Upon approval, a total of $51,300 will be paid to providers from Hospital Enterprise Fund I and $21,424 will be paid from Federal Substance Abuse Primary Treatment Block Grant Youth Set-Aside monies.
Theresa Kailikole, D.P.M., provided podiatry care to patients at CCRMC pursuant to Contract #26-924-15 (as amended by Contract Amendment #26-924-16) for the period from June 1, 2013 through May 31, 2015. Services were requested and provided beyond the payment limit of the contract. At the end of the contract period, charges of $298,300 had been incurred, of which $292,000 had been paid pursuant to the contract limits. The additional services were provided in May of 2015. Dr. Kailikole has not been paid for the additional services provided above the contract limit, which amount to $6,300.
Community Health for Asian Americans provided alcohol and drug abuse prevention and treatment services in West Contra Costa County pursuant to Contract #74-054-18 for the period January 1, 2015 through June 30, 2015. Services were requested and provided beyond the payment limit of the contract. At the end of the contract period, charges of $56,204 had been incurred, of which $34,780 had been paid pursuant to the contract limits. The additional services were provided in May of 2015. Community Health for Asian Americans has not been paid for the additional services provided above the contract limits, which amount to $21,424.
Health Care Interpreter Network provided consulting and technical assistance on the Health Care Interpreter Network System, including qualified foreign language interpretation services via video conferencing, pursuant to Contact #23-457-6 (as amended by Contract Amendments #23-457-7 and #23-457-8) during the period July 1, 2013 through June 30, 2015. Services were requested and provided beyond the payment limit of the contract. At the end of the contract period, charges of $218,086 had been incurred, of which $173,086 had been paid pursuant to the contract limits. The additional services were provided in April of 2015. The service provider has not been paid for the additional services provided above the contract limit, which amount to $45,000.
All of the excess services were rendered before the Department was aware that the contract limits had been reached. Theresa Kailikole, a Podiatrist, works at Podiatric clinics at CCRMC and Health Centers. Her contract expired on May 31, 2015. However, the number of cases assigned to Dr. Kailikole exceeded Department caseload projections. Dr. Kailikole, billed $6,300 more than the contract annual payment limit for the last month of the contract period. With regard to the contract with Health Care Interpreter’s Network, additional funds are needed to pay the last quarter invoice, dated July 19, 2015, for purchase of services from Health Care Interpreter Network during the last half of 2014/2015 fiscal year as utilization of the Health Care Interpreter Network unexpectedly exceeded projections and contract limits. Also, because invoicing takes place following the close of the quarter, this shortfall was not noticed in a timely manner. In order to prevent this from happening again, the Division will put into place measures to closely monitor expenses as they occur. Community Health for Asian Americans Contract #74-054 expired on June 30, 2015. On August 12, 2015, Alcohol and Other Drugs Services was notified by the contractor that the demand for treatment and prevention services was higher than anticipated and the payment limit had been exhausted effective as of May 1, 2015.
Because the contract limits have been reached, the Department cannot pay these providers under the contracts for the additional services they rendered. The providers are nonetheless entitled to payment for the reasonable value of their services under the equitable relief theory of quantum meruit. That theory provides that where a person has been asked to provide services without a valid contract, and the provider does so to the benefit of the recipient, the provider is entitled to recover the reasonable value of those services. Because the Health Services Department requested the additional services and the contractors provided the services in good faith, with the full expectation and understanding that they would receive payment for those services, the contractors have a right to claim the reasonable value of the services they provided above the contract limits. As such, the Department recommends that the Board authorize the Auditor-Controller to issue a one-time payment to each contractor in the amounts listed above.
The Department will make every effort to ensure that this situation does not occur in the future. The Health Services Finance Division plans to begin monitoring physician workloads. The Behavioral Health Services Division will put measures into place to track expenses as they occur. Alcohol and Other Drug Services will make every effort to monitor Contractors services closely in the future.
The service providers will not be paid for services rendered to the Health Services Department.