligible Medi-Cal recipients in Southern California,is alleged to have knowingly retained overpayments and failed to return surplus funds as required. The lawsuit claims that between 2014 and 2016, IEHP improperly spent hundreds of millions of dollars meant for Medi-Cal Expansion medical expenses on non-allowed costs such as attorneys and consultants, engaging in <a href=\"https:\/\/amzn.to\/3YuVZYV\" >fraudulent schemes including sham incentive programs<\/a> and unauthorized retroactive rate increases. IEHP serves approximately 1.5 million residents in San bernardino and Riverside counties and disputes the allegations, stating it will defend itself legally. The case highlights federal efforts to combat healthcare fraud and ensure Medicaid funds are used appropriately to prioritize patient care over financial gain. <br \/> <!DOCTYPE html><br \/>\n<?xml encoding=\"utf-8\" ?><html><body><\/p>\n<p class=\"readmore\">\n    <button onclick=\"showReadMore()\" id=\"readmorebtn\">Read more&#8230;<\/button>\n<\/p>\n<hr id=\"line\">\n<span id=\"more\"><\/p>\n<p><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><\/p>\n<div class=\"tdb-block-inner td-fix-index\"><span class=\"tdb-mobile-menu-button\"><i class=\"tdb-mobile-menu-icon td-icon-mobile\"><\/i><\/span><\/div>\n<div class=\"tdb-block-inner td-fix-index\"><span class=\"tdb-header-search-button-mob dropdown-toggle\" data-toggle=\"dropdown\"><i class=\"tdb-mobile-search-icon td-icon-search\"><\/i><\/span><\/div>\n<div class=\"tdb-block-inner td-fix-index\"><\/div>\n<div class=\"tdb-block-inner td-fix-index\"><span class=\"tdb-mobile-menu-button\"><i class=\"tdb-mobile-menu-icon td-icon-mobile\"><\/i><\/span><\/div>\n<div class=\"tdb-block-inner td-fix-index\">\n<div class=\"tdb-drop-down-search\" aria-labelledby=\"td-header-search-button\">\n<div class=\"tdb-drop-down-search-inner\">\n<form method=\"get\" class=\"tdb-search-form\" action=\"https:\/\/www.washingtonexaminer.com\/\"><\/form>\n<div class=\"tdb-aj-search\"><\/div>\n<\/div>\n<\/div>\n<p><a href=\"http:\/\/www.washingtonexaminer.com\/#\" role=\"button\" aria-label=\"Search\" class=\"tdb-head-search-btn dropdown-toggle\" data-toggle=\"dropdown\"><i class=\"tdb-search-icon td-icon-search\"><\/i><\/a><\/div>\n<div class=\"tdb-block-inner td-fix-index\"><\/div>\n<div class=\"tdb-block-inner td-fix-index\">\n<h1 class=\"tdb-title-text\">DOJ sues health plan that got almost $3.5 billion from Feds<\/h1>\n<div><\/div>\n<div class=\"tdb-title-line\"><\/div>\n<\/div>\n<div class=\"tdb-block-inner td-fix-index\"><\/div>\n<div class=\"tdb-block-inner td-fix-index\">\n<div id=\"Brid_2235219\" class=\"tpd-featured-video bridtv\"><\/div>\n<p>(The Center Square)&nbsp;&ndash; The U.S. Attorney&rsquo;s Office for the Central District of <a href=\"https:\/\/www.washingtonexaminer.com\/tag\/california\/\" target=\"_blank\" rel=\"noreferrer noopener\">California<\/a> is suing a <a href=\"https:\/\/www.washingtonexaminer.com\/tag\/health-insurance\/\" target=\"_blank\" rel=\"noreferrer noopener\">health insurance<\/a> plan for allegedly violating the public&rsquo;s trust at taxpayers&rsquo; expense.<\/p>\n<p>The federal government filed the&nbsp;<a href=\"https:\/\/www.justice.gov\/opa\/media\/1414371\/dl?utm_medium=email&amp;utm_source=govdelivery\" target=\"_blank\" rel=\"noreferrer noopener\">complaint<\/a>&nbsp;Wednesday&nbsp;under the False Claims Act against Inland Empire Health Plan, which received nearly $3.5 billion under the Patient Protection and <a href=\"https:\/\/www.washingtonexaminer.com\/tag\/affordable-care-act\/\" target=\"_blank\" rel=\"noreferrer noopener\">Affordable Care Act <\/a>to extend coverage to newly eligible Californians receiving Medi-Cal. The suit was filed in the U.S. District Court for the Central District.&nbsp;<\/p>\n<div class=\"recommended-stories\">\n<h2>Recommended Stories<\/h2>\n<ul>\n<li><a href=\"https:\/\/www.washingtonexaminer.com\/news\/campaigns\/state\/3815646\/what-to-know-early-voting-virginia-elections\/\">Early voting begins in Virginia elections: What to know<\/a><\/li>\n<li><a href=\"https:\/\/www.washingtonexaminer.com\/news\/justice\/3815884\/judge-strikes-trump-new-york-times-lawsuit-ordering-it-be-rewritten\/\">Judge strikes Trump&#8217;s New York Times lawsuit, ordering it to be rewritten<\/a><\/li>\n<li><a href=\"https:\/\/www.washingtonexaminer.com\/news\/senate\/3815835\/senate-rejects-two-funding-bills-government-shutdown-deadline\/\">Senate rejects dual Democrat and GOP funding bills ahead of shutdown deadline<\/a><\/li>\n<\/ul>\n<\/div>\n<div class=\"article-paywall\">\n<p>The health plan serves 1.5 million residents in inland Southern California&rsquo;s San Bernardino and Riverside counties, according to IEHP.<\/p>\n<p>&ldquo;The government&rsquo;s complaint alleges that IEHP violated the False Claims Act by making false statements to Medi-Cal and knowingly retaining overpayments,&rdquo;&nbsp;<a href=\"https:\/\/www.justice.gov\/usao-cdca\/pr\/united-states-files-lawsuit-against-san-bernardino-county-based-health-plan-alleged\" target=\"_blank\" rel=\"noreferrer noopener\">the&nbsp;U.S. Attorney&rsquo;s Office<\/a>&nbsp;said in a news release.