VENTURA COUNTY: Medicare Billing Dispute May Imperil Clinics
HCFA has informed Ventura County that its 43 public health clinics do not meet federal Medicare billing guidelines, giving the county until June 30 to "bring the clinics into compliance or face a possible reduction in funding." In an April letter to the county, Wayne Moon, HCFA's director of Hospital and Community Care Operations, said the county's 22 medical and 21 mental health clinics are not authorized to bill Medicare at a higher rate because they are effectively independent of the Ventura County Medical Center. Emery Lee, a billing specialist with HCFA, said, "They must reorganize in some way so the clinics come under the hospital's direct line of authority. Not just on paper, but in practice as well." But the county contends the clinics are in fact "outpatient satellites" of the medical center, which entitles them to collect the higher reimbursements. County Counsel James McBride said, "Everything is perspective. We're confident that whatever issues they have found with the clinics can be corrected." Mike Powers, deputy director of the county Health Care Agency, said the county can demonstrate that the clinics exist under the umbrella of the medical center. He said, "We want to make it very clear that there is one administrator and that all departments of the hospital report to the administrator." The Los Angeles Times reports that federal officials began investigating the clinics' billing practices last year, when the county attempted to merge its mental health and social services departments. County Supervisor Frank Schillo, who voted against the merger, said, "People say there is no fallout from the merger. Well, this is fallout from the merger. We are going to be making changes and hopefully not suffering too badly from this spotlight on the medical center." Doctors now run the clinics on a contract basis in mostly poor neighborhoods, where many patients are on Medicare and Medi-Cal. Schillo said, "These doctors we have contracted with are expecting a certain amount of income. If we don't get the (full) funding, we will have to change those contracts" (Saillant, 5/11).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.