ORANGE, Calif. (January 24, 2014) — CalOptima received notification from the Centers for Medicare & Medicaid Services (CMS) regarding the final outcome of the first comprehensive audit of OneCare, which was conducted in November 2013. The scope of the audit included CalOptima, our health networks and our pharmacy benefits manager.

Based on the audit, CMS has directed that CalOptima suspend marketing and enrollment into OneCare effective today. This action does not affect the services CalOptima provides to existing OneCare members, although it does delay the launch of our Cal MediConnect plan. CMS plans to return to conduct a follow-up audit within the next six months.

A recent scathing federal audit of Orange County’s, once showcase, provider of medical care for low-income residents found major problems with the agencies management of those services.

Details on the history of CalOPTIMA’s struggles here. All of this occurred on the heels of the Supervisor’s granting Supervisor Janet Nguyen unfettered control over the agency, as well as supporting her proposal to restructure the governing board to give hospitals more influence and control. Days after the action, led by Nguyen, local health care providers participating in CalOPTIMA held a major fundraising event to support Nguyen. The Voice of OC reports that California’s Department of Health Care Services will begin its own special review Monday of potential problems at CalOptima,

When it came time last year to determine how much hospitals would be reimbursed by the County for medical services, the Board of Supervisors dismissed the advice of County staff and instead voted to give hospitals more, even reading from the lobbyist recommendations (starting at 15:15 in the video below) to help formulate a motion during the meeting.

Thia is just another example of how the politicians on the Orange County Board of Supervisors have awarded hundreds millions of dollars in contracts to campaign contributors, including companies convicted of fraud, and allowed special interest lobbyists to write laws to benefit themselves instead of Orange County residents.