Complaint Investigation Report

Administrator stated the health clinic sent the prescription to the pharmacy but not to the facility, the facility didn’t know there was an order. The prescription was denied twice by the insurance company because C1 isn't diabetic. The prescription was written on 5/25/2022 according to Shasta Community Health Center. The facility received it on 9/14/2022. The pharmacy said they received the prescription sometime in June 2022. On 6/08/2022 the clinic called the facility and asked if they were testing C1’s blood sugar. Staff told the Shasta Community Health nurse that the facility was unaware that they were supposed to be testing C1’s blood sugar. Staff told them they need an order and they said they would call the facility back. The health clinic never called the facility back. The health clinic sent the prescription to the pharmacy but the facility was not aware. The pharmacy tried to run the prescription through both insurances, and it was denied due to lack of diagnosis. Even though the insurance denied coverage of the prescription, the licensee bought testing supplies with their own money once the order was received from the pharmacy on 9/14/2022, and staff started testing C1’s blood sugar daily thereafter.

It was determined that C1’s physician did prescribe daily blood sugar testing on May 25, 2022 but the facility was not notified of this by the health clinic. The facility received the prescription from the health clinic in September 2022, the prescription was denied twice by C1’s insurance company. As a result, the licensee used their own money to purchase the blood sugar test kit and immediately started testing C1’s blood sugar each day. This allegation is unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was emailed to facility license Evelyn Williams. No deficiency cited.