Payers & Providers California Edition – Issue of August 2, 2012

7/31/2019 Payers & Providers California Edition Issue of August 2, 2012

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Calendar

2 August 2012

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the details of your event, or call(877) 248-2360, ext. 3. It will be

published in the Calendar section,space permitting.

California Edition

The Department of Managed Health Careissued an unusual cease and desist orderagainst a Signal Hill medial group, claimingthe son of its chief executive ofcer had been

illegally reviewing cases and making medicalnecessity decisions for insurers. George Jayatilaka, M.D., is the CEO ofthe Accountable Health Care IPA. The DMHCalleges in his complaint that his son, DruviJayatilaka, the groups vice president, andanother employee, Ambarish Pathak, hadengaged in utilization reviews on behalf ofnine health plans. Neither is a licensedphysician, a requirement under state law toengage in prospective medical reviews, whichcould lead to the modication or even denialof specic kinds of care to patients.

Altogether, Accountable provides care to

more than 148,000 patients from ninedifferent health plans in a risk-bearingarrangement. It includes Medicaid insurer L.A.Care Health Plan, Anthem Blue Cross ofCalifornia, Aetna and Blue Shield ofCalifornia.

A DMHC spokesperson could not saywhether the decisions rendered by Pathak andDruvi Jayatilaka had a material impact on careoutcomes, adding that the case was still underinvestigation.

The younger Jayatilaka appears to hold amedical degree from an unknown institution,records suggest. In 2009, he led suit againstthe National Board of Medical Examiners in

an attempt to receive extra time to complete alicensing exam due to a disability. He lost thecase in federal court last year and was orderedto pay more than $6,100 in costs, recordsshow. He could not be reached for comment.George Jayatilaka did not return phone callsseeking comment.

Pathaks LinkedIn prole says he is amedical management consultant. He referreda telephone inquiry to his attorney, DouglasStuart of Santa Monica, who declinedcomment.

The DMHC accused the pair of engagingin medical reviews since December 2008

until the cease and desist order wasled onJuly 16. The agency was tipped to the alleged

practices at Accountable through acondential complaint, according to agencyspokesperson Marta Green.

Green said the cease and desist order alsoapplies to the health plans because theyreferred their patients over to Accountable.Under the Knox-Keene Act, everyoneinvolved has to comply with the law, shesaid.

August 19-21

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Payers & Providers Page 2

Top Placement...Bottomless Potential

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In Brief

L.A. Care To SponsorFree Clinic At Sports

Arena

L.A. Care Health Plan, the Medicaidmanaged care health plan, will again

sponsor a free medical clinic at theLos Angeles Sports Arena next month.The clinic, which will be staffed

by volunteer physician and dentists,drew an overwhelming response lastyear, with tens of thousands of peopleseeking care.

This years clinic, which will beheld Sept. 27 through Sept. 30, willfeature a 20% larger capacity fordental and vision care, including theon-site manufacturing of crowns anddenture repair. About 1,000 medicalstaff will be volunteering. Theirservices are being coordinated by thenot-for-prot group Care Harbor.

Care Harbor may be more

important this year than ever before,said L.A. Care Chief Executive OfcerHoward Kahn. Now is the time tobegin transitioning the uninsured intocare and to start the process ofinforming, educating and orientingpeople about what's to come with theimplementation of federal healthcarereform. The opportunities for accessto quality health services will betremendous, and Care Harbor will beuniquely positioned to raise publicawareness and eliminate hurdles forthose seeking long term healthsolutions.

Womens PreventativeServices Expand Under

ACA

Insurers are now required toprovide specific preventative careservices as part of the AffordableCare Act.

On Aug. 1, insurers wererequired to provide free of chargeeight services to women free ofcharge. They include well visits,

Continued on Page 3

NEWS

MEET YOUR FELLOW READERS

Need to promote a conference? Your brand? Payers &Provider!se-mail list for all editions is available for yourmarketing needs. Reach out to more than 12,000healthcare professionals who read our publications. CaClaire Thayer at (877) 248-2360, ext. 3 or e-mail her [email protected].

Litigious Doctor Sues Patient AgainKentucky Suit Filed After Treatment in California

The only individual physician in Californiaever to be the subject of an enforcementaction by the Department of Managed HealthCare has sued another one of her Californiapatients again this time in Kentucky.

Jeannette Y. Martello, M.D., led the suitagainst Bill Buck, a Duarte cabinetmaker, onJuly 20 in mostly rural Johnson County in theeastern portion of the state, records show.

Martello, who claimed in her lawsuit thatshe worked as a locum tenens physician atPaul B. Hall Regional Medical Center until2010, accused Buck in the lawsuit ofcontacting hospital management in July of that

year in an attempt to discourage hercontinued employment at the facility. Itcontends that Martellos employment at thehospital was terminated as a result.

