Borrego Sun - Since 1949

To quote Sandra Hansberger, Chair of the Borrego Community Health Foundation (BCHF), “Everything you read in the Borrego Sun is not true.” She’s right.

The Borrego Sun often relies on tips from credible sources to ferret out new information. Rumors are like the old saying, “Where there’s smoke, there’s fire.” That usually holds true, but sometimes it takes time for a rumor or tip to become reality. The Sun always contacts Borrego Health about a rumor or tip before printing an article.

Hansberger really has little room to complain because she is always given the opportunity to set the record straight. Her response would keep the information two-sided, but she prefers not to share information.

It’s very frustrating, working with a publicly funded non-profit that provides one of Borrego’s most essential services, to try to get information when protecting personal interests, egos or reputations, is more important than informing the community.

Often less than helpful are the agencies that are involved in monitoring, regulating and investigating a FQHC Health Center, such as Borrego Health. For example, the really big question: How did the federal Health Resources and Service Agency (HRSA), with an appointed individual to monitor Borrego Health, miss over 10 years of abusing taxpayer funds?

When asked repeatedly, the excuses are, “Can’t talk about anything currently under investigation,” “That was the last administration, you will have to track down the officials in charge at the time.” “We can’t reveal the name of Borrego’s monitor, because it’s a personnel issue.”

Just tracking down someone in the massive bureaucracy that is the federal government to even say they “can’t answer the question” is a big job. Then there’s the really big cop out: Ignoring the question and sending it to the press office, so it can be massaged into a bunch of words with no answers. Just like the following answers to questions about a tip that Borrego Health is discussing a settlement, discussed in the previous article.

Bruce Lim, Deputy Director at California Department of Health Care Services, (DHCS) in charge of audits and investigations, very nicely and respectfully, referred the Sun to the communications department, where Anthony Cava, the care services spokesman for the California Department of Health Care Services (DHCS) rudely reminded that reporters were not to go to official personnel, but to the press office.

He pointed out that this reporter had been warned before about going to officials involved with Borrego Health, in this case Lim, who has DHCS oversight over auditing and correcting the Foundation’s non-legal problems, but the underlying causes that left the Foundation, vulnerable to fraud and abuse of funding.

Here’s the email conversation with Anthony Cava:

Questions:

1. Borrego Sun: We have heard rumors of a reorganization, which basically entails Borrego Health divesting itself of its clinics as a means to settle the DOJ charges of fraud. Can you confirm or explain how this is done? Why and how does it affect the court case and investigation of Borrego Health?

Cava: “DHCS refers questions regarding a court case and ongoing investigation to the California Department of Justice and Borrego Health.”

“A federally qualified health center clinic divestiture requires that the clinic contact the federal Health Resources and Services Administration (HRSA) to seek approval to close or to transfer ownership to another operator. The clinic is also required to give notice to the Medi-Cal managed care plan that members are enrolled in so they can be reassigned to another provider group in order to ensure continuity of care. In addition, the clinic must contact the California Department of Public Health (CDPH) to surrender its license or transfer the license to a new operator.”

“The new operator must submit a Change of Ownership (CHOW) application to CDPH Licensing and Certification to inform CDPH that they will be operating the location. CDPH will then notify DHCS of the CHOW or any changes in operations (CDPH has not notified DHCS of any changes in ownership/operations related to Borrego). These processes can take a minimum of 60 days. We recommend that you contact HRSA and CDPH for more information.”

Sun response: One can easily get lost in the menu of government acronyms. And the problem is called “passing the buck” to another agency that likewise will not answer questions.

2. Sun: The first concern is that Borrego Health’s Riverside County Clinics are going to Riverside Community Health Foundation, owned by Dan Anderson. Will Anderson be in charge? How many clinics are involved?

Cava: “DHCS is not aware of any such decisions ratified by Borrego’s Board of Trustees.”

Sun response: The key word here is ratified.

3. Sun: What is the legal process for transferring or closing down clinics?

Cava:“Please see response 1.”

4. Sun: Does the community get notice or have any say?

Cava: “DHCS is not required to provide notice to the community, but DHCS encourages and welcomes public input about the health care needs of communities and any concerns about continuity of care. DHCS also requires that Medi-Cal managed care plans directly notify members to ensure continuity of care for members receiving services from a clinic that’s closing.”

Sun response: Journalists need not apply.

5. Sun: The second concern is that all San Diego County clinics will likewise be farmed out to another FQHC. Is this true and, if so, what nonprofits are taking over?

Cava: “DHCS is not aware of any such decisions ratified by Borrego’s Board of Trustees.”

6. Sun: The biggest concern is about the clinic in Borrego Springs. Can you tell us the plan for our only medical facility within 70 miles? The clinic is the heart of health care in Borrego Springs, and we believe the public has a right to know what is proposed or already happening.

Cava: “DHCS is not aware of any decisions ratified by Borrego’s Board of Trustees concerning the Borrego Springs clinic. However, please note that DHCS has network adequacy requirements in place – based on federal, state, and contractual requirements – that contracted Medi-Cal managed care plans (MCP) must meet as to their providers and networks, such as Borrego. Having timely access to medically necessary services is a top priority for DHCS.

“Thus, DHCS ensures MCP compliance with these requirements annually and at any time there is a significant change that impacts the MCP network. DHCS also works with MCPs to address access to care concerns and has various enforcement levers in place to ensure continuity of care, including requirements for MCPs to provide out-of-network access to medically necessary services and transportation.”

Sun response: They have everything in place. Except informing the community that relies on the service.

7. Sun: I am wondering if any audits are available to the public or any other reports on the progress under the monitors and the final plans for the clinics?

Cava: “No audits or reports associated with DHCS’ monitoring of Borrego are available to the public at this time since the investigation is ongoing. However, DHCS and the independent monitor remain engaged with Borrego and continue to assess Borrego’s progress in achieving compliance in order to remain eligible for reimbursement by the Medi-Cal program.”

Sun response: It’s a confirmed fact that the FBI investigation has been completed and handed over to the Department of Justice. And the DOJ isn’t talking.

Meanwhile, the Sun is patiently awaiting responses to emails and phone calls to HRSA, even the press department.

Someone in the federal government should answer to how HRSA’s Borrego Health monitor, and its computer-based Algorithms to find abuse, missed or overlooked the misuse of health care and taxpayer’s funds. The FBI admitted that there had been red flags. They saw red flags; the Borrego Sun saw neon floodlights.