County Says It's Working on Medicare Compliance


Ventura County is doing everything it can--and quickly--to bring the county's mental health billing procedures into compliance with Medicare rules, officials say.

For nearly a month now, a committee of psychiatrists, psychologists, social workers and mental health clinic administrators has been meeting daily to scour through complex billing practices and fix areas that run afoul of Medicare regulations.

Duane Essex, a county psychologist, said the Medicare Implementation Committee was formed late last month at the direction of county chief executive Lin Koester. The committee is submitting weekly reports on its progress to Koester.

"We're moving just as rapidly as we can to fix things," said Essex, one of seven committee members.

Because the changes essentially involve paperwork and billing procedures, patients in the mental health agency probably won't notice any difference in care, Essex said. Most will continue seeing the same therapists, nurses and doctors, he said.

"One thing that has been agreed upon from top to bottom is that patient care cannot be interrupted for any reason," Essex said.

The reorganization stems from a U.S. attorney's investigation that uncovered years of fraudulent Medicare billings in the mental health department. The county has agreed to settle the fraud case for $15.3 million.

The county will probably be monitored closely for months and perhaps years, sources said, so officials want to ensure every Medicare claim form submitted is done correctly. About 20% of the county's mental health patients are covered by Medicare, and billings from the federal health care program bring in about $2 million a year, officials said.

One major change has already occurred. Psychiatrists have been placed in charge of more than a dozen teams of psychologists, nurses and social workers who work together to serve the mentally ill.

Officials say this is important because Medicare regulations require that a physician directly oversee and agree to the necessity of any medical service. That rule was consistently violated in Ventura County, federal investigators have told county officials.

The county now has 42 psychiatrists assigned to the teams to supervise mental health services. Some of the psychiatrists are employees, but others are full- or part-time contract workers, Essex said.

Two consultants with Health Management Systems, a New York-based firm that specializes in Medicare regulations, have been brought in to help the committee sort through the maze of rules. Forms are being revised and doctors are being trained in how to properly fill out the paperwork, officials said.

"We need to be very thorough and it is not simple," County Counsel James McBride said.

Ventura County appeared to follow Medicare regulations until 1993, when the rules changed, sources say. Other counties changed their mental health programs to be in compliance with Medicare, but Ventura County apparently did not, sources say.

The director of the mental health department at that time was Randy Feltman. Feltman left the agency in 1995 and now runs the county's welfare-to-work program. The faulty billing practices continued until this year, investigators said, and Feltman has said he was unaware of any billing problems.

Some county officials have blamed the problem on the complexity of regulations and the fact that federal rules for reimbursement are far more stringent than the state's Medi-Cal regulations.

Supervisor John K. Flynn said he believes state and federal agencies should work together to make the rules easier to understand and follow.

"It's a very complicated system. Much too complicated," Flynn said. "I think it's hard for anyone to try to figure it out. We had to hire an outside law firm in federal rules and regulations just to figure it out ourselves."

The turmoil in Ventura County's mental health department is being closely watched by officials in other counties, said Nora Romero, a spokeswoman in the state Department of Mental Health.

"We don't know what the other counties are doing," Romero said. "But they are all pretty aware of what happened in Ventura [County] and they are taking note."

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