Telecare Corp.’s drug and alcohol program was supposed to be the “cream of the crop,” an important part of the much-heralded Be Well campus in Orange serving as a one-stop shop for mental health and substance abuse services for the poor and vulnerable.

But Telecare ended up quietly closing at the site after the discovery that staffers who did not meet Medi-Cal certification were servicing clients from at least July 2021 to February 2022. Moreover, the San Francisco-based company improperly attempted to bill Medi-Cal for the services, as first reported by the Voice of OC online news site.

Telecare also failed to fully provide services or follow up with hundreds of clients as required by the county contract.

Now, the treatment rooms, bedrooms and even a living room with an outdoor patio once staffed by Telecare have been empty for more than six months amid a massive oversight failure that has triggered a restructuring of Be Well’s entire operation.

A review by the Orange County Health Care Agency dated February 2022 said, “Telecare has continued to allow staff who are not properly credentialed to deliver Medi-Cal covered services and has claimed Medi-Cal reimbursement in reliance of those services. This practice is viewed as fraudulent.”

That review was not initially disclosed to law enforcement, the public or even to the full Board of Supervisors, and only recently came to light in published news reports.

‘Black eye’ for Be Well

Barbara Delgleize, a former Huntington Beach City Council member and early supporter of the Be Well project, said she was not pleased with the way the operation has begun.

“If somebody is not doing the right things or doing the right (qualifications) … that’s not going to work. It’s just going to bring a black eye to Be Well OC,” Delgleize said. “To have a Telecare situation and not have qualified people — yeah, I’m upset.”

Leigh White, an advocate for the unhoused in Fullerton, also said she was disappointed by the oversight failure at the Orange campus.

“Everything relating to mental health requires due diligence and oversight, because these are people’s lives. It’s urgent and you can’t take it for granted,” White said. “If people aren’t credentialed for drug and alcohol rehab, it’s reckless. If they aren’t credentialed and verified, they are just messing with the minds of people who need the most help.”

The county is a large financial supporter of the Be Well operation, contributing $37 million toward the Orange campus and another $136.6 million toward a second complex being built in Irvine.

Telecare runs a total of 10 programs for the county under contracts costing $31 million. At least four of those contracts appear to have been granted after the county was aware of the credentialing problems.

For several months, county health officials allowed the treatment by uncertified Telecare workers in Orange to continue while attempting to bring the contractor under compliance. Training sessions were offered. Deadlines were extended. But it didn’t work, and Telecare, by mutual agreement, shuttered its operations at the Be Well facility in early July 2022.

During its run, Telecare served 1,926 clients in Orange. After it closed, clients were spread around other county services while a replacement provider, Healthright 360, was hired.

New oversight

There also was another major organizational change.

As of Jan. 1, the residential substance abuse program at the Orange campus no longer is directly overseen by the county. Now it is managed by Mind OC, the nonprofit group managing the Be Well operation, according to Marshall Moncrief, chief executive of Mind OC/Be Well.

Be Well had pushed to be in control of the facility before it opened in January 2021 and now has been handed the reins because of the certification debacle.

Moncrief said that, until recently, Be Well had no jurisdiction over most of the facility’s operations, which were overseen by the county. Prior to the change, Moncrief said, Be Well staff was limited to maintaining the facility, such as cleaning the building. Substantive decisions regarding care inside the building were up to the county, Moncrief said. For about two years, the only programming under Be Well’s purview was its mobile response team, which provides aid in the field.

While Be Well staff was shut out, management-wise, there was quiet chatter about improper credentials for Telecare workers even before the county began looking into it. Moncrief said he and other Be Well staff were aware of these concerns, but had their hands tied from intervening.

The new provider, Healthright 360, is expected to arrive in June, staffing two residential programs — one for drug and alcohol treatment, the other for acute mental health crises, he added.

While Telecare was accused in the county review of conducting a “fraudulent practice,” Medi-Cal and law enforcement officials as well as the full county Board of Supervisors were not notified.

Supervisor Katrina Foley said she understood why she was not copied on the review, but would have liked to have been notified of the compliance problems when it came time to later terminate the contract.

Wrongdoing overstated

Dr. Veronica Kelley, Orange County’s chief of mental health and recovery services, said in an interview that the review overstated the wrongdoing.

While Telecare submitted the bills for uncertified services to Medi-Cal, the county interceded and covered the $389,000 in costs. No Medi-Cal money — which is basically funded by federal and state taxes — was spent on the services, according to Kelley. The county also recouped nearly $400,000 from Telecare, said the review.

Kelley insisted that Telecare employees did not intend to commit fraud, which is a necessary component for criminal charges.

“These were people who were trying to do their best during the pandemic. That’s not fraud,” she said. “(The review) should not have said ‘fraud.’ Was it a violation? Was it shoddy administration on the part of the provider? Yes.”

