Clinics Not Compliant on Medicare, U.S. Warns

Warning that Ventura County’s health clinics remain out of compliance with Medicare billing rules, federal officials have notified Pierre Durand that his dual role as health care agency director and public hospital administrator also violates regulations.

If the county does not bring the clinics into compliance with organizational changes by June 30, it will lose millions of dollars in reimbursement money, officials said Wednesday.

“We are continuing to work with the county and hope to mutually resolve this,” said Wayne Moon, a director at the U.S. Health Care Financing Administration in San Francisco. The agency oversees billing procedures at public hospitals and clinics.

Durand oversees the 1,700-employee Health Care Agency and also serves as the county hospital administrator. Dr. Samuel Edwards oversees much of the daily activities as the hospital’s associate administrator of the inpatient medical program.

“We don’t like the looks of that,” Moon said of the county’s organizational structure.

The dispute centers on the county’s contention that its 43 public health clinics are outpatient satellites of the Ventura County Medical Center--a designation that entitles the county to higher Medicare payments.

A June 4 letter from Janice Caldwell, another federal health official, concluded that the county’s clinics continue to violate federal billing guidelines. The county received its first warning in April.