A lawsuit claiming Community Health has misused $1 billion in tax funding reportedly misstates the funding rules for Medi-Cal reimbursements, a new report found.
Data from Hospital Care Access and Information shows that Clovis Community Hospital’s share of Medi-Cal revenue has grown faster than any other hospital in the region over the last five years.
The backstory: Last week two nonprofits, Cultiva La Salud and Fresno Building Healthy Communities, filed a lawsuit Against Community Health System claiming the healthcare provider misused money that comes from two funds: the Hospital Quality Assurance Fee program and the Disproportionate Share Hospital program.
- Healthcare providers are required to use those funds to support Medi-Cal patients.
- The nonprofits claim in the lawsuit that Community used the funding to enhance Clovis Community Medical Center instead of downtown Fresno’s Community Regional Medical Center, which serves more Medi-Cal patients.
- Community responded to the lawsuit by calling it baseless, adding that the claims are inaccurate.
The big picture: According to a report from GV Wire, 57 percent of the revenue generated at Clovis Community comes from Medi-Cal and Medicare.
- The Disproportionate Share Hospital program provides better reimbursement rates to hospitals when they serve a disproportionate amount of Medi-Cal patients.
- The Hospital Fee program gives hospitals the opportunity to pay more to draw on federal matching dollars.
By the numbers: Data shows that Community Regional Medical Center had 49 percent of outpatient discharges from Medi-Cal patients in 2023, with around 52 percent of inpatient days from Medi-Cal patients.
- Statewide, the average Medi-Cal funding of patient revenue in 2023 was 21.7 percent. That number was 39.15 percent at Community Regional Medical Center.
- Clovis Community had 21.99 percent of its patients on Medi-Cal last year, an increase from 14.56 percent in 2019.
- The closest hospital in the region in terms of growth in that same period is Kaweah Delta Medical Center at 4 percentage points.