The lawsuit accuses Buck of defamationand tortious interference and seeks aminimum of $5,000 in damages.

Hospital spokesperson Donna Waddellnoted that Martellos work at the hospitalended not because it terminated her, butbecause her license to practice medicine inKentucky had expired.

Records indicate Martellos license lapsedin Kentucky last February.

Although Martello is a SouthernCalifornia native and attended medical schoolat UCLA, she underwent a surgical fellowshipat the University of Kentucky Medical Centerearly in her career as a physician, and hadbeen licensed to practice in Kentucky since1991.

Waddell also noted that Martellosemployment contract was with a locumtenens rm, Houston-based WhitakerMedical, and not directly with the hospital.

Martello treated Buck at HuntingtonMemorial Hospital in Pasadena in April 2010after he had severed part of a nger in aworkplace accident. Although he hadinsurance with Anthem Blue Cross, and the

insurer paid Martello about $2,500, shereturned the money to Anthem and sought payment from the Bucks, ling a lawsuit in Angeles Superior Court seeking more than$15,000.

Martello received a default judgmentagainst Jae Buck as the result of the way theBucks led their response. Martello later la lien against the Bucks South Pasadenacondominium, claiming in her motion that Buck had been abusive to her and that thecouple fought often.

A Payers & Providers investigationpublished last May determined Martello, w

in addition to her medical training holds a degree from UC Berkeley, had sued at leasof her patients in California after treating that Huntington and other hosptial ERs in theSan Fernando and San Gabriel Valleys.

In 2010, the DMHC ordered Martello tstop balance billing her patients who hadinsurance, and led suit against her last yeawhen she did not heed the order. The DMHhas also gotten many of Martellos lawsuitsagainst her patients dismissed.

In May, the DMHC successfully soughtpreliminary injunction against Martello thaprohibits her from ling further suits agains

her insured patients.Bill Buck has been one of the most voc

critics of Martellos conduct, posting severanotices of the DMHC cease-and-desist ordeon review websites such as Yelp.

The California Medical Board is alsoattempting to revoke Martellos license topractice medicine in this state, in part becaof her balance billing of patients and suingthem. A licensure hearing is scheduled forOctober.

The allegations against Martello inCalifornia have no bearing on the case inKentucky, according to her attorney, JeremyRogers of Louisville.

The case speaks for itself, Rogers said


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Page 3Payers & Providers

Longer ALOS!*

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*For our ads, not your hospital

In Brief

gestational diabetes screening,breastfeeding support, FDA-approved contraception methodsand counseling, and HIVscreening, among others. Certainreligious organizations areexempted from paying for theprovisions of the contraceptive

services.The Obama administrationwill continue to work with allemployers to give them theflexibility and resources they needto implement the healthcare law ina way that protects womens healthwhile making common-senseaccommodations for values likereligious liberty, the U.S.Department of Health and HumanServices said in a statement.

Altogether, the expansion ofservices is being made to about 47million women nationwide,including about 5 million inCalifornia.

Kaiser Enrollees MoreLikely To Stay AfterUsing EHR System

Kaiser Permanente enrollees whouse the systems electronic healthrecords and associated patientportal are more likely to remainenrolled compared to non-users.

According to a survey ofnearly 400,000 Kaiser enrollees,those who use the My HealthManager are 2.6 times more likelyto stay with the organization thanthose who do not use the system.

We have always known thatour members find these onlinetools convenient and empowering,but now we have proof that theseofferings actually increase memberloyalty and can improve therelationships betweenpatients and their physicians, saidChristine Paige, senior vicepresident for marketing andInternet services.

The results of the study will bepublished in the latest issue of the

American Journal of ManagedCare.

NEWS

STORIES OF ONE HIGHLY LITIGIOUS PHYSICIAN

$149

Call (877) 248-2360, ext. 2 to order

OR CLICK HERE

Kacic also co-chaired anotherorganization, the Managed System of Care,that was in line to receive as much as $12.7million in funding from CalOptima.

Kacic and other ofcials have said thatthe Managed System of Care would havesubmitted the application for the federalgrant itself, but had not been properlyincorporated to do so.

Although Kacic has strenuously deniedany conicts and the California Fair PoliticaPractices Commission declined to provideadvice on the matter at the request ofOrange County Counsel Chris Chrisos,

fellow CalOptima board member andCounty Supervisor Janet Nguyen termed it aconict of interest.

Nguyen, who received an appointment tothe CalOptima board last year after lobbyingby the regions hospitals, has been at oddswith Kacic and other board members.

In March, the Supervisors voted to delayKacics reappointment. In May, theCalOptima board voted to remove Kacic aschairman on the same day it also voted tobeef up its compliance practices.

