L.A. Doctor Group Threatens to Cut Medi-Cal Role to Protest Audits

A group of Los Angeles physicians who treat many Medi-Cal patients threatened Friday to stop seeing indigent patients or to cut back their participation in the Medi-Cal program because of what they regard as unjust and arbitrary state audits.

At a legislative hearing in Los Angeles, members of Concerned Medi-Cal Providers strongly protested the audit policies of the state Department of Health Services.

In response, a department official said the agency intends to work more closely with the group to address its concerns before the end of the year.

At issue is whether doctors treating Medi-Cal patients are providing adequate documentation of their services to justify the bills they submit to the state. It is standard practice for insurance companies and government officials to require written documentation as a condition for paying such claims.

There have been no allegations of fraud or substandard care, which have previously plagued Medi-Cal, the state’s health insurance program for the poor.

At the hearing, Dr. Herbert Karlow of Los Angeles criticized the state for furnishing inadequate record-keeping guidelines for Medi-Cal providers and for not properly training the auditors. “Each decision is made subjectively,” said Dr. Pauline Furth of Los Angeles, a member of the group. “We are facing a hooded accuser.”

Dr. Agop Aintablian, a Los Angeles cardiologist who was audited, said he had been denied payments for office visits because he failed to conduct pelvic and rectal exams of his patients. Such exams, he noted, are not normally considered part of an exam of the heart and circulatory system.

Other physicians questioned the fairness of the appeals process because the salaries of the administrative judges who conduct such hearings are paid by the department.

The state’s auditing practices were defended by Eugene K. Lynch, deputy director of the department’s auditing and investigations division.

In light of the protests, Lynch said the department would review about 70 pending audits of Medi-Cal physicians. As a result of such audits, the state has demanded that some doctors, including members of Concerned Medi-Cal Providers, repay more than $100,000 apiece.

But Lynch rejected the doctors’ request to excuse them from repaying the state.

“(An amnesty) would be a gift of public funds,” he said at the Senate Committee on Health and Human Services hearing. “There is an awful lot of validity in the audits we have done.”

Doctors also testified that the audits are unjust because the state pays them much less for services provided to Medi-Cal patients than they receive for comparable services for regular patients.

The department conducts about 70 audits a year, mostly targeting the nearly 2,000 individual physicians and medical groups that are paid from $50,000 to more than $1 million a year by the state.