State deals blow to Santa Rosa birthing center
Founder of women's clinic can't take Medi-Cal patients because of improper paperwork
Certified nurse-midwife Jennifer Nydam, top right, weighs 7-week-old Addison Gerolaga while parents Sylvia Case, left, and Michael Gerolaga watch at the Women's Health & Birth Center on Summerfield Road in Santa Rosa last week.
CRISTA JEREMIASON / The Press DemocratPublished: Wednesday, July 28, 2010 at 3:00 a.m.
Last Modified: Wednesday, July 28, 2010 at 10:45 p.m.
Sylvia Case, 27, visited the Women's Health & Birth Center in Santa Rosa a week ago to get an intrauterine contraceptive, or IUD. But what she encountered instead was a flier referring her to a county clinic.
As of July 19, the center's founder, Rosanne Gephart, is no longer able to use her Medi-Cal provider number to bill for services that she and others provide. Gephart is being penalized by the California Department of Health Care Services for improper documentation.
The state's action is a severe blow to the center, where 85 percent of its patients are covered by the state's health program for those who cannot afford medical care. Since last week, Gephart said she's been forced to lay off four employees and put two others on extended vacation.
“We will be open, but we won't be taking Medi-Cal patients,” Gephart said. “But that's unspeakable. Only rich people get to have nice births?”
State officials said that Gephart was improperly using her Medi-Cal provider number to bill for the services of other medical professionals at the center. That triggered an audit, and state officials said Gephart failed to take the necessary steps to remedy the situation.
The loss of Medi-Cal reimbursements is destabilizing the center's funding and its very existence could be threatened, Gephart said. She said she's referring some expecting moms to other providers.
For women who are committed to a natural birth, free of drug inducement and other medical interventions, the prospect of having to go to a hospital can be devastating.
“It's horrible,” said Brenda Caro, 25, of Santa Rosa. “I'd have to go to another provider. I'd have to have a hospital birth.”
Caro, who is covered by Medi-Cal, is expecting a girl and is due Aug. 31. She said she was “indifferent” about where to have her baby until she started reading about the controversies surrounding births aided by medical intervention.
Caro said she wants to do everything she can to “avoid having a C-section.” With Gephart currently unable to bill for Medi-Cal, Caro said she's worried about what will happen to her.
“If feels like my ability to make that decision has been taken away,” she said.
The trouble for the birth center began last spring, when Medi-Cal investigators noticed a sharp increase in services billed under Gephart's Medi-Cal number, said Raul Ramirez, chief of the Department of Health Care Services' provider enrollment division.
The audit team sampled Gephart's bills sent to the state in 2009 between April 1 and Sept. 30 to reimburse for services to Medi-Cal patients. They found that the state paid her close to $40,000 for 726 home visits.
Gephart said there was nothing deceptive about that billing. The center had partnered with local health care providers to deliver breast-feeding assistance to new moms, hiring six nurses to do home visits.
Gephart said she did not know that she wasn't supposed to bill for the services using her provider number. She added that in the past, two billing services she had hired instructed her to bill in this way.
“Nobody told me I couldn't do it that way,” Gephart said.
But the state said there were other billing problems.
The center billed for services performed at home visits that weren't prescribed as necessary by clinicians, a step required by medical charting standards, Ramirez said.
Also, auditors found that Gephart's medical charts showed that medical assistants were performing tasks only physicians or certified midwifes were licensed to do, Ramirez said.
“Home visits were conducted by registered nurses but billed as services by nurse-midwife at a higher rate,” Ramirez said. “You had (registered nurses) performing services during those home visits that they weren't authorized to perform.”
Gephart started the birth center in 1991 at its current location on Summerfield Road as a haven for natural births, where the age-old practice of midwifery is emphasized, rather than taking a back seat to modern medicine.
When she first opened the center, Gephart was the only midwife, aided by a single nurse and receptionist. The center has grown to 27 employees, including four full-time certified nurse-midwives, six nurses, three educators, two billers, two receptionists and one administrative director.
The state's action threatens the institution's financial health, Gephart said.
Ruth Rees, 34, of Sebastopol tears up when she compares her first birthing experience to her second. Her 15-year-old daughter, Morgynne, was born in a hospital in Fontana, and her second, Indigo, was born at the birth center last October.
Rees said that at the hospital she was given demerol through an IV, even though she requested no drugs. She also received an episiotomy.
“When I got to have my baby here, with no interventions, it was beautiful,” she said, adding that during her first birth, “I don't remember the sensation of birthing because I was high on some medication.”
After faxing a summary of their audit findings, state auditors held an exit conference with Gephart on Feb. 18, Ramirez said. Gephart had 35 days to submit an application for a group Medi-Cal number, Ramirez said. If that application was approved, Gephart would have been able to move forward with the assumption that she'd correct the other billing errors, Ramirez said.
But Ramirez said Gephart didn't mail an application to the department until May 2 and she also failed to submit a tax identification number, a business license and proof of worker's compensation insurance that would be used under that new group provider number.
The form also asks applicants if they participate in a Medi-Cal program, and if so to provide that program's Medi-Cal number. Gephart should have included the birth center's name and its Medi-Cal provider number on the forms. But she didn't, and that omission is what may keep the birth center from serving Medi-Cal patients.
"Ultimately the fatal flaw is that she failed to disclose on the application that she owned the birthing center," Ramirez said.
Gephart said she didn't understand that line in the form. State officials said that applicants are required to voluntarily disclose that information and, by state and federal law, auditors can't tell someone to submit that information because it's a method to detect fraud, Ramirez said.
“It really helps us determine whether there's any conflict of interest between the businesses they own and the businesses they operate," Ramirez said.
Failure to disclose ownership results in the automatic denial of that application, deactivation of her enrollment number and a three-year ban from her applying to re-enroll, Ramirez said.
Gephart said she tried to put through the correct paperwork but the forms were confusing to the young staff member who handled the application.
Ramirez said Gephart's patients won't have to find another place to deliver their babies if she acts quickly to bring on other certified nurse-midwives to care for them.
“We recognize the potential issues that we have here and the issue it presents for the women,” expecting to give birth soon, Ramirez said.
Gephart could hire a midwife who already has a Medi-Cal number, which Gephart said is rare. Or, Ramirez said, other certified nurse-midwives could apply for an individual or group Medi-Cal number to serve patients at the clinic.
“This is probably a case where from the date we receive an application, we would rush it,” he added. “It only takes our staff two to three days to get (the application) through the system.”
But independent midwives are hard to find, and getting hospital clearance, required in case a patient suffers complications during labor, could take weeks, Gephart said.
“There are no midwives,” Gephart said. “You find me an independent, and if you do find her, she's going to want $50 an hour. My rate is $34. We are unique in our work; also unique in the fact that the birth center doesn't make very much.”
“Why would I hire a new midwife when I have five who need work and are the sole supporters of their family?” Gephart said. “We're going to be able to keep five of our employees. We're trying, we're willing to do whatever it is they want us to do.”
Gephart said she has an attorney helping her appeal the decision to reject her application for a group Medi-Cal number.
You can reach Staff Writers Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com and Julie Johnson at 521-5220 or julie.johnson @pressdemocrat.com.
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