A feud between county officials and the owner of the only San Gabriel Valley clinic offering methadone treatment for heroin addiction will leave about 85 addicts with the choice of traveling to East Los Angeles daily for free treatment or paying for it themselves.
Community Health Projects Inc., run by West Covina Mayor Forest Tennant, a medical doctor, has canceled its $272,500-a-year-contract with the county to treat indigent heroin addicts with methadone, effective Feb. 28. The clinics will still provide methadone for a fee, $150 a month, to more than 600 addicts.
County health officials say it will take at least three months to line up another clinic in the San Gabriel Valley to provide county-paid methadone, a synthetic drug used to combat heroin addiction. Meanwhile, addicts are being referred to programs in East Los Angeles and South-Central Los Angeles.
Tennant said his organization canceled its contract because of burdensome paper-work requirements. "When you deal with the county, paper is your most important product," he said.
Staffing, Billing Problems
County officials said that Tennant's clinics have a history of staffing and billing problems, inadequate medical care and other deficiencies, but are now meeting all requirements. The state Department of Health Services has ordered a complete field audit of the billing procedures of Community Health Projects to determine if Medi-Cal was billed improperly for methadone patients.
Tennant rejected the county's criticisms and said the billing questions raised by the state stem from complex, ever-changing regulations for government-funded programs.
"There will be times when they pay us for something and will come back and say 'you shouldn't have been paid' and we will pay the money back," Tennant said. "That is standard for hospitals and clinics. I know it sounds bizarre, but that is SOP (standard operating procedure) in the health industry."
State health officials would not say how much money is in dispute in the audit, which will begin within a few weeks. Tennant acknowledged that audits in 1984-85 resulted in $36,000 in disallowed billings for Community Health Projects.
The state Department of Alcohol and Drug Programs last fall asked the Department of Health Services, which oversees Medi-Cal billing, "to determine the propriety and legality" of billing practices by Community Health Projects. A spokesman for the Department of Health Services said it cannot comment because the "matter is potentially under investigation."
Question of Billing
But other county and state officials said the issues involve billing Medi-Cal for laboratory fees for methadone patients, although methadone is not a covered expense, and charging patients partial fees for services while also billing Medi-Cal. Tennant said his agency has changed its policies as a result of the questions raised. In a letter to the state drug program administrator, Tennant said, "Specifically we have stopped our programs that have partial fee payments and the taking of extra urine tests that are billed to Medi-Cal."
"Anybody who says they have been double-billed and we have been paid twice for a service we've done, tell us and we'll send the money back," Tennant said. Financial records for Community Health Projects are open for public inspection, he said.
Community Health Projects, founded in 1974, is a nonprofit organization that grosses $5 million a year running two dozen clinics that offer low-cost general health care and drug abuse treatment. The organization has clinics in Pomona, Pasadena, Baldwin Park, El Monte, La Puente and West Covina in the San Gabriel Valley and others as far away as Fresno. Tennant said the clinics treat 2,000 patients a week, about one-third for drug problems.
Both Tennant and county officials estimate that there are 10,000 heroin addicts in the San Gabriel Valley.
"We have no cure for heroin addiction--that's our problem," Tennant said. "The recovery rate is less than 20% in a lifetime, meaning only 20% of the addicts get off and stay off for as long as three years."
Tennant said methadone is "a last-resort treatment," used only after other efforts to detoxify patients have failed. Those on methadone maintenance programs must come to the clinic every day. Tennant said the average treatment period is four to six months.
Limited Number of Patients
Dr. Irma Strantz, director of the county drug abuse program, said there are tight controls over the use of methadone to make sure that patients receive counseling and other services and to prevent methadone overdoses. The state, acting on the county's recommendation, sets limits on the number of patients each clinic may treat, based on an analysis of heroin addiction in the area and on the clinic's capabilities.
Strantz and Tennant have been arguing for years over how many patients Community Health Projects should be licensed to treat on a methadone program. The current limit is 675.