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Medicare clients sue state over computer flub

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Beth Winegarner
Examiner Staff Writer
February 27, 2007

A computer glitch caused the California Department of Health Services to stop reimbursing thousands of Californians for their Medicare premiums, according to a class-action lawsuit filed in San Francisco Superior Court on Monday.

The lawsuit, which represents clients in San Francisco and San Mateo counties along with 16 other counties in California, alleges that after DHS began using the CalWIN computer system to manage its Medicare rolls, thousands of low-income clients were accidentally dropped.

When that happened, clients stopped receiving medical-care reimbursements without any notice, according to Melissa Rodgers, directing attorney for the Legal Aid Society of San Mateo County, who filed the lawsuit.

For example, when San Mateo County began using CalWIN in October 2005, clients such as Juan Ledezma were dropped. Ledezma didn’t realize the problem until March 2006, when he received a $786 bill from Medicare; he is on a fixed income of $830 per month.

“The old system was set up to keep people on unless they were no longer eligible [for reimbursements], in which case they were notified,” Rodgers said. “The new one was designed to cut people off unless they went in manually to prevent it, even if they were continually eligible.”

The California Department of Health Services became aware of the glitch shortly after clients began receiving unexpected Medicare bills, according to department spokesman Michael Bowman.

DHS has already ordered the counties to correct their automated systems, and has provided the Centers for Medicare Services with the names of clients who were accidentally discontinued so their premiums can be repaid, Bowman said.

The Health Plan of San Mateo was able to get roughly 100 of its clients re-enrolled in the reimbursement program by working cooperatively with the San Mateo County Human Services Agency, said Health Plan’s Carolyn Thon. The plan covered members who were dropped by Medicare in the interim.

“It took us awhile to realize the connection” between the CalWIN rollout and clients losing their coverage, Thon said. “Once we recognized what happened, we were able to resolve our members really quickly.”

In the suit, clients are seeking reimbursement for their medical bills as well as an assured fix for the glitch that disenrolled them, according to Rodgers. Although DHS is asking counties to fix the problem, it’s unclear whether the responsibility lies with individual counties or the DHS, according to Bowman.

No court date has been set in the legal proceedings.

This article originally appeared in the San Francisco Examiner.

Written by Beth Winegarner

February 27, 2007 at 10:43 PM

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