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Audit ordered for low-income health program

A sign advertising a Los Angeles medical clinic. (Photo: JDS via Shutterstock)

A state legislative committee has ordered an audit of provider directories that are given to people in California’s low-income health program, after reports of major inaccuracies.

The state audit, proposed by Sen. Ricardo Lara, will examine the managed-care directories, whether they list enough doctors who are accepting new patients and whether state regulators have done their jobs overseeing that aspect of the Medi-Cal program.

The California Association of Health Plans, which represents all of the managed-care plans in the state, blamed doctors for the directory inaccuracies.

“The accuracy of directories is critical to ensure that our most vulnerable populations receive the health care they need and have been promised,” Lara, a Los Angeles Democrat, said in a press conference Thursday.

In June, The California Health Report found that more than half of the primary-care doctors in provider directories given to low-income patients in three counties in Northern, Central and Southern California were not accepting new patients with Medi-Cal, the state’s low-income health plan, or could not be reached by telephone.

The inaccuracies make it difficult for people to get the health care they’re entitled to under state law.

The California Association of Health Plans, which represents all of the managed-care plans in the state, blamed doctors for the directory inaccuracies.

“Medi-Cal managed care plans work hard to keep their online provider directories up-to-date, however, they rely upon doctors to inform them when they stop accepting new patients, offices move, or doctors retire,” president and CEO Patrick Johnston said in a statement Thursday. “Health plans need accurate information from providers in order to have accurate directories.”

More than 7 million California residents are enrolled in a Medi-Cal managed-care plan. That’s about 20 percent of the state’s population.

The California Medical Association, however, has said that doctors have reported that their practices are often listed erroneously even after they tell insurers that they are no longer accepting patients.

Lara said the California Health Report story “had some pretty alarming findings,” which caused him to want to have the state auditor investigate the matter.

“This request, I believe, is about making sure we deliver on the promise of providing for the care of Medi-Cal beneficiaries,” he said.

The audit, which was ordered Aug., 14, is expected to take six to eight months and cost about $287,000.

More than 7 million California residents are enrolled in a Medi-Cal managed-care plan. That’s about 20 percent of the state’s population.

Many enrollees have expressed frustration with finding a doctor due to the inaccuracy of the directories.

“Just because we want to give millions of people medical insurance and cards doesn’t necessarily mean they’re going to be able to receive services,” Lara said.

California State Auditor Elaine Howle will select three managed-care plans in three counties as part of the audit. It was unclear Thursday whether Howle will choose the same counties that the California Health Report investigated: Butte, Fresno and Imperial counties.

At one plan in Butte County, more than 95 percent of the doctors listed in the printed directory were either unavailable to new patients or could not be reached, the California Health Report found. Even in the most accurate directory, from a plan in Fresno County, reporters were able to confirm that a doctor would see a new patient at only six out of every ten offices listed.

Some of the doctors listed in the directories have moved out of the area, retired or are otherwise no longer practicing. Others who were erroneously listed had decided to stop accepting Medi-Cal, while some said they never accepted the insurance. Some of the phone numbers listed had been disconnected, were for the wrong office or were actually fax numbers. Many of the receptionists who answered the phone said they had never heard of the doctor who was listed as practicing at their office.

Dr. Richard Thorpe, president of the medical association and a general internist who practices in Butte County, said he’s heard from many Medi-Cal patients who have trouble finding a doctor.

“I think it’s really important that we don’t just give people the promise of a health card, we actually provide them real access,” he said at Thursday’s press conference.

The medical association conducted its own investigation into Medi-Cal directories in Butte and Imperial counties and also found that they were highly inaccurate.

Anthony Wright, executive director of Health Access, said the state agencies that are supposed to oversee managed-care plans must ensure that the directories are accurate so that enrollees can get timely care.

“Let’s be clear, the issue of access to doctors and specialists and provider directories — this is not a frill,” he said.

“Otherwise that plan is defrauding patients and we’re violating that promise.”

The Department of Health Care Services, which contracts with health companies to offer managed-care plans, responded to the news of the audit Thursday.

“DHCS carefully reviews health plan data and meets regularly with plans to help make sure that their networks are adequate,” spokesman Norman Williams said. “The top priority of DHCS is to ensure that our members are able to receive the health care services that they need and deserve.”

The Department of Managed Health Care, which regulates managed-care plans, did not respond to requests for comment Thursday.

Ed’s Note: Hannah Guzik is the assignment editor at California Health Report, where this story originally appeared on Aug. 14.


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