Borrego Sun - Since 1949

Three Borrego Community Health Foundation Trustees – Martha Deichler, David Hernandez and Sandra Hansberger – took the Borrego Sun’s repeated requests for transparency seriously, and floated a one-page flier in the community. The flier, signed by the three BCHF Trustees affirmed that despite the suspension of Medi-Cal claims by the state, patients are being cared for and doctors are available at the Borrego Springs clinic.

That’s good news. It’s also refreshing that the local Trustees are taking seriously the anxiety the Borrego Community feels about possibly losing its only medical provider, as a result of the ongoing FBI/Dept. of Justice (DOJ) investigations.

The Trustees were even honest enough to reveal that the one-day closure of the pharmacy happened because an employee tested positive for COVID-19.

Speaking of the state suspension of BCHF Medi-Cal claims, the Sun continues to inquire about the status of the foundation’s appeal to the California Department of Health Care Services (DHCS), regarding the state’s suspension of Medi-Cal claims. The appeal was learned about from a December letter to the Foundation’s employees from the new CEO, Dr. Edgar Bulloch. Unfortunately, BCHF Trustees don’t see the need to extend the same courtesy to their patients about critical actions that will affect their health care.

Since the Foundation isn’t talk-ing about it, the Sun contacted the spokesperson for DHCS; and learned the foundation’s appeal to terminate or modify the suspension of Medi-Cal claims hasn’t yet occurred.

According to Anthony Cava from DHCS, Borrego has not appealed DHCS’ suspension via the Department’s Office of Administrative Hearings and Appeals pursuant to Welfare and Institutions Code (WIC) section 14043.65. However, Borrego did formally request a meet and confer with DHCS pursuant to WIC section 14123.05 for purposes of presenting and discussing information and evidence that may impact the Department’s decision to modify or terminate the sanction. The meet and confer took place on December 16, 2020.

No other details are available. However, it can be assumed, the financial stability of the Foundation is tied to state Medi-Cal reimbursements. Equally relative and important, is that the outcome of the appeal will make a difference in BCHF’s ability to continue to pro-vide services for Medi-Cal patients, which are a large majority of the Foundation’s patients.

The Sun asked Cava, “What hap-pens next if BCHF stops accepting Medi-Cal patients?”

His reply, “DHCS continuously monitors the Medi-Cal delivery systems to ensure timely access to medically necessary services. DHCS is actively assessing the availability of alternative providers and work-ing with the managed care plans in Borrego’s service area to ensure that Medi-Cal members continue to receive access to medically necessary services.”

This is similar to the response from the federal government, which has the primary oversight of the Foundation as a non-profit health clinic. Unfortunately, it appears to be a wait and see situation, which is not assuring to persons dependent on the Foundation’s services in Borrego Springs. Perhaps, the trustees will see the importance of updating Borrego residents on this important issue.

The Sun is the regular recipient of many unsettling stories from employees, and community members about the Foundation. Some lead to new questions about BCHF and potentially fraudulent practices. Much of the past research arose from connections and incidents that seemed too coincidental to be ignored. For the welfare of BCHF’s mental health patients, an evolving set of facts seem to ask someone to investigate a new trail of coincidences, ask questions, and see what can be confirmed.

The BCHF is outsourcing mental health therapies, much like it was outsourcing dental services – a practice that got out of hand, lead-ing to false client claims by some of the contracting, private dentists. The difference is that in the case of mental health services, there is no middle man, like Premier Management, which was recruiting, and credentialing dentists, as well as verifying claims for government insurance, and billing patient invoices on behalf of BCHF.

As the current fraud investigation shows, Premier failed to fulfill many of these responsibilities, and is potentially complicit in ripping off taxpayers that ultimately fund BCHF and its dental services. The BCHF-Premier contact included a per-visit fee paid to Premier by BCHF that was never disclosed on the foundation’s non-profit, IRS-990 tax disclosures. The contract with Premier has also been ongoing with-out the approval of Trustees for a number of years. Indeed, Trustees had voted against the contract. Both acts are illegal, according to federal regulations.

More to come...