Orange County Supervisor Andrew Do on Thursday criticized state officials for taking back millions of dollars from area doctors who provide care for the needy due to a bureaucratic error in billing.
Do — who also represents the county on the board of directors of CalOptima, the agency that oversees health insurance for low-income Orange County residents — call on the state to stop its attempts to retrieve the money paid to healthcare providers.
“Medi-Cal made the mistake, yet it’s shifted the costs to doctors and patients,” Do said, referring to the state’s insurance program for the poor.
The issue came to light following complaints from local ophthalmologists, Do said.
“It’s wrong for Medi-Cal to unilaterally withhold payments on new claims as it tried to clear up old billing disputes,” Do said.
The billing error happened between July 26, 2011, and May 21, 2013, Do said.
“This was clearly and admittedly a mistake made by Medi-Cal, yet it is placing these providers in a position to possibly suffer financial hardship,” said Dr. Craig H. Kliger, executive vice president of the California Academy of Eye Physicians and Surgeons.
Do wants state officials to stop trying to retrieve the money paid out, keep paying for undisputed claims and work out a compromise on the disputed billings.
The Department of Health Care Services started to recoup the erroneously paid bills in August 2014. Nearly all of the money has been recovered, according to Anthony Cava of the Department of Health Care Services.
The state is required under federal law to recover the payments, Cava said. The money was retrieved by withholding payments for other claims until the disputed billings were resolved, he added.
Physicians were also given the option to pay back the money in installments, he said.
“Our Medi-Cal providers are critical for delivering care to millions of beneficiaries throughout the state,” said Jennifer Kent, the state agency’s director, said. “We are actively working with CalOptima and the other County Organized Health Systems (COHS) to fairly reconcile provider payments made by DHCS in error.
“The COHS will then make appropriate payments to providers from whom DHCS has already recovered payment to make sure they receive the payments to which they are entitled. We have also identified duplicate claims submitted to the state and COHS plans for the same services, and these providers have already been paid appropriately by the COHS for the services rendered.
“We suspended collections in April from affected providers, and we continue to work with these counties to resolve this error.”
— City News Service