Ventura County’s Medi-Cal plan owes a health system that operates hospitals in Oxnard and Camarillo more than $30 million in unpaid claims, a lawsuit alleges.
Filed by Dignity Health on Aug. 24, the action asserts Gold Coast Health Plan underpaid or did not pay more than 5,000 bills submitted by nonprofit Dignity Health, which owns St. John’s hospitals in Oxnard and Camarillo. The lawsuit also covers Northridge Hospital Medical Center, operated by a subsidiary of Dignity parent company CommonSpirit Health.
The Ventura County Superior Court litigation alleges Gold Coast is inundated with billing and payment system issues and has not been able to properly respond to claims for two years because of changes in computer software.
Gold Coast is the 15-year-old
publicly funded entity that administers Medi-Cal health insurance for more than 220,000 low-income people in Ventura County. Gold Coast spokesperson Susana Enriquez-Euyoque said plan leaders do not comment on pending litigation.
Dignity Health spokesperson Christina Zicklin said the health system also does not comment on ongoing lawsuits.
Gold Coast reported two years ago that Dignity indicated it was terminating its contract with the Medi-Cal plan for primary and most specialty care. But the agreement for hospital care was extended.
Dignity alleged Gold Coast’s software change came in July 2024 and spurred systemwide payment problems.
“It has been over two years since this system switch, and Gold Coast’s claims processing system is still not functioning appropriately,” the lawsuit says. “Plaintiffs continue to submit medical bills to Gold Coast for processing pursuant to the contract, and Gold Coast either does not respond in writing at all to the submitted bill, fails to pay the claim or underpays the claim.”
The lawsuit says claims that should be approved are denied without clear reason. The health plan’s online portal doesn’t work and phone calls are unanswered or placed on hold for more than an hour, Dignity’s lawyers said.
The lawsuit says Dignity has not received more than $30 million in unpaid claims. It says the payment problems also mean the hospital has not received reimbursement in a supplemental payment program managed by the California Department of Health Care Services.
The lawsuit says Dignity asked in writing for $48 million from Gold Coast to cover owed payments and interest.
The problems have affected other providers, too, the lawsuit says. It alleged one healthcare company stopped treating Gold Coast members because the plan “owed the group more than $600,000, was not honoring contracted rates and had requested that thousands of claims be resubmitted on paper.”
The company did not respond to messages.
Other providers that contract with Gold Coast, including Clinicas del Camino Real and the Ventura County Health Care Agency also did not immediately respond to messages.
Jamie Maites, spokesperson for Community Memorial Healthcare, declined comment on the lawsuit but said reimbursement challenges have grown for healthcare providers, government coverage programs and private insurers.
“Hospitals across the county are experiencing longer processing times and greater administrative complexity in getting claims adjudicated and paid,” she said in an email. “These delays can create significant financial and operational challenges as healthcare organizations work to manage rising costs while maintaining access to care for their communities.”
In the Dignity lawsuit, lawyers said Gold Coast failed to adequately respond to a litany of attempts to get payment or to provide reasons for unpaid claims.
“Gold Coast has repeatedly made promises to resolve this dispute but has failed to take the necessary remedial actions,” the lawsuit says.
Tom Kisken covers health care and other news for the Ventura County Star. Reach him at tom.kisken@vcstar.com.
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This article originally appeared on Ventura County Star: St. John's parent company sues Medi-Cal plan for over $30M left unpaid
