Borrego Sun - Since 1949

The Borrego Sun questioned the Borrego Community Health Foundation (BCHF) about the dismissal of Jan Jones and Dr. Pamela McEvoy, and subsequent resignation of Charles Collum. The foundation responded with an unsigned, generic statement, claiming workforce layoffs, furloughs and salary reductions were the result of the COVID-19 pandemic.

BCHF Chief Executive Officer Mikia Wallis, was more specific in an Orange County Registrar article, March 3, 2020, stating that “BH has shuttered nine out of 27 clinics with one third of its employees laid off, furloughed, or are working at reduced hours.” The article went on to say that “85 percent of Borrego Health’s patients are on Medi-Cal with about 10 percent uninsured.”

According to Wallis, “BH had to shut down weekend operations in Coachella Valley due to cutbacks, affecting migrant farm workers that count on the clinics being open during weekends.”

She has also been quoted in Boss Magazine, stating that the Borrego Health patient to doctor ratio is 5,000 to 1. Regardless of the obstacles presented by these statistics, Wallis claims the dedication of the foundation’s team at “Borrego Health makes it happen.” There is a pattern here quantity first, quality second. Patients and providers realize that placing quantity over quality in health care is not the formula the government intended for non-profits. It’s difficult to get solid facts about the foundation. There’s the ever changing number of clinics and partnerships, which are hard enough to track down, let alone measure the actual performance of the advertised accumulated services that vary from one clinic to another. One thing, however, remains consistent, and that is: the large amount of money the foundation earns and spends gratuitously on executive staff and select personnel. All the money accrued to the foundation over the years inspired questions, like, “Why were Borrego’s professionals fired?” And, “Why does our clinic suffer from financial neglect?”

The Sun has asked numerous questions of the Executive Team and Trustees. Despite prodding by phone and email, there’s been no direct response. One of the questions was, “Did the foundation receive funds to help keep employees, like Jan Jones and Dr. Pamela McEvoy, during the pandemics impact on clinics? No comment. Yet, reporting appears to show the clinic received $3 million from the Paycheck Protection Loan program, $4 million from Cares, and minor dollars from a Desert health care foundation. Surely that was enough to keep the Borrego Springs clinic operational.

Shame on you, Borrego Health. Your actions taint the name of our town, and pervert the meaning of community.

From the limited perspective of our little clinic, how much do Borregans know about the federally-funded health network that bears the name Borrego, and, which originated right here in Borrego Springs? Things are constantly changing with BH. Clinics opening, clinics closing, partnerships, acquisitions, and other contractual relationships, pop up on the news or internet.

By one count, BCHF boasts anywhere from 20 to 27 clinics, six dental centers, 20 mobile units, three pharmacies, 17 telehealth providers, and one assisted living facility, and even Borrego’s Frugal Coyote. How many partnerships exist, and what that means remains unclear. Borrego Health began as Scripps Health Care, which was sold and converted to Borrego Health in 2002.

Eventually adopting the name Borrego community Health Foundation (BCHF), it became a federally qualified health center (FQHC) funded by Medicaid and Medicare, and other government sponsored health programs. The non-profit foundation proudly claims on different occasions to be the “fifth,” or the “third largest community health center network in the US,” and, sometimes, the “fastest growing network in the US.”

More recent facts:

From humble beginnings in Borrego Springs, BCHF reported a fat income of $236 million in revenue and $67 million in assets, in its 2017-IRS 990. The foundation is expected to show a significant increase in income of $330 million in 2018. That’s an increase of $100 million in one year. Borrego Health was reported to be number one – the costliest – federally-funded health care clinic by the government Center for Medicaid and Medicare Services (CMS), with total costs of $929,285,933, or 14.3 percent of the combined costs for the top 20 federally-qualified health centers in the United States.

CMS also reported that BCHF received $4.6 million in accrued health center expenditures, $303 million in total accrued costs (excluding donations), with the grand total accrued cost per patient of $1,320.74. Public IRS disclosures may be found on the Health Resources and Services administration (HRSA) site, which is part of the federal Department of Health and Human Services, with more detailed information available on the CMS website.

The care available is not consistent or equitable from clinic to clinic. That’s probably because some sites have larger under served populations and draw larger profits. For example, the Barstow Clinic opened October, 2018, was touted as BCHF’s 25th medical center. It boasts 26 exam rooms, in a 27,000-square foot building, and includes immunizations, and family planning, in addition to managing chronic conditions. According to a newspaper account, the Barstow clinic offers “various partnerships with area dentists to help patients to be treated for advanced dental problems.”

To quote CEO Mikia Wallis, “Partnerships extend to Barstow Community Hospital and area school districts.” There’s also a mobile unit, staffed by a nurse practitioner, providing services on a rotating basis to five rural/suburban communities. Naturally, there was a party celebrating the clinic’s opening, including politicians, Borrego Health executives, balloons, face painting, health checks, and other activities. (Article from the Barstow Daily News).

Shame on you, BCHF. Barstow gets a party; Borrego Springs gets screwed with un-met staff and equipment needs.