<\/p>\n<p>The U.S. Department of Justice suit accuses IEHP of failing to keep its promise to return surplus funding to the federal government for a newly insured Medi-Cal Expansion population between Jan. 1, 2014 and June 30, 2016. Medi-Cal is California&rsquo;s Medicaid program.<\/p>\n<p>&ldquo;Instead of keeping that promise, IEHP illegally spent hundreds of millions of dollars of surplus funding in a fraudulent scheme designed to pad its own coffers,&rdquo; according to the 58-page lawsuit.<\/p>\n<p>The Medi-Cal expansion covered adults between ages 19 and 64 without dependent children and with annual incomes of up to 133% of the <a href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/oakland-to-enroll-600-families-of-color-in-guranteed-income-pilot-program\/\" title=\"Oakland to Enroll 600 Families of Color in \u2018Guranteed Income\u2019 Pilot Program\">federal poverty level<\/a>. If IEHP didn&rsquo;t spend at least 85% of the funds on &ldquo;allowed medical expenses,&rdquo; it was required to pay the difference to the state, which would then pay it back to the federal government, the U.S. Attorney&rsquo;s Office said.<\/p>\n<p>In a statement Wednesday to media,&nbsp;<a href=\"https:\/\/www.prnewswire.com\/news-releases\/inland-empire-health-plan-statement-on-department-of-justice-filing-302559988.html\" target=\"_blank\" rel=\"noreferrer noopener\">IEHP<\/a>&nbsp;said it strongly disagreed &ldquo;with the DOJ allegations and is prepared to defend our efforts through the appropriate legal process.&rdquo;<\/p>\n<p>The lawsuit said IEHP committed schemes falling in the categories of &ldquo;(1) sham incentive programs and (2) an extra-contractual retroactive rate increase.&rdquo;<\/p>\n<p>&ldquo;To further these schemes, IEHP improperly spent money intended for the MCE population&rsquo;s medical expenses on attorneys, consultants, and technology contractors,&rdquo; according to the lawsuit. MCE stands for &ldquo;Medi-Cal Expansion.&rdquo;<\/p>\n<p>Acting U.S. Attorney Bill Essayli said the lawsuit shows his office&rsquo;s commitment to hold insurers accountable when they &ldquo;brazenly compromise the Medicaid system.<\/p>\n<p>&ldquo;We will take every measure to restore integrity and accountability to the Medicaid system and ensure that patient care &ndash; not financial gain &ndash; is the primary focus of our health care system,&rdquo; Essayli said.<\/p>\n<p><strong><a href=\"https:\/\/www.washingtonexaminer.com\/policy\/healthcare\/3815444\/cdc-vaccine-panel-postpones-decision-newborn-hepatitis-b-vaccine\/\" target=\"_blank\" rel=\"noreferrer noopener\">CDC VACCINE PANEL POSTPONES DECISION ON NEWBORN HEPATITIS B VACCINE<\/a><\/strong><\/p>\n<p>The suit illustrates the <a href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/texas-judge-grants-gop-lawmaker-standing-to-sue-biden-administration-over-unrwa-funding-washington-examiner\/\" title=\"Texas judge grants GOP lawmaker standing to sue Biden administration over UNRWA funding - Washington Examiner\">federal government&#038;rsquo<\/a>;s emphasis on combating health care fraud, the U.S. Attorney&rsquo;s Office said.<\/p>\n<p>The U.S. Department of Health and Human Services welcomes information about potential fraud, waste, abuse and mismanagement at 1-800-HHS-TIPS&nbsp;(800-447-8477).<\/p>\n<\/div>\n<p> <script data-cfasync=\"false\" src=\"http:\/\/www.washingtonexaminer.com\/cdn-cgi\/scripts\/5c5dd728\/cloudflare-static\/email-decode.min.js\"><\/script> <\/div>\n<div class=\"tdb-block-inner td-fix-index\"><\/div>\n<div class=\"tdb-block-inner td-fix-index\"><\/div>\n<p><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>DOJ sues Inland Empire Health Plan over $3.5B federal funds misuse<\/p>\n","protected":false},"author":2869,"featured_media":2488696,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_mo_disable_npp":"","fifu_image_url":"https:\/\/www.washingtonexaminer.com\/wp-content\/uploads\/2025\/09\/AP23026630057707.jpg?w=696","fifu_image_alt":"","footnotes":""},"categories":[33651],"tags":[7076,52756,63700,63701,4585],"class_list":["post-2488695","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-the-western-journal","tag-doj","tag-federal-funds","tag-health-plan","tag-healthcare-fraud","tag-lawsuit"],"fifu_image_url":"https:\/\/www.washingtonexaminer.com\/wp-content\/uploads\/2025\/09\/AP23026630057707.jpg?w=696","_links":{"self":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2488695","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/users\/2869"}],"replies":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/comments?post=2488695"}],"version-history":[{"count":3,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2488695\/revisions"}],"predecessor-version":[{"id":2488699,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2488695\/revisions\/2488699"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media\/2488696"}],"wp:attachment":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media?parent=2488695"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/categories?post=2488695"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/tags?post=2488695"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}