County Cleared to Bill Medi-Cal for $16 Million : Reimbursement: A supervisor welcomes the news. Claims have been on hold for 10 months, since federal officials questioned billing practices.
After receiving clearance from the state Department of Mental Health, Ventura County will submit $16 million worth of Medi-Cal claims it has been withholding for 10 months, officials said Monday.
“Based on a cursory review of both your billing system and some clinical charts, it is recommended that you resume submitting claims immediately,†state officials wrote in an Aug. 27 letter to David Gudeman, director of the Ventura County Behavioral Health Department.
Supervisor John Flynn said he was relieved that the county would recoup all or most of the $16 million in Medi-Cal reimbursements.
“This is absolutely incredibly good news,†Flynn said Monday. “The money will now start flowing, in and it gets us over this issue.â€
The county stopped billing Medi-Cal for mental health services last November after federal authorities questioned its billing practices. The county was ordered to stop submitting claims for reimbursement after it merged its mental health and social services departments, a move that federal officials said violated federal organizational and billing rules.
Supervisors disbanded the 9-month-old merged agency in December after authorities made it clear that the new organization was unacceptable under federal law.
The failed merger touched off several state and federal audits of the county’s mental health system. One investigation determined that the county overcharged Medicare by more than $15 million in bills spanning nearly a decade.
Federal investigators contend that county social workers, nurses and psychologists used doctors’ names and billing numbers to charge Medicare for services, even if a doctor had never had contact with the patient.
That practice is illegal under federal law, but allowable under state law.
Although the county has settled the Medicare case for $15.3 million, some officials had worried about the outstanding Medi-Cal reimbursements.
In its letter to Gudeman, however, state authorities warned that “the department cannot guarantee approval of all the claims that have been held.
“You should exercise caution before submitting any specific claims which have already been identified as inappropriate,†wrote Teri Barthels, an official with the state mental health agency.
Officials could not immediately say how much of the $16 million, if any, the county stands to lose.
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