Of note are the foundation’s subsidized dental services, which account for 65 percent of the profits. The 2017-IRS-990 discloses five dentists/dental corporations that receive over $1 million each. One dental provider, Hussam Aldain, earned a staggering $5 million. Borrego Health also claims to have its own dental services in six locations, and 40 contract dentists. We wonder about the non-profit firewall separating reimbursements between private and non-profit providers. Missing from the public version of the 990 are answers to what the highest-earning dental providers did to earn so much? Or how many clients were seen? And, how many hours did they actually work?

Complaints about Borrego Springs clinic’s lack of professional providers, need for urgent care, and inadequate, aged equipment, have only increased as the foundation’s income from federal and state reimbursements have grown by leaps and bounds. The salaries, bonuses, and benefits of the “Executive Team” have likewise grown disproportionately.

The problem does not seem to be with the many caring Borrego Health providers, charged with the noble mission of saving lives and promoting wellness. But with executives overseeing the operations, exhibiting a seemingly baser motive of increasing personal wealth at the expense of providers, clients and taxpayers. Remember, it’s taxpayers, who ultimately pay the bill to care for the poor, old and uninsured through Medicaid and Medicare. Abuse of Medicaid funding in California is a terrible waste since it’s 20 percent of the state’s budget. Profiteering from Medicaid, not only hurts sick people, but takes money from other important services, like fire protection, parks, education, and disaster funding.

Where does the money go? BCHF has a large executive management team, receiving higher than standard salaries. There are also numerous family members of officers or highest compensated individuals on the payroll. The 2018-IRS990 should disclose some improper reporting of questionable, if not irregular accounting, including a retirement bonus given to the late Bruce Hebets.

Hebets, former CEO of BCHF, received a retirement gift, or buyout of $1.8 million, which is not an appropriate expenditure. He didn’t work. In fact, he died three months after receiving the gift. He’s always disclosed as a 40-hour employee, earning a combined income of $1 million with his wife. That’s a lot of money – money that could have increased professional staff at Borrego Springs, bought new equipment, and even underwritten the demand for urgent care. Besides from IRS reporting, and other sources, it’s clear that over 16 years, Hebets and his wife made a great deal of money from the clinics.

From the 990s, we don’t get real answers about funding, staffing, or how the money is actually being used. It appears neither do the federal or state regulators. It’s not so much what’s disclosed, but what’s missing from public disclosures. The 2017 filing had $32 million recorded for management and general expenses. The question is who, and what, specifically, this includes, or hides?

An example is the case of Alfredo Ratniewski. He’s the individual involved in the state lawsuit against Borrego Health, regarding undocumented, unsupported compensation for purchase of his two clinics in El Cajon and Cathedral City for $3 million plus. The court decided against Borrego Health in favor of the state’s refusal to compensate. As the foundation’s Chief Medical Officer, and eventually, Executive Chief Medical Officer, Ratniewski, received an annual salary of $642,000, plus $4,076 in other compensation from BCHF, or other related organizations.

The filing claims he works 40 hours a week. For all of his various responsibilities, the man would have to be five people. Ratniewski has been simultaneously identified as an internal medicine provider and doctor at Centro Medico, Escondido, and Borrego springs; medical director at Borrego Arlanza Clinic, in Riverside; and co-founder of Centro Medico Latino, six clinics in Chula Vista, El Cajon, San Marcos, Escondido and Cathedral City, and there’s more. Among the 12 persons the 2017-990 reported drawing salaries as family members of officers, or the highest compensated individuals, were the names of Karen Hebets and Janet Ratniewski.

Another officer earning six figures annually was John Heydt, Chief Academic Officer, with $677,268 annually, and $4,187 in additional compensation. Please tell us what does the Chief Academic Officer do? An interesting person is Bernard Wosk, identified only as a “provider,” who earns nearly $600,000. He must either be the security detail or a brain surgeon. Mikia Wallis’ 2018-salary increased from $363,238 to approximately $450,000.

She also receives a monthly stipend of $1,360 for travel, cell phone and other expenses. It seems all officers and family members received raises, and larger bonuses, resulting from the 2018-$100 million revenue windfall.

Borrego Springs’ clinic professionals certainly didn’t share in the bonanza. In fact, two of the most important to the community, were fired. There was $178,000 spent on conferences, conventions and meetings. Lobbying activities of nearly $500,000 were incurred, despite the 2017-990 assertions that “no funds were spent on lobbying.” Another mystery, why did Dan Anderson, CEO of Riverside Community Health Foundation and Chairman of the Board of BCHF Trustees, receive “rental payments” and an “annual donation” of $620,000? Trustees are not paid, so how was this potential conflict of interest explained? Speaking of Dan Anderson, we have questions, regarding the relationship between his role at Borrego Health and his Riverside Community Health Foundation. But that’s another story.

Employee benefits of more than $11 million in 2017, raises a number of questions. Should executive benefits include $10,000 allowances for cars, free car maintenance, and who knows what else? Hopefully, the feds and state have more adequate accounting. The public IRS 990s, available to those of us that pay the bills to provide health care for others, in good faith and through our own economic sacrifice, don’t provide an accurate picture of where money goes.

Shame on you, BCHF. You could at least give a truthful accounting to the people you claim to serve. Should Borrego Health be found to be profiteering, involved in fraud, conflicts of interest, or other violations of federal and state regulations, the result would be disastrous for the under served populations that BCHF says, “receives the best care possible.” There are simply too many questions that need answers, and we deserve some transparency from Borrego Health, now rather than later. Stay tuned.