Durand’s Dual Role ‘Not Acceptable’

Warning that Ventura County’s health clinics remain out of compliance with Medicare billing rules, federal officials have notified Pierre Durand that his dual role as health care agency director and public hospital administrator also violates regulations.

If the county does not bring the clinics into compliance with organizational changes by June 30, it will lose millions of dollars in reimbursement money, officials said Wednesday.

“We are continuing to work with the county and hope to mutually resolve this,” said Wayne Moon, a director at the U.S. Health Care Financing Administration in San Francisco. The agency oversees billing procedures at public hospitals and clinics.

“There are a number of clinics and each one has to be looked at individually,” Moon said. “We’re certainly going to resolve this one way or another.”

The dispute centers on the county’s contention that its 43 public health clinics are outpatient satellites of Ventura County Medical Center--a designation that entitles the county to higher Medicare payments.

A June 4 letter from Janice Caldwell, another Health Care Financing Administration official, concluded that the county’s clinics continue to violate federal billing guidelines. The county received its first warning from the agency in April.

“The situation has remained unresolved from our standpoint for over a year in spite of numerous exchanges of letters, proposed organizational charts, draft job descriptions and face-to-face meetings,” Caldwell wrote to Durand.

Durand could not be reached for comment Wednesday. But in a letter sent to county supervisors Monday, Durand said that federal officials misunderstand the county’s health delivery system.

“We believe the hospital’s administrative framework is compliant with HCFA requirements,” Durand wrote. “Nevertheless, we intend to attempt to address [Caldwell’s] concerns and, if necessary, develop alternative solutions.”

Federal officials contend that many of the public clinics operate independently from the county hospital and should not be billing Medicare at the higher rate. They say the 21 mental health clinics, for example, are ineligible for the higher rate because they are a part of the Behavioral Health Department, which operates separately from the hospital.

Under Medicare rules, doctors at the hospital’s inpatient psychiatric unit must report directly to the hospital administrator on a daily basis. Federal officials say these regulations are not being met.

Durand oversees the 1,700-employee Health Care Agency and serves as the county hospital administrator. Federal officials said Durand’s dual role carries too much responsibility to provide proper oversight of the hospital and its satellite clinics.

“Your proposal suggesting you wear ‘two hats’ is not acceptable,” Caldwell wrote in her letter to Durand. “The responsibilities of being the Health Care Agency director clearly would not allow you time to also be the administrator of the hospital.”

Caldwell’s letter went on to say that federal officials agreed with a recent state Department of Mental Health audit that concluded the hospital administration “is poorly organized and not in control of all the operational activities of Ventura County Medical Center on an on-going, daily basis.”

“This letter is the most scathing one we’ve received” from the federal agency, Supervisor Kathy Long said Wednesday. “I’m alarmed by it.”

Long said supervisors need to step in and work with federal officials to resolve the matter. She said Durand had assured the board that everything was under control.

“We’ve been told all along that this was being handled,” Long said. “This letter clearly tells us something very different is happening. The problems are not being related back to us.”

Long suggested that she or Supervisor Judy Mikels attend the next meeting between federal officials and Durand. Long and Mikels sit on the Ventura County Medical Center Oversight Committee.

Mike Powers, deputy director of the Health Care Agency, said Durand is scheduled to meet with federal officials June 24. Powers said the county hopes to get an extension on its June 30 compliance deadline.

“We had a positive discussion with them today,” Powers said Wednesday. “We plan to work with them to get this thing resolved as soon as possible.”

If the matter is not settled after the June 24 meeting, Supervisor John Flynn said he will solicit the help of top federal health and welfare officials and state representatives.

“We’re getting beaten up by all these bureaucrats feeding on each other,” Flynn said. “We need to consider some political intervention . . . [U.S. Sen.] Dianne Feinstein and [U.S. Sen.] Barbara Boxer. People who I think can help us out of this bureaucratic mess.”

Supervisor Frank Schillo said Caldwell’s letter was filled with “innuendoes and unsupported facts.” He was confident that Durand will resolve what he considered to be misunderstandings.

“The letter can’t be taken seriously,” Schillo said. “We’re bound to listen to them, but their facts are flapping in the breeze.”