CalOptima Granted More Time to Fix Problems
By: OC Supervisor Todd Spitzer
CalOptima is the county’s $1.7 billion health plan for low income and disabled residents. The county’s organized health system administers health insurance programs for low-income families, children, seniors, and persons with disabilities in Orange County. A Federal Centers for Medicare and Medicaid Services (CMS) audit was conducted to analyze CalOptima’s OneCare Program. Subsequently the Board of Supervisors appointed Supervisor Todd Spitzer to the CalOptima Board of Directors to help bring corrective action to CalOptima.
In response to the recent audit, federal officials have given CalOptima a six month extension to address the issues identified in the audit surrounding a program for the delivery of health services to elderly Orange County residents. These issues include efforts to detect fraud. CMS has extended its review period to support the agency’s effort to implement long-term solutions in the OneCare program.
On the CalOptima Board, Supervisor Spitzer has been actively working to ensure that CalOptima is cooperating with CMS to make corrective actions required by the audit findings. “$1.7 billion is a huge investment on behalf of taxpayers to provide these state mandated health care services,” said Supervisor Todd Spitzer. “I want to make sure service is delivered in an efficient and fiscally solvent way.”
CalOptima reports that it has strengthened the monitoring and oversight of its 11 health networks and pharmacy management company. In addition, new systems have improved providers’ authorization of members’ health and pharmacy services.
Editor’s Note: Here are more articles about the mess at CalOptima, which came about after Supervisor Janet Nguyen took over their Board: