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    HomeGovernmentSanta Barbara County Settles Medi-Cal Billing Case

    Santa Barbara County Settles Medi-Cal Billing Case

    By Suzanne Grimmesey, MFT
    Santa Barbara County Department of Behavioral Wellness

    Santa Barbara County announced a settlement with the United States Department of Justice for reimbursement of Specialty Mental Health Services through California’s Medi-Cal program. Under the settlement agreement, the County will pay $28 million to resolve federal litigation in which a former Santa Barbara County Behavioral Wellness Department employee Judith Zissa claimed that the County made “false claims” for Medi-Cal reimbursement from 2008 to 2018, a 10-year period.

    Ms. Zissa alleged the County failed to complete treatment plans for Medi-Cal clients prior to providing services; submitted claims for medication support without required client interaction; and billed for non-reimbursable inmate mental health services. She also alleged she was fired in retaliation for reporting these issues.

    The settlement, approved by the County Board of Supervisors, means the County will avoid a potentially lengthy and expensive trial defending itself. The settlement was approved by the Department of Justice. The claims resolved by the settlement are allegations only and there has been no determination of liability.

    “While the County does not concur with the tenor of the allegations made, it’s true that documentation requirements were not met in all instances,” said Assistant County Executive Officer Terri Maus-Nisich.

    Antonette Navarro, Director of the Santa Barbara County Behavioral Wellness Department, who took over as Director in December 2021, added, “We want the community to know that professional and proper treatment was provided to all of our clients, who are those most in need of mental health services in our community, including those suffering from extreme mental health challenges. While some documentation requirements were not met, the treatment provided met all professional medical standards.

    Behavioral Wellness Numbers

    The County’s Behavioral Wellness Department annually provides mental health services to approximately 7,500 County residents who suffer from serious emotional disorders and moderate to severe mental illness and also serves approximately 3,000 County residents in the Drug Medi-Cal Organized Delivery System. The Department’s current operating budget is approximately $164 million.

    Behavioral Wellness operates 22 clinics and manages 58 programs that provide an array of behavioral health services to its clients, including children struggling with serious emotional disorders, individuals experiencing psychiatric crises, troubled youth transitioning from juvenile hall into adulthood, and individuals battling substance use disorders, including severe opioid addiction. Behavioral Wellness is invested in the overall well-being of its clients.

    Through its diversified team and programs, Behavioral Wellness provides services on an inpatient, outpatient, and crisis basis to underserved populations. Behavioral Wellness’ system of care is strengthened by its partnerships with community-based organizations, which are under contract with the County to assist in providing Specialty Mental Health Services to County residents. Funding comes from local, state and federal sources, including Medi-Cal (Medicaid), Medicare, the State Mental Health Services Act and 1991 Realignment, various grants, and the County’s General Fund.

    Navarro noted, “We have a remarkably dedicated and talented clinical staff made up of psychiatrists, psychologists, social workers, clinicians, licensed professional health care workers, peer services specialists, and other key staff. These individuals, along with community providers, have a heart for helping those most in need in our community,” she added.

    Settlement Impact on County Budget

    The County will fund the settlement using litigation reserves. The settlement will not impact the County’s operating budget. “No Behavioral Wellness or other County operations will see a funding reduction related to this settlement,” said Maus-Nisich.

    Behavioral Wellness Quality Control to be Restructured

    At a department and County level, new systems and staff are being put into place to ensure that these types of issues aren’t repeated. Behavioral Wellness is adding staff to provide enhanced oversight of quality control and the contract monitoring process. Behavioral Wellness will also be transitioning to a new electronic health record system over the next year which is aligned with the State of California’s Medi-Cal system that will provide improved coordination of client records. The Auditor-Controller will evaluate internal controls of the billing processes within the departments that receive Medi-Cal funding.

    Additionally, the Board of Supervisors recently established a Compliance and Accountability function in the County Executive Office with investigative and enforcement responsibilities as well as oversight of policies and programs aimed at ensuring transparent and accountable County operations. The County Compliance and Accountability position will be assessing and monitoring the remediation efforts of all County departments in response to audit findings, including assisting with ensuring internal controls are implemented to support ongoing compliance.



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