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OC Healthcare Provider to be Audited

OC Healthcare Provider to be Audited

SANTA ANA (CNS) - Orange County Supervisor Janet Nguyen, who represents the county on its agency that provides healthcare for the county's poor and some seniors, today called for a full audit of the agency following a stinging report from federal officials.

The embarrassing audit of CalOptima from the federal Centers for Medicare and Medicaid Services from Nov. 4-15 led officials to suspend the county agency's enrollment of Medicare beneficiaries and marketing to Medicare beneficiaries.

Orange County Board of Supervisors Chairman Shawn Nelson said the board will consider adding another supervisor to the CalOptima board. Nguyen is the sole supervisor on the board.

“It's a monumental task and we ask one person” to handle it, Nelson said. “We need to look once again at at expanding this board's representation to at least two of us. It's an awful to to have one of us shoulder it.”

Supervisor Todd Spitzer, the board's alternate on the CalOptima board, accused Nguyen of directing agency staff to “block” him from getting any information about the audit, which was released Friday.

Spitzer complained he was getting calls from reporters over the weekend  and could not respond.

“I was in this awkward position all weekend, getting questions when I didn't know what was going on,” Spitzer said. “It's not appreciated when information is blocked.”

Nguyen said, “I spoke to Supervisor Spitzer this morning and apologized for that.”

Nguyen has called for an independent outside audit of CalOptima's OneCare program and additional audits across the board.

The agency has about 16,000 patients enrolled in the OneCare program, according to Nguyen.

Federal officials said there CalOptima's violations “resulted in enrollees experiencing delays or denials in receiving covered medical services or prescription drugs, and increased out-of-pocket costs.”

CalOptima failed to comply with rules regarding appeals and grievances from enrollees, according to the audit.

“I was assured by CalOptima staff that these findings are not a  reflection of CalOptima's quality of service, as evidence by our high CMS star ratings which measure quality of care, customer satisfaction and overall outcomes but instead reflect a systemic problem arising from insufficient due  process and documentation in the delivery of services,” Nguyen said.

 

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