Gold Coast Health Plan (GCHP) has reached a mediated settlement with federal regulators on a 7-year-old dispute regarding disbursements of Medicaid funding to network providers for the benefit of the then-newly eligible adult expansion population resulting from the implementation of the Affordable Care Act. Under the mediated settlement agreement, GCHP agreed to pay $17.2 million – about 24% of the total settlement – and enter into a Corporate Integrity Agreement (CIA) with federal regulators.
The settlement reflects a compromise resolution of a multi-year disagreement between GCHP and the U.S. Department of Justice (DOJ) and the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) over the appropriate amount of disbursements to its providers under the Adult Expansion Program.
“Although Gold Coast Health Plan believes that its disbursements to providers under this program were lawful and proper, we agreed to participate in a mediation with the regulators to reach a settlement to prevent an expensive and protracted process,” said Nick Liguori, GCHP’s chief executive officer. “The settlement reflects a compromise that will finally and fully resolve this dispute.”