Kelley noted a county investigation ultimately concluded there was no evidence of fraud.

Telecare spokesperson Daphne Phillips also stressed the belief that no fraud was committed, and pointed to the firm’s lengthy history of success.

“Telecare for 55 years has had overwhelming success with an extremely complex population,” Phillips said. “We have survived and thrived by providing excellence and we have many contracts throughout California that are over 25 years.”

Pandemic blamed

So what went wrong?

Kelley blamed the COVID-19 pandemic.

“I (had) a 30% vacancy rate, we were down (county) staff. So, unfortunately, all of those things kind of fell,” Kelley said. “When we came back on, the pandemic had kind of subsided a little bit, we were back in helping, and we saw this is a problem.”

She said 16 Telecare staffers had credentialing problems; in fact, two were never certified or registered to begin with.

According to the review, “While some of the staff at Telecare Be Well did complete the credentialing process, most did not.”

Kelley explained the county’s physical presence at the facility was limited.

“We had some difficulties being on-site at all times to monitor and there was some confusion as well because of how we set it up,” Kelley added. “Mind OC was here and Mind OC is better situated to see and help our providers, but they had no legal ability to do that.”

County role

In the end, it was the county’s job to oversee the Telecare contract and make sure its employees had all the proper certifications, including the training required by Medi-Cal.

“Many of their folks did not complete the training,” Kelley said. “We could not keep up with getting all of the staff credentialed and onboarded before they started providing services.”

Kelley explained that amid the “discrepancies,” the county initiated a corrective action plan to resolve the Telecare credentialing issue. But the remediation ultimately proved unfruitful in bringing Telecare into compliance. The county review labeled Telecare as “non-responsive.”

The county review said Telecare received multiple chances to make sure its workers were properly certified. Telecare was first given a deadline of July 2021, which was extended to August 31, 2021. After failing to meet that deadline, it was again extended to September 30, 2021.

Despite the missed deadlines, it wasn’t until March 2022 that the county started reducing the number of patients admitted to Telecare-staffed programs at Be Well.

The county review also found Telecare failed to provide the minimum five hours of service per week to each beneficiary and failed to document those services altogether.

The review attributed the problems to Telecare’s “poor reporting, communication, follow through and cooperation.”

Telecare spokesperson Phillips said the company had taken on a large endeavor in quick order in the middle of the pandemic. She called it a learning experience for the firm.

Previous Telecare problems

This is not the first time Telecare has been called out in Orange County.

The company was accused in 2018 of not providing proper services to homeless people placed under its care by the county at an Anaheim motel.

The next year, Telecare was under fire from the county for a mental health residential program in Orange.

A Jan. 9, 2019, letter to Telecare from Health Care Agency officials cited a “general lack of structure and programming at the facility.” That lack of oversight resulted in boredom, an increase in drug use at the facility, and clients leaving the site without permission.

In December 2018, one resident sustained a dog bite to the nose and another resident attempted suicide using a bottle he retrieved from outside the facility.

County officials also observed a general lack of attention to the residents from the program director and staff.

Worse still, two residents complained to the county that they were raped and sexually assault by a staff member, the letter said. Additionally, a female client was asked to disrobe by a male staff member who put her clothes into a bedbug oven, prompting the county to require that the facility tighten its policy on the use of the oven.

County still optimistic

Despite the problems with Telecare, county health officials still have high hopes for the 60,000-square-foot Be Well campus in Orange — viewed as an especially important resource for first responders to take those suffering from addiction or mental health crises.

One of the features once operated by Telecare, which has remained open, is the 12-bed “sobering station,” where intoxicated people can be taken.

Related links

Be Well OC mental and behavioral health services hub touted as a place for ‘hope’ at groundbreaking ceremony
Be Well OC campus set to open, marking hoped-for turning point in mental and behavioral health services
Local, state officials spotlight Orange County mental health services
OC Health Care agency to get new $78 million Irvine headquarters
Police reform: In Huntington Beach, non-criminal mental emergencies go to Be Well OC

The Be Well campus also provides a crisis stabilization unit that could serve about 15 adults a day who suffer acute mental health emergencies. Be Well data showed the unit was 73% full as of late February.

As with other crisis stabilization centers, stays at the Be Well OC units are limited to 24 hours or less. During that time, care providers can conduct psychiatric evaluations, dispense medications, make referrals for further care, and transfer people to inpatient treatment.

With the build-out of a second Be Well facility in Irvine underway, Moncrief said the organization’s newfound control over its operation will increase the quality of its services, bring a renewed sense of transparency and help prevent another oversight failure.

“We have to have operational and clinical control if we’re going to ensure that we adhere to the commitments we made as a community,” Moncrief said. “We know it’s not going to be perfect, but we need to report that, too — and that’s what you’re going to see moving forward.”