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District Attorney recommending the Board:
1) Approve and authorize the Chair to execute Agreement 5689 with Coding Continuum, Inc. in the amount of $130,000 with an agreement term effective for up to one year upon execution, to provide expert medical billing audit services in reference to a Workers’ Compensation Fraud case; and
2) Make findings in accordance with County Ordinance 3.13.030 that it is appropriate to contract with Coding Continuum, Inc. for services provided under Agreement 5689 because (B) "Specialty skills and qualifications not expressly identified in classifications are involved in the performance of the work".
FUNDING: California Department of Insurance.
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DISCUSSION / BACKGROUND
Contract 5689 with CCI will provide expert medical billing audit services required for an on-going Workers’ Compensation Fraud case currently assigned to the District Attorney’s Office. Services include the validation audit and forensic review of a total 1,939 claim lines at a rate of $64.47 per line. The Consultant’s work product will consist of detailed documentation memorializing audit findings and results of validation audit findings including line-by-line comparison of the Consultant and prior expert audit results, with additional comments.
Total estimated amount for the project is $125,007.33. The Consultant does not anticipate exceeding the estimated amount for Scope of Works services, however any change in scope or request for additional work will be billed in accordance with the Consultant’s billing rates as identified per the agreement. Total contract not-to-exceed value is $130,000. All contractor costs will be directly funded by the District Attorney’s Workers’ Compensation Grant award as administered by the California Department of Insurance.
Additionally, in accordance with chapter 3.13, Section 3.13.030, the Board is being asked to make findings that it is appropriate to contract out for the necessary services as the work is not expressly identified in County job classifications and requires specialized skill. This case involves a specific and unique area of medical provider fraud law, where very few experts are qualified to complete the in-depth audit requirement; CCI being one of them who has willingly agreed to accept the task.
ALTERNATIVES
Should the Board opt not to approve and execute contract 5689 with CCI, the District Attorney’s Office will not be able to proceed with procuring expert auditing services as required for the case at hand.
PRIOR BOARD ACTION
Legistar 20-1331, October 20, 2020 - Board approved the acceptance of the CDI Workers’ Compensation Fraud (WC) Program for the July 1, 2020 - June 30, 2021 grant period
OTHER DEPARTMENT / AGENCY INVOLVEMENT
N/A
CAO RECOMMENDATION / COMMENTS
Approve as recommended.
FINANCIAL IMPACT
There is no change to Net County Cost associated with the execution of CCI contract 5689. Services will be completely funded by the Workers’ Compensation Grant. Appropriations for the services are included in the District Attorney’s FY 2020-2021 budget.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Upon approval, Clerk of the Board to obtain the Board Chair’s signature on two copies of Agreement 5689 with CCI and return one certified copy to the Chief Administrative Office, Central Fiscal Unit, Attention: Justene Cline.
STRATEGIC PLAN COMPONENT
Public Safety
CONTACT
Vern Pierson