Doctor blames closing on Medi-Cal bureaucracy

OAKDALE -- One would think it would be simple to move a medical practice from one office to another a few blocks away.

But Dr. William Poirier of Oakdale said he ran into bureaucratic hassles with the state Medi-Cal system and the federal Medicare program, and now low-income patients in the county have access to one fewer ear, nose and throat specialist.

For seven months, Medi-Cal and Medicare didn't pay him for seeing patients at the new office because of delays in processing the required applications for a change of location, he said.

Poirier, who saw 15 to 20 Medi-Cal patients a day and was one of the few specialists in the county who had an open-door policy for low-income patients, said he needed the payments to stay afloat. So, he closed his practice Dec. 1.

State Medi-Cal officials said Poirier's office didn't submit the paperwork within the required time and that doctors will have a more streamlined process next year.

Health care providers who referred patients to Poirier said it's a blow for low- income patients in the area. They were scrambling to find other specialists for patients who need treatment for sinus and throat problems and other maladies.

"There is no replacement for him," said Matt Freitas, a nurse practitioner and co-owner of Aspen Family Medical Group in Modesto. He noted that another ENT specialist in the area who accepted Medi-Cal referrals retired this month.

Aspen will have to refer patients to Sacramento, he said.

Poirier said he drew down his personal savings to cover $6,000 to $7,000 in monthly expenses for rent, office staff and other bills while waiting for the government reimbursements. Medi-Cal and Medicare each owe him about $30,000, he said. About 70 percent of his patients were in the government health programs, he said.

"I didn't go into medicine to make a lot of money," said Poirier, who spent about 25 years practicing in other states before coming to Oakdale four years ago. "I took the Hippocratic oath to take care of patients. I didn't take a vow of poverty."

Many doctors say they don't accept Medi-Cal patients because of the low reimbursements and the kind of paperwork hassles that Poirier experienced.

In May, Poirier moved his practice from an office near Oak Valley Hospital to one on G Street; he said he notified the government agencies of the change of address the same week.

The office submitted claims for reimbursements for seeing patients at the new location, but no payments came for two months, he said.

When they called Medi-Cal, they had to wade through automated telephone prompts and rarely talked with a person, he said. When they finally got through, a Medi-Cal representative said the agency had no record of the application.

Poirier said his office resubmitted the forms to Medi-Cal two or three times. The federal agency that runs Medicare simply said it was processing the change of address, Poirier said. His office also sought help from legislative representatives.

The doctor said the state Department of Health Care Services started processing the Medi-Cal application in October and he decided to close when the agency kept asking for information, such as a city business license bearing the new address.

"The private insurers just took the information over the phone and they changed us over," Poirier noted.

Karen Nikos, a spokeswoman for the California Medical Association, said the same problem with Medi-Cal has occurred with hundreds of doctors in California, even to doctors who moved to a different suite in the same building. The association, which represents more than 30,000 physicians in the state, sponsored legislation to streamline the process three years ago and a bill was signed into law this year.

Toby Douglas, deputy director of the Department of Health Care Services, said the agency has cut the turnaround time for approving a change of location to 40 days, even though legally the agency has six months.

Shorter form coming in July

As a measure to prevent fraud, the state requires physicians who participate in Medi-Cal to submit a complete application package when they move. The agency asks for tax identification numbers, proof of liability insurance, a business license and other documentation. As of July 1, doctors in good standing will be able to submit a shorter form with a 90-day review time when they change locations in the same county.

Douglas said physicians can submit reimbursement claims during the review process and payments are not supposed to stop. The agency didn't have a record of Poirier submitting a change of address within 35 days of the move, as required, he said.

Raul Ramirez, chief of provider enrollment for Medi-Cal, said the department received a change of address application from Poirier on Sept. 12 and an analysis seeking additional information was sent to his office by Oct. 18.

When the doctor didn't provide all the requested information in his response Nov. 20, he said, enrollment personnel called the office in late November to try to fill in the remaining gaps.

"We are working as much as we can to increase the number of providers in the program," Douglas said. "But we balance that with ensuring that providers follow the rules to ensure the integrity of the program."

Valerie Mayfield, Poirier's office mana-ger, said the office submitted at least two applications prior to September and she believes the agency misplaced them. Mayfield, one of two office workers who lost their jobs, said she feels for the patients.

Poirier is considering job offers in other states and expects to be practicing outside California by early next year.

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or 578-2321.