Report 2013-119 Recommendation 21 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 #21 To: Health Care Services, Department of

To prevent the certification of ineligible providers, Health Care Services should immediately identify and perform an immediate recertification of providers that signed the Compliance Agreement to ensure that these providers are currently meeting all program requirements.

Annual Follow-Up Agency Response From August 2017

DHCS completed the continued certification efforts for all providers that were identified as billing or could bill in FY 2012-13.

Status and Implementation Date: Fully Implemented, 12/15/2016.

  • Completion Date: December 2016

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

Although Health Care Services asserts that it fully implemented this recommendation, it did not provide any documentation to support its assertion.

  • Auditee did not substantiate its claim of full implementation

Annual Follow-Up Agency Response From October 2016

DHCS is 95.6% completed with the continued certification efforts for all providers that were identified as billing or could bill in the fiscal year 2012-13. DHCS expects to finalize the continued certification efforts in January 2017 or sooner.

  • Estimated Completion Date: January 2017

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented


1-Year Agency Response

DHCS has already implemented a recertification process that will capture all providers that signed the Compliance Agreement. In July of 2013, DHCS began a recertification process of all DMC providers that billed or could bill for services during fiscal year 2012-13, regardless of their original enrollment method. The continued certification process is required of all DMC providers; therefore, providers that signed the Compliance Agreement are required to submit a current and complete application package, including all attachments and disclosure information. They will also be subject to an onsite inspection.

  • Estimated Completion Date: March 2016
  • Response Date: August 2015

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

Date of implementation is set for March 2016.


6-Month Agency Response

DHCS has already implemented a recertification process that will capture all providers that signed the Compliance Agreement. In July of 2013, the department began a recertification process of all DMC providers that billed or could bill for services during fiscal year 2012-2013, regardless of their original enrollment method. The current continued certification process is required of all DMC providers therefore providers that signed the Compliance Agreement are required to submit a current and complete application package, including all attachments and disclosure information. They will also be subject to an onsite inspection.

  • Estimated Completion Date: November 2015
  • Response Date: February 2015

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


60-Day Agency Response

No update.

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

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

Based on its response, the department has not yet implemented this recommendation. In addition, 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.


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