VENTURA COUNTY: Health Agency Retraces Missteps
The financial staff of Ventura County's Health Care Agency convened Tuesday to inform county Supervisor John Flynn how the beleaguered agency ran "$15.3 million afoul of the federal government in wrongful Medicare billing," the Ventura County Star reports. The answers "aren't simple," Flynn learned. Part of the problem can be traced to the early 1990s when ever-changing Medicare billing guidelines collided with state guidelines, causing overwhelming "confusion," staff members informed Flynn. Because federal rules mandated physician oversight for all aspects of treatment for the county's mentally ill, whereas state guidelines were more "loosely drawn," staff had to "keep the billing requirements separate and supported by documentation." But "[l]ack of communication" and "sloppy charting" prevented that from happening. In some cases, the department billed Medicare for services done by psychiatrists no longer working for the county. "That kind of thing happened because no one (from the mental health department) notified us when a doctor left," said Karen Schmidt, manager of patient accounting. Federal investigators have had difficulty even determining "who authorized a treatment, what it was for and if it was medically necessary." The $15.3 million settlement reached with the government mandates a complete overhaul of the agency; workers are starting by redesigning "Medicare rule books," said Schmidt. But a requisite "integrity agreement" has Flynn steaming. "We're ready to sign off and pay back what we owe, but the sticking point now is this integrity agreement," he said, "For instance, they want as much as eight hours of training for all employees, even those who have nothing to do with billing -- it's ridiculous. They don't care how much it costs" (Koehler, 8/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.