Ron Kuerbitz, CEO, Reaffirms agilon health’s Commitment to Compliance and Integrity as a Leader in Care Delivery.

//Ron Kuerbitz, CEO, Reaffirms agilon health’s Commitment to Compliance and Integrity as a Leader in Care Delivery.

Ron Kuerbitz, CEO, Reaffirms agilon health’s Commitment to Compliance and Integrity as a Leader in Care Delivery.

I wrote to you this past summer as we developed and executed remediation plans to address compliance issues that we identified in our historical PPMC operations.  From time to time we get questions regarding our progress on the remediation and about the compliance issues from our legacy California operations.  As the year comes to a close, I would like to reaffirm that the facts we disclosed were accurate and no new information has come to our attention; our view has not changed.

As part of our work to centralize and standardize our claims payment operations into a single, high-functioning department, we identified practices in the claims audit processes of our legacy California operations that required remediation.  We immediately, and without hesitation, disclosed these claims issues to the California Department of Managed Health Care (DMHC) and our plan partners in February 2018 and engaged outside experts to conduct a thorough investigation.  This voluntary self-disclosure reflects our singular commitment to compliance and our integrity as leaders in care delivery.

The investigation confirmed improprieties in the claims audit process but did not identify systemic errors or processes that would have impacted patient care. Following a complete remediation of those processes, we have since passed audits from all our health plan partners as well as DMHC. Our remediation plan focused on three key initiatives:

  1. The appointment of highly experienced new leadership to oversee the claims, customer service and utilization management functions;
  2. The implementation of new claims processing and operating system and enhanced management processes and procedures;
  3. The dismissal of all employees who took part in the improper activities.

In short, we identified potential wrongdoing, we disclosed it, we investigated further to ensure the wellbeing of patients under our care was not impacted, and we swiftly corrected the issues.

We continue to work closely with our health plan partners to improve the care for patients in California and across the nation and we are excited about the innovative steps we are taking to bring new levels of quality and efficiency to our physician partners, health plan collaborators, and patients in 2019.  I look forward to being able to share more details on those plans as the new year unfolds.

 

2018-12-20T17:31:55+00:00 December 18th, 2018|