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Ventura County seeks to keep healthcare plan audit a secret

The Medi-Cal Managed Care Commission hires a consultant to investigate complaints about late payments and poor management, but seeks to use attorney-client privilege so results will be confidential.

March 07, 2012|By Catherine Saillant, Los Angeles Times

A Ventura County commission is trying to keep secret the details of a state-ordered investigation into the management and claims procedures of a healthcare plan designed to serve the county's neediest residents.

Complaints about alleged late payments and poor management prompted the Department of Health Care Services to request that auditors step in and examine the plan's financial condition and claims practices.

Gold Coast Health Plan was launched last year to switch an estimated 110,000 Ventura County Medi-Cal beneficiaries into an HMO-style healthcare plan.  Previously, doctors and hospitals were free to charge Medi-Cal directly on a fee-for-service basis.

The Ventura County Medi-Cal Managed Care Commission, which operates the plan, voted last week to approve a $450,000 contract with BRG, a Berkeley consulting firm, to conduct a three-month review.

But at the same time, it also voted to try to keep the findings confidential by saying that they are legal proceedings not open to public scrutiny.

Tin Kin Lee, the commission's attorney, outlined a "strategy" in which he would sign the contract with auditors, thereby making the findings confidential because of attorney-client laws.

The board majority voted to go along with Lee's recommendation, provided that state officials give their blessing.  Commissioner Robert Gonzalez, director of the Ventura County Health Care Agency, voted against the move, saying: "We have nothing to hide."

"Going down the road to somehow sequester this information feels uncomfortable,'' Gonzalez said.

Those in support said it "couldn't hurt" to ask the state to agree to keep the audit secret.

"I don't see it as a risk to us,'' said Lanyard Dial, the board chairman. "We should trust our counsel."

Anthony Cava, a spokesman for the state's Department of Health Care Services, declined to comment on whether the confidentiality request had been approved. In a prepared statement, Cava said only that the state is working with Ventura County officials to "ensure they continue to provide appropriate care to its Medi-Cal members and meet the required goals and objectives of a managed-care plan."

State investigators will examine claims and complaints from doctors, hospital administrators and some of the 40 employees at Gold Coast Health Care Plan's Oxnard headquarters. Gold Coast employees contend that they have been told to keep quiet about the organization's problems, according to sources who asked not to be identified for fear of retaliation.

Earl Greenia, the plan's executive director and previously the chief executive officer of two hospitals in Hawaii, declined to comment on complaints about the organization but defended his leadership.

"I led the startup of this plan,'' he said. "In record time, we received approval from the state to go live. Like every startup we have operational challenges, but we are addressing those and moving forward."

Ventura is one of more than 30 counties in the state that have adopted differing managed-care systems to replace traditional fee-for-service Medi-Cal.  Ventura County's version opened for business in 2010 and is governed by an 11-member commission made up of representatives of public and private providers, hospitals and healthcare services.

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