Soures have also suggested that aninvestigation is continuing into the possible

use of CalOptima employees to prepare theIrvine Health Foundations bid for the grant.

In his letter of resignation, Kacic said thatit was inappropriate for CalOptima to beinvestigating such matters internally, and thaan outside entity, such as a law rm, wouldhave been more appropriate for an inquiry.

The inquiry seems to have been takeninside the organization, with the internalcounsel playing a signicant rolesince Idont believe in the propriety of askingindividuals to investigate those to whom theyultimately report, I nd this situation odd, atbest, he wrote.

Edward B. Kacic has resigned from the boardof CalOptima, little more than ve monthsafter accusations of self-dealing involving anon-for-prot foundation he heads hadsurfaced.

Kacic submitted his letter of resignation tothe Orange County Board of Supervisors onJuly 30. He had served on the board since2009, and although appointed its chairman inAugust 2011, he had temporarily beenremoved from the post earlier this year.Moreover, his reappointment to the board hadbeen delayed, and it appeared increasinglyunlikely he would receive one before his term

expired on Sept. 30.CalOptima, which provides managed

care coverage to about 400,000 of thecountys Medi-Cal recipients, have beenrocked by allegations of mismanagement formonths now. Published reports indicate that asmany as 14 top and middle managementexecutives have left the organization in thepast year. It is currently lacking both a chiefexecutive and chief operating ofcer.

Kacics conict with CalOptima began inFebruary, when an anonymous letter surfacedthat accused him of self-dealing.

Payers & Providers reported on Feb. 23

that the Irvine Health Foundation, of whichKacic is the executive director, had submittedan application to receive a $9.3 millionfederal grant that would be used to providemedical homes and other services toCalOptima members.

The foundation itself would not havereceived funds for its own use, but wouldsupervise the employees engaged in theinitiative.

The Center for Medicare and MedicaidInnovation an afliate of the Centers forMedicare and Medicaid Services ultimatelyturned down the grant application.

Kacic Resigns From CalOptimaFormer Chairman Steps Down After Grant Issues
https://www.managedcarestore.com/pandp/p&pphysicianwp.htmhttps://www.managedcarestore.com/pandp/p&pphysicianwp.htm


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Payers & Providers PageOPINION

A New View Of Americas PhysicianPredictive Analytics, Link Analysis Playing Larger Role

Geoffrey Charlton-Perrin is the director of

marketing and communications for the

Accreditation Association for Ambulatory

Health Care.

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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

HEALTH PLAN/HOSPITAL CONTRACTING CONSULTANT(flexible hours)

A dynamic and growing medical group in the Los AngelesCounty area is currently seeking a highly experienced con-tracting consultant for the purpose of leading and success-fully negotiating and renegotiating health plan and hospitalcontracts. The ideal candidate will have an understandingof all product lines within the managed care industry, bewell-versed in contractual language, excel at maintainingpositive working relationships internally and externally, anddemonstrate an understanding of legal, financial and opera-tional processes that meet company objectives. Flexiblehours and telecommuting are available.

If interested, please email your cover letterand resume to:[email protected]

Casa Colina Centers for Rehabilitation, a nationally recognizeleader in the field of medical rehabilitation located in Pomona, iseeking to fill the vital role of Controller to oversee the Financand Accounting functions for the entire rehabilitation continuumwith a total bed complement of 178 beds, and consisting of hospital, brain injury program, 3 long term care facilities, an AduDay Health Center and outpatient childrens program.

The selected candidate will be responsible for all financial, payroand A/P activities. Oversees internal controls to ensure revenucycle effectiveness, expenditure management and safeguardinof assets. Prepares financial statements in a timely, accuratand efficient manner. Supervises all accounting and payroll stafResponsible for tax returns and regulatory filings. Requirementinclude a Bachelors degree in Accounting or Business relatefield, two (2) years of supervisory experience, prior hospitalhealthcare accounting experience, and a working knowledge oaccounting software programs. CPA background is strongly preferred. Excellent work ethic and motivation required.

Competitive compensation and excellent benefit optionsavailable. To apply, visit us at www.casacolina.org/jobs.

Principals only at this time.

CONTROLLER/

DIRECTOR OF FINANCE

It costs up to $27,000 to fill a healthcare job*

will do it for a lot less.

Employment listings begin at just $1.65 a word

Call (877) 248-2360, ext. 2

Or e-mail: [email protected]

Or visit: www.payersandproviders.com

*New England Journal of Medicine, 2004.


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Page 7Payers & Providers MARKETPLACE/EMPLOYMENT

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CAN HELP.

We publish advertisements for those seekingnew career

opportunities for just $1.25 a word.

If you prefer discretion, well handle allresponses to your ad.

Call (877) 248-2360, ext. 2, or [email protected].

Payers & Providers California Edition – Issue of August 2, 2012

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