Borrego Sun - Since 1949

Individuals covered by Medi-Cal/Medicaid insurance can continue receiving medical services at the Borrego Springs Clinic, as the result of a temporary agreement reached by the state Department of Health Care Services (DHCS) and Borrego Community Health Foundation (BCHF) officials. The announcement came in a DHCS letter forwarded to the Borrego Sun by the department spokesperson.

“This is very positive news, and we are grateful for the opportunity to continue to serve our community. Borrego Medical Clinic continues to remain open to provide quality medical service that you, our patients, have come to expect and deserve,” stated Martha Deichler, Borrego Health board member.

The agreement partially lifts a state-imposed, November 18, 2020 hold on Medi-Cal reimbursement and coverage, resulting from an ongoing FBI/DOJ investigation of Borrego Health, and allows the foundation to continue to provide health care with the exception of dental services. The terms, also include appointment of an independent DHCS watchdog, to enforce federal and state regulations throughout the Borrego Health organization and operations. The agreement, according to the state, is provisional, and if a formal settlement is not executed in 30 calendar days, it will become null and void, and the November- Medi-Cal suspension will be reinstated.

Dr. Edgar Bulloch, Borrego Health CEO, provided this statement to the Borrego Sun: “I am pleased to share that as of January 27, 2021, Borrego Health has signed a provisional agreement with DHCS that modifies our payment suspension and allows us to begin receiving Medi-Cal payments for our medical services.”

With 90 percent of income from Medi-Cal dental services, Borrego Health was facing a serious financial crisis and other ramifications from loss of Medi-Cal reimbursements. In the new agreement, the state will pay Borrego Health withheld Medi-Cal claims in the amount of $9,607,487.78.

Besides being good news for persons covered by Medi-Cal, the settlement is good news for employees that are said to have been concerned about their ability to deliver services, resulting from the Medi-Cal suspension. Fears of clinic closures and job losses have also been temporarily allayed. The provisional agreement mandates that Borrego Health hire an independent monitor chosen by the DHCS, who will have full access to all books and records, attend all meetings, including open and closed BCHF Trustee meetings.

The monitor will report directly to the DHCS, and arrange meetings between Borrego Health officials and state health officials to discuss corporate integrity, corrective actions, and compliance with federal and state Medicaid/Medi-Cal law. Failure to take corrective actions recommended by the independent watchdog, which may include removal of paid and non-paid personnel implicated in misconduct related to Medi-Cal billing, will lead to a return to state suspension.

Dental services, the largest money maker for Borrego Health, had a backlog of $15,604,653.03 in fees. However, the state will not be returning these funds, as it continues to focus its investigation on the alleged fraudulent dental practices of private doctors and Borrego Health’s management company, Premier Healthcare Management.

The contract created by former Borrego CEO, Bruce Hebets, and Daryl Priest, owner of the El Cajon health management corporation, was not approved by the Borrego Health Board of Trustees, or disclosed in the nonprofit’s IRS990 tax disclosures. Both acts are violations of federal and state regulations and oversight of the FQHC non-profit. Besides concern about falsified claims, earning one dentist $6 million in 2019-2020, profits of $25 million in fees for Premier, and a yet undisclosed financial benefit for Borrego Health, the terms of the agreement do not restrict the ongoing investigation or new investigations of Borrego’s Medi-Cal activities.

According to the terms of agreement signed on Jan. 27, 2021, by Dr. Bulloch, and Bruce Lim, California Department of Health Care Services, and their respective attorneys, “No provision in this Term Sheet is intended to limit or restrict the filing of a criminal or civic action, or limit any claims that may be made in any such action, by any federal, state, or local prosecuting, administrative or regulatory authorities.”

The terms also provide for “The event that DHCS identifies new or different information that Borrego is non-compliant with Medi-Cal restrictions or regulations, the state at its discretion, may at any time impose a temporary suspension and reinstate or modify the Medi-Cal suspension.”

In addition, the agreement allows DHCS to recover any overpayments Borrego Health may have received.Borrego Health will continue to provide dental services at its six locations, which are staffed by the non-profit’s employees. However, there will be no state reimbursements. Anthony Cava, spokesperson for the state said that dental patients should seek out qualified, dental providers from other clinics. He offered a phone number (800 322-6384) for help in finding dental services and the state website http://www.smilecalifornia.org to find a new dentist.

According to an article in the San Diego Union-Tribune, Dan Kramer, spokesperson for Borrego Health, stated that, “In areas where there is no inhouse dentistry services, he said, it (Borrego Health) will provide transportation, where feasible, to clinics that do.” Kramer also noted that it can make referrals to providers who accept Denti-Cal.