Report 2013-119 Recommendation 6 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 #6 To: Health Care Services, Department of

To ensure that the providers receive reimbursement for only valid services, Health Care Services should immediately direct its fiscal management and accountability branch to work with Fresno, Los Angeles, and Sacramento counties to recover the specific overpayments we identified during our visits.

Annual Follow-Up Agency Response From October 2016

All the disallowances resulting from PSPP disallowances for these three counties were recovered.

  • Completion Date: February 2016

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

Health Care Services provided a county-level summary of the payments it recouped from counties/providers that had been overpaid for Drug Medi-Cal services or paid for inappropriate services.

1-Year Agency Response

Los Angeles, Fresno and Sacramento Counties and one direct provider in Los Angeles were issued notices of recovery for overpayments resulting from the CSA Audit. FMAB received copies of the reports of overpayment and is preparing invoices for the disallowed units identified in the notices.

  • Estimated Completion Date: September 2015
  • Response Date: August 2015

California State Auditor's Assessment of 1-Year Status: Pending

Date of implementation is set for September 2015.

6-Month Agency Response

DHCS received all source documents from a PRA of CSA's audit findings of Los Angeles, Sacramento and Fresno. Los Angeles County and one direct provider in Los Angeles were issued a notice of recovery for overpayments on January 2, 2015. DHCS anticipates both Fresno and Sacramento County notices will be completed by February 16, 2015.

  • Estimated Completion Date: February 16, 2015
  • Response Date: February 2015

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

60-Day Agency Response

No update.

  • Estimated Completion Date: April 2015
  • Response Date: October 2014

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

Health Care Services indicated that it has not taken any action and will not do so until April 2015.

All Recommendations in 2013-119

Agency responses received are posted verbatim.