Yesterday's Los Angeles Times has an article indicating that 20% of the people in Los Angeles County are on public aid. This includes those who receive health benefits such as Medi-Cal. It does not include those in need of services but who have not applied. See:
http://www.latimes.com/news/local/la-me-welfare22-2009feb22,0,4377048.story?page=1
Thus, at a time when benefits for patients and reimbursement to providers are being cut, the need for services is growing. There will be greater demand on existing providers who are subjected to increased audits, difficulty getting paid and other problems. It has become increasingly difficult to find specialists to treat Medi-Cal patients. There is a public health crisis and we see that in the government's attempt to deal with its budget issues and cut out fraud it is placing the pressure on health care providers.
As attorneys who represent health care providers, we counsel them that a Medi-Cal practice is difficult since the regulations and rules are stricter than those for private insurers and that after you get paid the government can audit for up to three years later and claim an "overpayment." If providers are going to provide services to Medi-Cal patients, a compliance plan is a must and the rules need to be strictly followed. The pressure on the programs and providers will continue. We expect the problems with Medi-Cal to get worse especially with California in its current financial crisis.
Any questions or comments should be directed to: tgreen@greenassoc.com. Tracy Green is a principal at Green and Associates in Los Angeles, California. They focus their practice on the representation of individuals, businesses and licensed professionals, with an emphasis on health care professionals.
