COUNTY CLINICS MAKING FALSE CLAIMS, U.S. OFFICIALS SAY.Byline: David Greenberg The creator of this article, or someone who has substantially contributed to it, may have a conflict of interest regarding its subject matter. It may require cleanup to comply with Wikipedia's content policies, particularly neutral point of view. Daily News Staff Writer Ventura County's 43 public health clinics are violating federal Medicare reimbursement Reimbursement Payment made to someone for out-of-pocket expenses has incurred. rules by falsely claiming to be affiliated with the county Medical Center, federal officials said Tuesday. County officials were given an extended deadline, until June 30, to fix the problem, which came to light as federal health care financing officials continued to probe last year's failed merger of two county health care agencies. ``The clinics did not demonstrate they were affiliated with the hospital,'' said Janice Caldwell, associate regional administrator Health Care Financing Administration Health Care Financing Administration, n.pr department in the U.S. agency of Health and Human Services responsible for the oversight of the Medicaid and Medicare benefit programs, including guidelines, payment, and coverage policies. . ``As a matter of fact, some of them appear to be operating quite independently. We want them to get into compliance. It's there job to put it down in a way that makes it intelligible to us.'' The hospital is the only county entity with a provider identification number, enabling it to bill for Medicare reimbursements. An evaluation by the federal Health Care Financing Administration has showed that the 21 mental health and 22 medical clinics do not qualify for reimbursements because they are not integrated into the county hospital's operations and are not listed on its state license. The administration is conducting a sweeping audit of the county's failed merger last year of the Behavioral Health Behavioral health was first used in the 1980's to name the combination of the fields mental health and substance abuse. As an example, an organization serving both mental health and substance abuse clients might refer to its practice as behavioral health or Department and Human Services Agency that could cost the county $15 million in lost Medicare and Medi-Cal reimbursements. That audit is expected to be released in coming months. Mike Powers Ellis Foree Powers (born March 2, 1906, in Toddspoint, Kentucky; died December 2, 1983, in Louisville, Kentucky) was an American major league baseball player. He played for the Cleveland Indians from 1932-1933. , the Health Care Agency's deputy director, said the 43 clinics already operate as part of the hospital system, adding that his office simply needs to give federal agency the proof. ``They're putting our feet in the fire,'' he said. ``They want to see that the clinics are operating as an integrated part of the hospital. We believe they are. We may need to make some adjustments. Perhaps we need to clarify the organization chart.'' By establishing the clinics as direct outpatient units of the hospital, the county may attach hospital overhead costs overhead costs see fixed costs. to Medicare bills, thereby increasing the amount of reimbursements. However, independently operated clinics would bill Medicare directly at a lower rate. The Health Care Financing Administration originally set May 17 as the deadline for establishing a direct line of authority between the clinics and the hospital, but has extended the date to June 30, officials said. The county is already under fire from the federal agency for the failed merger of its Behavioral Health Department with the Human Service's Agency, which temporarily detached the inpatient inpatient /in·pa·tient/ (in´pa-shent) a patient who comes to a hospital or other health care facility for diagnosis or treatment that requires an overnight stay. in·pa·tient n. psychiatric unit from the hospital. The review of health care services expanded to clinics last winter as a result of the merger debacle, said Emery emery: see corundum. emery Granular rock consisting of a mixture of the mineral corundum (aluminum oxide, Al2O3) and iron oxides such as magnetite (Fe3O4) or hematite (Fe2O3). Lee, the Health Care Financing Administration's billing specialist. Meanwhile, the federal agency is waiting for Blue Cross to finish its audit of mental health services health services Managed care The benefits covered under a health contract before it determines whether the county will lose any money from the merger. The supervisors approved the merger in April 1998 but dissolved it in December after it was learned that the county stands to lose up to $15 million because the merger did not meet Medicare and Medi-Cal requirements, officials have said. The Health Care Financing Administration did not outline a specific strategy for the county to put its clinics in compliance, calling that micromanaging, but the administration expects more than simply an organizational chart An organizational chart is a chart which represents the structure of an organization in terms of rank. The chart usually shows the managers and sub-workers who make up an organization. , said Lee. Caldwell said her office could extend the deadline for compliance again if the county shows it is moving in a positive direction. |
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