Report 2013-119 Recommendation 29 Responses

Report 2013-119: California Department of Health Care Services: Its Failure to Properly Administer the Drug Medi-Cal Treatment Program Created Opportunities for Fraud (Release Date: August 2014)

Recommendation #29 To: Health Care Services, Department of

To ensure that it appropriately and consistently reviews provider applications and conducts site visits, Health Care Services should retain the documentation, such as checklists, that it uses to support its certification decisions in accordance with its retention policy.

6-Month Agency Response

DHCS currently retains, in accordance with its retention policy, the documentation that it uses to support certification decisions. The PED Document Management System (DMS) is a computer program developed in 2001 and was designed for the purpose of maintaining a complete electronic record of all documents received by PED. All applicant-submitted documents, PED working papers, correspondence to and from providers, Special Claims Review action letters, A&I findings, and other miscellaneous documents are scanned into DMS to maintain a permanent record. Additionally, PETS and PETSII are programs that maintain dates, notes, and all action items made on an application. All application review requires extensive usage of at least two of these programs. Any documents associated with approved applications for DMC continued certification or new certification will also be maintained in DMS.

  • Completion Date: July 2013
  • Response Date: February 2015

California State Auditor's Assessment of 6-Month Status: Fully Implemented

Since the time of our audit, Health Care Services has taken over the certification of Drug Medi-Cal providers and it retains those applications electronically. Previously, these applications were stored in hardcopy and Health Care Services was unable to locate the applications for our audit. If Health Care Services continues to use its Document Management System to store these records electronically, it would address this recommendation.

60-Day Agency Response

No update.

  • Completion Date: July 2013
  • Response Date: October 2014

California State Auditor's Assessment of 60-Day Status: No Action Taken

Although Health Care Services indicated that it has fully implemented this recommendation, it has not provided any information to indicate that it has taken any action on this recommendation.

All Recommendations in 2013-119

Agency responses received are posted verbatim.