Some Vietnamese Americans Say Orange County Medi-Cal Managed Care Program Discriminates Against Beneficiaries, Local Pharmacies
About 200 Vietnamese-American doctors, pharmacists and Medi-Cal beneficiaries on Wednesday in Orange County met to protest CalOPTIMA, which provides benefits to the county's Medi-Cal beneficiaries, and said that the agency is discriminating against them, the Orange County Register reports (Wolfson, Orange County Register, 1/27).
According to the Committee to Support Medi-Cal Beneficiaries, which sponsored the meeting, about 15,000 residents have signed a petition to abolish the program's managed care system and return to a traditional Medi-Cal program. The committee says CalOPTIMA provides inadequate care and compromises privacy.
The committee said it plans to send the petition to state officials. Thuan Van Pham, chair of the committee, said he also sent a letter to Gov. Arnold Schwarzenegger (R) asking him to investigate the committee's complaints (Wolfson, Orange County Register, 1/27).
According to the Register, a one-year pilot program that would require CalOPTIMA pharmacies to be certified by the not-for-profit Fraud Prevention Institute is "heart of the dispute." CalOPTIMA says the program, which requires pharmacies to fill out a short survey, could help reduce costs. The agency noted that, according to the Attorney General's Office, 30% of Medi-Cal's $34 billion budget is spent on fraud cases and half of all fraud cases involve prescription drugs.
However, Vietnamese-American pharmacists say the pilot program is intended to force them out of the Medi-Cal network in favor of larger chain pharmacies. Pharmacists and beneficiaries also say the FPI contracts would violate patient privacy, and they note that the institute has a conflict of interest because it can require pharmacies to pay as much as $5,000 to continue to participate in Medi-Cal if evidence of fraud is discovered.
Between 28 and 40 of the pharmacies have refused to sign a deal with FPI and have been dropped from the Medi-Cal network (Wolfson, Orange County Register, 1/26). Beneficiaries at the meeting said they have had trouble finding the prescription drugs they need (Orange County Register, 1/27). The Vietnamese-American Independent Pharmacies Group has filed a lawsuit against CalOPTIMA seeking to nullify the requirement that stores sign the FPI deal.
Alan Cates, FPI's director of fraud-prevention services, said the $5,000 fee is intended to help defray costs of further investigations, adding that he has told the pharmacists "that even if fraud is found, [the surveillance is] used to get rid of fraud, not to get rid of you."
Kenneth Bell, CalOPTIMA's chief medical officer, said the antifraud measures, which were implemented Jan. 1, are intended for "the whole community," adding, "We can't treat one group differently."
CalOPTIMA CEO Richard Chambers said "it's difficult to understand" why the pharmacies chose to decline the FPI deal, but he added that 93% of pharmacies in the county have agreed to it (Orange County Register, 1/26). Chambers also said that the beneficiaries' complaints about CalOPTIMA reflect misunderstandings about the nature of managed care.
Chambers, noting the beneficiaries' complaints about replacing brand-name drugs with generics, said, "It's very common in managed care to have prescription limitations and to prescribe generic medications where a substitution is appropriate. We save money by making generic substitutions ... so we can have money to provide for all the prescription drugs and all the doctor visits that are necessary" (Orange County Register, 1/27).
Bui Van Nhan of the local beneficiary committee said that if CalOPTIMA continues its current policies, "then we will directly move to have them evicted."
Assembly member Van Tran (R-Costa Mesa), whose district includes much of the county's Vietnamese-American community, said, "Our office has gotten tons of (petition) signatures and tons of calls. If the issues are not resolved soon, I'll be looking into investigative and legislative remedies" (Orange County Register, 1/26).
Tran said he has proposed a compromise to CalOPTIMA that would temporarily suspend the fraud surveillance requirement while the two sides discuss possible alternatives. Tran also said he proposed allowing the pharmacies that closed in response to the requirement to continue filing electronic claims with CalOPTIMA for the time being. The agency has said it will only honor paper claims through Feb. 28, a policy pharmacies said would lead to difficulties collecting reimbursements and checking patient profiles.
Chambers said his agency was considering Tran's proposals, as well as ideas from county Supervisor Lou Correa. Tran said Chambers had told him CalOPTIMA was considering setting up a group to communicate with the Vietnamese-American community, a policy Tran described as a good idea to combat the "fear of the unknown" that was driving the beneficiary and pharmacist complaints (Orange County Register, 1/27).