Accountable IPA Issues Statement

A Signal Hill IPA ordered by a state regulator to stop using non-medical professionals to make prior authorization care decisions for patients has simultaneously defended its conduct while saying it is trying to resolve the matter.

The Accountable Health Care IPA initially did not respond to repeated requests for comment from Payers & Providers prior to its reporting on Aug. 2 about the Department of Managed Health Care’s cease and desist order. That order was issued to Accountable and nine health plans it contracts with, including Blue Shield of California and Anthem Blue Cross of California.

According to the order, Accountable Care was using two non-medical professionals, including the son of its chief executive officer, George Jayatilaka, M.D., to make such determinations.

Since the initial report, which was also reported on Aug. 6 by the investigative website California Watch, Accountable has retained Sitrick And Co., a Los Angeles public relations firm known for its crisis PR acumen.

“All medical necessity decisions at Accountable Health Care are made by a licensed California physician in compliance with state law,” George Jayatilaka said in a prepared statement issued by Sitrick. “While the final decision is the physician’s, other competent healthcare professionals also participate in the review process. This has been our practice for many years, and it is the process used by many other independent practice association service providers.”

The statement added that “we have met with the Department of Managed Health Care and explained our process. And we will continue to work with the department on any revisions to our process that will assure the department of Accountable’s continued compliance with all applicable laws and regulations.”