SAN FRANCISCO II: Board Attempts to Help HIV Clinic Keep Medicare Funding

      San Francisco Supervisor Tom Ammiano yesterday introduced a resolution to keep The Wellness Center at Davies Medical Center, one of the city's largest HIV clinics, open until a two-year dispute over Medicare overcharges can be resolved, the San Francisco Chronicle reports. The center, which treats 1,500 chronically ill patients including 500 HIV-positive patients, may have to close its doors on Jan. 31 if the owner, Dr. Jon Kaiser, does not repay $126,932 in alleged overcharges. Medicare reimbursements are scheduled to stop at the end of the month if the money is not repaid. Kaiser argues that the financially strapped center cannot function without Medicare payments. Ammiano's resolution asks Medicare and its contractor, the National Heritage Insurance Co., to extend the repayment schedule and allow the center to appeal the charges before repaying. "It's so heartbreaking because a lot of the patients call and they don't know where to go. When they close the door on a medical plan or extension, it just seems like a heartless bureaucracy," Ammiano said. However, Richard Chambers, deputy regional administrator of the Health Care Financing Administration that oversees Medicare, said the Jan. 31 deadline was already a two-week extension and the first extension ever granted. The Board of Supervisors is expected to vote on the resolution Monday.

The Issue
      Problems at The Wellness Center began in 1997, when previous owner Quest Corp., suddenly closed the clinic giving 48-hours notice. Kaiser, a staff member at the clinic, scrambled for funding to keep the clinic open (Minton, 1/25). Shortly after taking the reigns, Kaiser received a phone call from Quest saying it needed to produce patient charts for a Medicare audit. Suspicious, Kaiser decided to launch his own internal audit, which that found the clinic was using incorrect Medicare billing procedures. Before the changes were in place, the National Heritage Insurance Co. sent auditors to look at patient files and determined that Medicare had overpaid $30,000. From that number, auditors estimated that The Wellness Center owed $138,000 and they sent their findings to Kaiser. In response, Kaiser sent them 100 pages of documents and a 10-page cover letter outlining the bleak financial picture at the clinic, including a copy of the second mortgage he took out on his house to keep the clinic operating. On Dec. 15, Kaiser received a letter telling him that if the payment was not received by Jan. 7, Medicare payments would be stopped on Jan. 14. Although he received an extension, Kaiser contends that it is not long enough and has asked for one-year grace period. That request has since been denied. "This is not an endeavor I took on to make money. This was to prevent the abrupt discontinuation of care for many seriously ill people. We already, unilaterally ... embarked on our own internal review and had just finished making all of these changes," Kaiser said. Even federal lawmakers have championed his cause. U.S. Rep. Nancy Pelosi (D-Calif.) has written to HCFA asking them to compromise. "We're reaching out in every possible way we can to make HCFA aware of the consequences for patients. HCFA doesn't have a great deal of discretion," Pelosi said (Torassa, San Francisco Examiner, 1/24).