CalOptima Compliance Exec Leaves in Mid Audit Process

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CalOptima’s top executive charged with making sure medical professionals who care for Orange County low income residents strictly follow federal and state rules has left in the middle of an audit process focused on those compliance issues.

CalOptima Chief Executive Officer Michael Schrader, in a Sept. 3 email to the health plan’s board of directors, said “Barbara Saak, Executive Director of Compliance is no longer employed with CalOptima.”

CalOptima officials said there would be no further details about the reasons for Saak’s departure barely a year after coming to the health plan from St. Joseph Health System.

Her management biography still was posted on the CalOptima site Monday morning but was taken down later this week.

“As Executive Director of Compliance, Ms. Saak ensures that CalOptima meets all state and federal regulatory and contractual requirements,” it said. “She is responsible for all internal compliance and auditing activities, including developing annual compliance plans for each CalOptima program. Ms. Saak also works externally to ensure compliance in CalOptima’s extensive provider network.”

Compliance is at the heart of issues raised in a federal audit of CalOptima’s 16,000-member OneCare program that resulted in a halt to new enrollments of elderly patients because it posed a “serious threat to the health and safety” of participants.

The federal audit was conducted in November, 2013 and the results were made public in February, this year. Federal officials are scheduled to come back in January to determine if all problems have been fixed.

Following the federal audit, state examiners came in this spring and reported “serious and significant” problems in other areas of CalOptima, including potentially dangerous delays in approving prescriptions.

Saak, who could not be reached for comment, only had held her job for about two months when the federal audit began.

But after the audit, she was in charge of correcting problems found with the health plan’s pharmacy vendor, doctor networks and others in the OneCare program.

Until those problems are corrected to the satisfaction of federal auditors, CalOptima is barred from participating in a new program called Cal MediConnect, which expands the former OneCare plan and is considered one of the most financially attractive federal medical programs for medical providers.

With the implementation of the federal Affordable Care Act or ObamaCare, this year, CalOptima’s enrolled has doubled to more than 625,000 low income residents, more than half of them children. The health plan anticipates its 2014-15 revenue will be about $3 billion, assuming its federal audit issues are corrected quickly.

In his email to the CalOptima board of directors, Schrader wrote “I am implementing a full leadership transition plan focused on ensuring the ongoing effectiveness of our compliance and audit activities. This transition will not disrupt our (audit) remediation efforts.”

Please contact Tracy Wood directly at twood@voiceofoc.org and follow her on Twitter: twitter.com/tracyVOC.

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