Drug Clinic Drops County Contract : Methadone Treatment Program Canceled Amid Billing Disputes

A feud between county officials and the owner of the only San Gabriel Valley clinic offering methadone treatment for heroin addiction will leave about 85 addicts with the choice of traveling to East Los Angeles daily for free treatment or paying for it themselves.

Community Health Projects Inc., run by West Covina Mayor Forest Tennant, a medical doctor, has canceled its $272,500-a-year-contract with the county to treat indigent heroin addicts with methadone, effective Feb. 28. The clinics will still provide methadone for a fee, $150 a month, to more than 600 addicts.

County health officials say it will take at least three months to line up another clinic in the San Gabriel Valley to provide county-paid methadone, a synthetic drug used to combat heroin addiction. Meanwhile, addicts are being referred to programs in East Los Angeles and South-Central Los Angeles.

Tennant said his organization canceled its contract because of burdensome paper-work requirements. “When you deal with the county, paper is your most important product,” he said.

Staffing, Billing Problems

County officials said that Tennant’s clinics have a history of staffing and billing problems, inadequate medical care and other deficiencies, but are now meeting all requirements. The state Department of Health Services has ordered a complete field audit of the billing procedures of Community Health Projects to determine if Medi-Cal was billed improperly for methadone patients.

Tennant rejected the county’s criticisms and said the billing questions raised by the state stem from complex, ever-changing regulations for government-funded programs.

“There will be times when they pay us for something and will come back and say ‘you shouldn’t have been paid’ and we will pay the money back,” Tennant said. “That is standard for hospitals and clinics. I know it sounds bizarre, but that is SOP (standard operating procedure) in the health industry.”

State health officials would not say how much money is in dispute in the audit, which will begin within a few weeks. Tennant acknowledged that audits in 1984-85 resulted in $36,000 in disallowed billings for Community Health Projects.

The state Department of Alcohol and Drug Programs last fall asked the Department of Health Services, which oversees Medi-Cal billing, “to determine the propriety and legality” of billing practices by Community Health Projects. A spokesman for the Department of Health Services said it cannot comment because the “matter is potentially under investigation.”

Question of Billing

But other county and state officials said the issues involve billing Medi-Cal for laboratory fees for methadone patients, although methadone is not a covered expense, and charging patients partial fees for services while also billing Medi-Cal. Tennant said his agency has changed its policies as a result of the questions raised. In a letter to the state drug program administrator, Tennant said, “Specifically we have stopped our programs that have partial fee payments and the taking of extra urine tests that are billed to Medi-Cal.”

“Anybody who says they have been double-billed and we have been paid twice for a service we’ve done, tell us and we’ll send the money back,” Tennant said. Financial records for Community Health Projects are open for public inspection, he said.

Community Health Projects, founded in 1974, is a nonprofit organization that grosses $5 million a year running two dozen clinics that offer low-cost general health care and drug abuse treatment. The organization has clinics in Pomona, Pasadena, Baldwin Park, El Monte, La Puente and West Covina in the San Gabriel Valley and others as far away as Fresno. Tennant said the clinics treat 2,000 patients a week, about one-third for drug problems.

Both Tennant and county officials estimate that there are 10,000 heroin addicts in the San Gabriel Valley.

“We have no cure for heroin addiction--that’s our problem,” Tennant said. “The recovery rate is less than 20% in a lifetime, meaning only 20% of the addicts get off and stay off for as long as three years.”

Tennant said methadone is “a last-resort treatment,” used only after other efforts to detoxify patients have failed. Those on methadone maintenance programs must come to the clinic every day. Tennant said the average treatment period is four to six months.

Limited Number of Patients

Dr. Irma Strantz, director of the county drug abuse program, said there are tight controls over the use of methadone to make sure that patients receive counseling and other services and to prevent methadone overdoses. The state, acting on the county’s recommendation, sets limits on the number of patients each clinic may treat, based on an analysis of heroin addiction in the area and on the clinic’s capabilities.

Strantz and Tennant have been arguing for years over how many patients Community Health Projects should be licensed to treat on a methadone program. The current limit is 675.

Tennant said his San Gabriel Valley clinics have 200 to 300 people on waiting lists for methadone and said his clinics are equipped to handle 100 more than they are seeing now.

Tennant said his waiting lists are all the evidence the county needs to raise the limits.

“If some guy walks up the stairs and says, ‘I’m addicted and I need help,’ I don’t know what kind of data you need. (But) the county says, ‘You can’t be treated, young man. You must go out and steal. You must go out and keep putting heroin in your arm four times a day.’ ”

Strantz Changes Stance

Strantz said she agrees that the methadone program should be expanded in the San Gabriel Valley but that the problem has been getting a contractor capable of doing the job. She said she will recommend approval of a pending request from Community Health Projects to run a methadone program in El Monte for 30 patients. She rejected the proposed El Monte program earlier because the clinic was next to a house where children lived. Community Health Projects arranged last month to move the family and rent the house for offices, and Strantz said she will now recommend approval of the program.

Strantz also disclosed that other organizations are seeking licenses to run clinics in Whittier and the West San Gabriel Valley and she will recommend that they be licensed for 150 patients each. She declined to identify the clinic operators because they are still in the licensing process.

The county operated its own methadone program until 1980, when it decided to contract with private organizations. Community Health Projects was the only applicant then for the San Gabriel Valley contract.

Although Strantz said Community Health Projects is currently in compliance with regulations, she outlined a host of problems with the agency in a memo last month.

9 Problems Listed

“Almost from the inception of the contract, county drug program monitors were hard-pressed to elicit an acceptable level of client services from this agency,” she wrote. She listed nine major problems, ranging from billing irregularities to inadequate staffing to inappropriate use of research drugs.

Tennant said he regarded some of the criticisms as slanderous. He said the county has discouraged the use of new technology to treat heroin addiction, has misunderstood his clinics’ operations and refused to discuss problems.

“The county won’t return phone calls. It has been noncommunication for a long time,” he said. “We have been unable to sit down with them and have a reasonable discussion.”

Larry Cole, a minister who is chairman of the board of Community Health Projects, said the board decided to drop its county contract for methadone maintenance because administering it was taking too much time and effort.

“Our goal is to provide the lowest-cost health care we can, and if you’re spending all your time doing this kind of thing (meeting paper-work requirements), it’s going to run the cost up. It’s not an efficient use of personnel,” Cole said.

Community Health Projects gave up two contracts, both of which would have run through the fiscal year ending in June. One was for $198,000 for the methadone maintenance program and the other for $74,800 for a program that attempts to get addicts off drugs in a 21-day period.

Tennant said the county contracts, which apply only to indigent patients, represent less than 5% of his organization’s budget. He said most heroin addicts are employed and have insurance to pay for treatment. Thus it is more important to his organization financially to have the authority to offer methadone maintenance to patients than to receive payment from the county.

But, he said, his concern is not just financial. “I think people ought to be treated,” he said, “and the county ought to make sure that the programs are there.”

He said he does not care whether his clinics, the county or other clinics offer the treatment, although he added that it would be wrong of the county to put the programs “too close together.”

Tennant said his clinics would give free methadone treatment to indigent addicts if the county would let him expand his methadone program.

Under his organization’s contract with the county, indigent patients have been served from clinics in Whittier and West Covina.

Community Health Projects notified patients covered by the county program that they could transfer to another county program in East Los Angeles, try to detoxify by the end of February or remain in the program by paying a reduced fee for the first three months. Tennant said patients who are pregnant can continue to receive free treatment through the end of their pregnancy.