MEDICARE BILLING REVIEWED FEDS TO RECONSIDER PROCESS.

Byline: Lisa Mascaro Staff Writer

VENTURA - After meeting Wednesday with Ventura County representatives, a federal health care official has vowed to reconsider $1.6 million in disputed Medicare reimbursements, a lawmaker said.

Rep. Elton Gallegly, R-Oxnard, issued a statement saying that a Health Care Financing Administration official plans to review the way Ventura County administers its outpatient clinics - a sticking point between the county and the federal agency that jeopardized federal funding.

``(Gallegly) was very encouraged by the meeting,'' spokesman Tom Pfeifer said. ``He is a big supporter of the county's health care system, thinks the way they have put this together is very (efficient) . . . and is a very good working model that could be used elsewhere.''

The Wednesday meeting included Ventura County Interim Chief Administrative Officer Harry Hufford, Health Care Agency Director Pierre Durand and other county officials who are lobbying lawmakers in Washington, D.C.

The meeting focused on $1.6 million in annual Medicare reimbursements that has been jeopardized because HCFA has said 22 of the county's 31 outpatient clinics do not meet funding guidelines.

Federal officials say those 22 clinics are too far from the Ventura County Medical Center to be considered under its jurisdiction, so they are ineligible for Medicare funding the county had requested.

Pfeifer said the county officials presented details about their operations and Thomas A. Gustafson, director of the HCFA Purchasing Policy Group, seemed open to the county presentation.

``They're going to take it under advisement, take a look at it and see if the county's way of business does fit HCFA's regulations,'' Pfeifer said.

``We've taken one giant step forward,'' said Supervisor John Flynn of Oxnard, who said he had been updated by Hufford. ``That's the best news we've had in some time.''

Ventura County's system of outpatient clinics came under scrutiny last year when the federal health care administration questioned administration of the clinics and withheld reimbursements for patient services.

The action was part of a series of reviews and investigations into the county's health care system after last year's failed superagency merger of the Behavioral Health Department with Social Services.

The merger was reversed once county officials realized the new agency would not meet HCFA guidelines for Medicare funding.

But further investigation also brought to light a decade of faulty Medicare billing practices that resulted in the county agreeing to a $15.3 million settlement with the federal government.

The county officials also met Wednesday with Rep. Brad Sherman, D-Woodland Hills, to try to reduce the settlement, said Flynn.

Pfeifer said Gallegly was pleased with the meeting he had arranged.

``We need to cover all the people .T.T. regardless of who they are or what their circumstances are, that's what the county's trying to do. That $1.6 million a year goes a long way,'' said Pfeifer.