U. S. Audit Slated Over Medicare Reimbursements

The federal government will perform an audit to determine whether Ventura County will be forced to repay millions of dollars in medical reimbursements, county officials said Tuesday.

The audit is expected to begin by the end of the month and will be performed by the Health Care Financing Administration in San Francisco.

Hoping to head off the possibility that the county could be forced to repay as much as $15 million in Medicare and Medicaid payments, a contingent of local officials is flying to San Francisco today to try to persuade the government not to demand the money.

In April--in a move they said was meant to improve care of the mentally ill--county supervisors voted to merge the Behavioral Health Department and Public Social Services Agency into one superagency.

But in November, the federal government said the merger violated Medicare and Medicaid billing rules. As a result, the county dismantled the agency Dec. 22.

The county stands to lose as much as $2 million in Medicare reimbursements alone and millions more in Medicaid reimbursements for money paid during the 259 days that the merged agency existed. Some officials say the county could be ordered to repay as much as $15 million.

Those traveling to San Francisco include county Chief Administrative Officer Lin Koester, Heath Care Agency Director Pierre Durand, County Counsel Jim McBride and an attorney from Hooper, Lundy & Bookman. The county hired the law firm to advise on the merger issue.

It will be the second trip to San Francisco to talk to officials at the Health Care Financing Administration.

“I was going to go and so was [Supervisor] Kathy Long,” said Supervisor John Flynn, who along with board Chairwoman Susan Lacey and Long had voted in favor of the merger. “But let’s see what the technicians can do first.”

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Flynn, after admitting that the audit is imminent, denied that it is a danger sign for the county.

“It’s not such an unusual thing,” he said. “Any time you get federal funding, you’re going to get a federal auditor. It’s routine.”

Meanwhile, Lacey, the moving force behind the merger, waved her 20-year-old master’s thesis over her head at the board meeting in defending her failed initiative.

She previously said her objective in calling for the merger was to avoid placing mentally ill people in the hospital and instead move them toward independent living. By allowing social workers to work side by side with doctors, mentally ill clients would get better treatment, she said.

On Tuesday, she elaborated, holding her 1978 thesis about the importance of mainstreaming special education clients, which she also wants to do for the mentally ill.

“I don’t think people realize my background. I’m a trained special education teacher,” Lacey said. “I think it’s important for people to understand that in 20 years, we have seen no change in the way our social services are run.

“We have to stay open before we can make a change, otherwise everything will remain the same. . . . We cannot close down, and we’ve got to be open and willing to make some changes.”

Flynn said he liked Lacey’s message.

“I think she was saying that we didn’t succeed here, but that doesn’t mean we can’t think about change,” he said.

“People are so fearful of change that they overreacted [about the merger] and it caused us more problems than the whole issue merited.”

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But Supervisor Frank Schillo, a strong opponent of the merger, disagreed.

“There’s a process for change,” he said. “At least make sure the change is understood before it happens.”

Dick Clemence, a Ventura consultant to families of the mentally ill and a merger opponent, was harsher.

“I thought her explanation was just as muddled as the plan to implement this so-called merger,” Clemence said in an interview.