(SAN FRANCISCO, August 20, 2015) Serious concerns over the management of Chinese Community Health Plan (CCHP) are being raised following the disclosure of sanctions for “widespread and systemic failures” involving Medicare beneficiaries, along with new allegations raised in a whistleblower lawsuit involving Medicare Advantage.
“The same management team that is trying to destroy the health-care alliance in Chinatown and put the future of Chinese Hospital at risk is under fire for Medicare fraud and abuse,” said John Williams, CEO of Chinese Community Health Care Association (CCHCA), an independent physicians group representing 197 doctors in Chinatown.
The non-profit CCHCA announced last week that it had filed suit against the for-profit CCHP for attempting to siphon away CCHCA doctors by misleading them into signing individual physician contracts. Doctors fear that putting physicians directly under CCHP control would destroy the independent association, allowing the health plan to manipulate reimbursements, control the way doctors manage patients and reap greater profits.
In addition to the CCHCA lawsuit, the Centers for Medicare & Medicaid Services (CMS) has issued severe sanctions against CCHP, barring any further Medicare enrollments for conduct that “poses a serious threat to the health and safety of Medicare beneficiaries.”
In all, CMS cited the health plan for 29 patient violations, ranging from inappropriately denying payment for emergency medical services to issuing a denial of service letter to Medicare enrollees while they were still lying in their hospital beds. The sanctions issued by CMS will remain in effect until CCHP proves it has made the necessary corrections.
Making matters worse for CCHP, the health plan has been named as a defendant in a whistleblower lawsuit claiming that it participated in a scheme to overcharge Medicare.
The lawsuit, recently unsealed in Texas, claims CCHP engaged in a conspiracy with a company called Censeo Health to increase Medicare payments by coding patients for unsubstantiated diagnoses.
“These allegations make it clear CCHP management cannot be the sole overseer of health care in our community,” said Dr. Eric Leung, community ophthalmologist in Chinatown. “The checks and balances needed to provide quality care would no longer exist if CCHP were allowed to eliminate the CCHCA by signing on doctors under direct, individual physician contracts.”
CCHP claims the individual contracts were sent as a requirement under Covered California and in order to expand physician availability at Chinese Hospital. But in fact the state has no such requirement, and the offers were sent to doctors who already serve Chinese Hospital through the physicians association.
“If the quality of the medical staff or the number of doctors available were really the issue, as the health plan claims, why would they be trying to poach the same doctors who already serve CCHP and Chinese Hospital through the existing CCHCA physician network?” pediatrician Dr. Raymond Li asked. “CCHCA is not against bringing new physicians into the community, and in fact we share the cost with CCHP and Chinese Hospital to employ a physician recruiter to add physicians to serve the community and the hospital.”
The doctors association filed its lawsuit as a last resort, and believes the health care alliance that has served the Chinese community well for the past three decades should continue.
“For years CCHP, the doctors of CCHCA and the Chinese Hospital have worked in unison,” said Williams. “We want to continue to be supportive of CCHP, but these recent developments are troubling.”