D.C. rushing to fix problems with AIDS records at clinics

By Sandhya Somashekhar, Debbie Cenziper and Susan Kinzie
Washington Post Staff Writers
Tuesday, March 2, 2010; B04

The District's troubled HIV/AIDS Administration is scrambling to correct dozens of billing and record-keeping deficiencies discovered at Washington area medical clinics that draw federal AIDS funding.

Federal monitors found last summer that some of the programs did not appear to be tracking fundamental information about AIDS patients, such as lab tests, medications and infection levels. Monitors also said in their report that clinics might have paid their bills by improperly tapping federal funds set aside for low-income AIDS patients without insurance.

If the lapses are not corrected, monitors could ask for the federal money back.

The problems come at a time when city leaders are struggling to overhaul the District's $100 million-a-year program for people with AIDS. A Washington Post investigation late last year found that the HIV/AIDS Administration had awarded $25 million to nonprofit groups that delivered substandard care or could not account for any work at all.

D.C. Council member David A. Catania (I-At Large) has held a series of hearings in recent months to address the problems.

"I want to get past these efficiency issues so we can move on to tackle quality-of-care issues," Catania said. "Once we get our administrative house in order, there are any number of things that we are poised to do that are going to have light-year advances in the way we respond to this epidemic."

AIDS advocates say the lapses described by federal monitors have vexed some clinics for years, despite oversight that should have been performed by the HIV/AIDS Administration. A consultant hired by the city had found similar problems at more than 20 AIDS programs in the region in recent years, records show.

"This could be a potentially devastating situation for us," said Patricia Hawkins, a longtime local AIDS advocate. "There's so much volume going through the medical clinics, and for a long time, no one had been adequately monitoring whether clients were actually eligible" for federal assistance.

Last summer's report by the U.S. Health Resources and Services Administration focused on programs that receive money under the federal Ryan White program, which pays for medical care and support services. Monitors visited medical clinics in the District but said problems had also turned up repeatedly in routine inspections across the region.

The Washington area receives about $45 million annually from the program, named for the Indiana teenager who died of the disease in 1990. The HIV/AIDS Administration is responsible for doling out a portion of the grant to AIDS programs in Northern Virginia, suburban Maryland and West Virginia.

According to federal rules, the Ryan White fund is supposed to be a "payer of last resort" for low-income people without insurance. Medical clinics must bill Medicaid, private insurance and other health programs before drawing from the fund, ensuring that it remains a safety net for the destitute. Leftover Ryan White money can be used to pay for critical support services, including case management, emergency housing and counseling.

Federal monitors, however, found that some of the clinics they examined were not tracking patients' income levels or insurance eligibility, leaving little way of knowing whether patients qualified for Ryan White funding.

"Our law is very clear: The Ryan White program is the payer of last resort," Douglas Morgan, who helps oversee the program for the Health Resources and Services Administration, recently told The Post. "My sense is that perhaps it may be easier just to submit a bill to the Ryan White program as opposed to going through a third-party insurer where you have to substantiate billing."

Monitors also described problems with record-keeping and patient care. They said some clinics had not tracked such data as patients' vaccination histories, the presence of infection or stage of the disease, which could be signs of "possible substandard medical treatment."

The Health Resources and Services Administration approved about $3 million over several years so the District could build a data-collection system.

"Obviously, things haven't happened as quickly as they should," Morgan said. "The city is still working on it."

HIV/AIDS Administration officials acknowledged the deficiencies but said they have been working to correct the problems.

"You always want to make sure every provider is vigilant," said HIV/AIDS Administration Director Shannon L. Hader. "From our experience, the vast majority are usually very good. . . . The next part is how to document and where to document to . . . meet all the requirements. That's where we see the biggest opportunity for making sure we improve."

Officials at several local medical clinics said they routinely check for patient eligibility before drawing Ryan White money. They did say, however, that it's often easier and less time-consuming to draw money from the Ryan White program rather than health insurance programs not focused exclusively on AIDS.

"The clinics are all mission-driven and got into the business to serve patients," said Catalina Sol, HIV/AIDS director at La Clinica del Pueblo in Northwest Washington. "We've all had to mature in the world of billing in the health industry that we have, which is very disjointed. It's not as easy as it looks."

Clinic officials said they keep tabs on medications, infection levels and other health information but that documentation might be scattered on different records.

Arlington County Board of Supervisors member Barbara A. Favola (D), past chairman of a regional group that manages AIDS funding in Northern Virginia, said that sometimes staff workers at small clinics aren't trained to track federal dollars in the way government monitors expect but that "it's not necessarily that the dollars are misspent. Sometimes they're not annotated correctly on the various reports."

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