A confidential assessment of CalOptima, the $1.3-billion medical program for Orange County’s poor, shows important defects in its organization and management that could cause serious problems, according to the Orange County Register.

The review by Woodland Hills health care consultant Arthur S. Shorr urges the CalOptima board of directors to order a full audit of the Medicare and Medicaid program, which serves 430,000 Orange County residents, most of them children but also disabled adults and seniors. The federal Medicaid program is called Medi-Cal in California.

The Register reported that the CalOptima board violated California’s open meeting laws by attempting to vote in closed session on whether to proceed with an audit and that a new vote will be held.

The CalOptima assessment comes in the same week Supervisor Janet Nguyen won Board of Supervisors approval to revamp the CalOptima board, enlarging it to 11 members from the current nine and increasing the influence on the board of the healthcare industry and government.

Here are the items from the consultant’s report as reported by the Register:

  • Cal-Optima doesn’t do an adequate job of assuring that billings and reimbursements are in compliance with state and federal regulations, placing “management and the board at risk of criticism and the organization at risk of disaster.”
  • The CEO, not the board, is in control of executive pay, which could be used to suggest the board is being manipulated. It is “likely to produce embarrassment, if not worse.”
  • The organization is dysfunctional and not large enough to support 32 executives, which slows down the agency and complicates compliance with policy.
  • There is no process to inform new executives of their responsibilities.
  • Federal exclusion lists are not being checked, which could force the agency to reimburse the government for the costs of some contracts.
  • The relationship is poor between the legal and executive departments, creating the risk that legal advice will be ignored by management.
  • Neither management nor the board has held personnel accountable for operations.

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