In a newly released audit report, the California Department of Health Care Services (DHCS) found Contra Costa Health Plan (CCHP) failed to ensure proper medical care for its sickest, most medically complicated, and expensive patients.
It also found the Plan failed to handle medical grievances properly, did not ensure an independent compliance officer, and failed to properly report all suspected fraud cases to the state.
The State says it expanded the scope of its audit because of publicly reported concerns about CCHP’s Enhanced Care Management (ECM) program first exposed by NBC Bay Area’s Investigative Unit last May.
Public health nurse manager Irene Graham said the county’s ECM program ignored the medical needs of its members. Often, medical appointments were handled by someone with no medical training, she said, putting patients at risk. For instance, they were handled by a social worker or a housing specialist instead of a nurse or a doctor.
“I still feel like I have to come forward, although it's pretty hard, because I met some of the patients that this was affecting and some of them are no longer with us,” she told NBC Bay Area in an earlier interview.
In an email to the Investigative Unit, DHCS said it found “no evidence that [[Contra Costa Health Plan’s deficiencies]] directly caused patient harm or death.” However, according to its audit report, that’s based on the state’s assessment of a sample size of 22 patients, out of thousands.
NBC Bay Area confirmed with the...
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