Big HHS Grantee May Owe Feds Millions
California's biggest grant recipient from a U.S. Department of Health and Human Services initiative to improve insurance enrollment under the Affordable Care Act was deemed earlier this year to potentially owe that agency millions of dollars due to improperly documented billings.
HHS Secretary Kathleen Sebelius announced on Wednesday that Family Health Centers of San Diego received $861,208 as part of a nationwide initiative to get low and middle-income Americans to obtain health insurance as part of the ACA. The initiative is being undertaken by the Health Resources and Services Administration, an arm of the HHS.
The grant is the second from HHS this month to Family Health Centers. They total more than $1.8 million.
The outreach grant to Family Health Centers was by far the largest award received by the 125 community clinics and federally qualified health centers in California -- $158,000 more than the second-largest grant recipient, Clinica Sierra Vista in Bakersfield. Family Health Centers operates 30 different sites in San Diego County, including 15 primary care clinics and three dental clinics.
But in February the Office of the Inspector General – HHS's investigative arm – concluded that Family Health Centers had overbilled HRSA $4.5 million out of the $10.8 million it received as part of the 2009 federal stimulus package. The money was disbursed in 2009 and 2010.
According to the OIG report, Family Health Centers had been overpaid more than $4.4 million to cover employee salaries, primarily due to lack of documentation of their specific activities. Another $113,000 was paid for rental costs that were excluded under stimulus payment guidelines.
OIG recommended that the money for employee costs either be repaid or properly documented by Family Health Services, and that the rental monies be repaid. The report did not allege any criminal wrongdoing or malfeasance.
The money determined to have been properly spent by Family Health Centers was used to build a new facility in the San Diego suburb of Lemon Grove and to expand outreach, according to published reports.
A spokesperson for Family Medical Centers did not respond to telephone calls and emails seeking comment.
According to HRSA Communications Director Martin Kramer, all 1,200 of the nation's federally qualified health clinics were eligible for the grant money, with issues regarding prior grants not taken into consideration as part of the process.
A total of $150 million in grants were announced on Wednesday, and 1,159 clinics received outreach funding. The remaining 41 either did not submit applications or submitted them incorrectly, Kramer said.
Kramer noted that each outreach grantee received a base award of $54,000, with additional funds awarded based on the percentage of patients treated at each clinic who are uninsured. In California, about 41.6% of patients lack insurance coverage, versus 36% nationwide.
Specific data was not available for San Diego County, but the city of San Diego is the largest in the nation without a public hospital, putting a larger burden of patient care on the community clinic system, observers say.
In addition to the grant it just received for outreach, Family Health Centers also received more than $993,000 in a separate HHS grant awarded earlier this month to boost Medi-Cal enrollment among children.
Altogether, HHS awarded $21.9 million to California clinics. The average grant was slightly more than $175,000. The smallest was slightly more than $50,000, while 10 clinics received more than $400,000.
“Health centers are excited to help individuals in their communities take advantage of the benefits of new health insurance coverage options that start January 2014,” said HRSA Administrator Mary Wakefield. “Having trained, face-to-face assistance in enrollment from trusted resources at local health centers means that more people will get the help they need.”
AltaMed Health Services Corp. in East Los Angeles operates 43 different sites in Los Angeles and Orange Counties. It received one the larger California grants: $536,410. “We're thrilled we got the grant,” said spokesperson Lauren Astor.
Astor said the funds would be used to hire additional personnel at clinic sites to help with insurance enrollment of patients, along with media outreach and education. The latter component will consist of small advertising buys and public relations outreach to Spanish-language television stations in the region.
“We've found the awareness of (the Affordable Care Act) is really low,” Astor observed, adding that few people who seek treatment at AltaMed facilities are aware of either the significant expansion of the Medi-Cal program or subsidies to purchase health insurance through the Covered California exchange.
The Venice Family Clinic, which operates seven healthcare sites in West Los Angeles and Inglewood, received $166,789. It will use the money to update its existing technology for enrollment purposes, as well as send out mailers and other forms of outreach communication.
Karen Lauterbach, the Venice Family Clinic community health insurance program manager, said the organization will also focus on enrolling the sizable homeless population it serves into Medi-Cal or other public insurance programs It is considering purchasing tablets with wireless capability in order for staff to expedite the enrollment of homeless people in the field – or at least make an appointment at a clinic site so they may be enrolled.
“We're going to try and make sure they're aware of what's going on,” Lauterbach said.
