Report 2013-119 Recommendation 33 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 #33 To: Health Care Services, Department of

To improve the coordination between its divisions, branches, and units and ensure that it addresses allegations of fraud in a timely manner, Health Care Services should fully implement the investigations division's recommendations shown in Appendix B. If it chooses not to implement a recommendation, it should document sufficiently the reasons for its decision.

Agency Response*

Of the 32 recommendations issued by the Audits & Investigations Division, DHCS has implemented an additional three recommendations (1, 4, and 6). Emergency regulations giving Provider Enrollment Division authority to certify DMC providers and increasing Medical Director responsibilities including medical oversight was approved by Office of Administrative Law on August 17, 2015 and made permanent on February 11, 2016. Recommendation 20 to explore the use of statistical extrapolation was completed but it was determined to be not be feasible to implement

Substance Use Disorders Program, Policy and Fiscal Division (SUDPPFD) is responsible for one remaining recommendation: #25 Partially implemented. Estimated completion date July 2017

  • Response Type†: Annual Follow Up
  • Estimated Completion Date: July 2017
  • Response Date: October 2016

California State Auditor's Assessment of Status: Not Fully Implemented


Agency Response*

Of the 32 recommendations issued by the Audits & Investigations Division, DHCS has fully implemented 25 (recommendations 3, 5, 7 - 20, 22, 23, and 26 - 32), and continues to work toward implementing the remaining recommendations. DHCS continues to aim for full implementation by June 2016.

  • Response Type†: 1-Year
  • Estimated Completion Date: June 2016
  • Response Date: August 2015

California State Auditor's Assessment of Status: Pending

Date of implementation was set for June 2016.


Agency Response*

Update for Appendix B's partially implemented recommendations and implementation dates are as follows:

A. On June 25, 2014, Health Care Services used its emergency regulatory authority to amend Title 22 of the California Code of Regulations to clarify the responsibilities of program providers and other provider personnel. Health Care Services is in the process of aligning program certification standards with the enrollment requirements for the Medi-Cal fee-for-service providers and is in the process of drafting regulatory changes to accomplish this alignment. Health Care Services anticipates implementing the new requirements by mid-year 2015.Estimated completion date is July 2015.

B. Health Care Services stated that its enrollment division assumed responsibility of all program certifications as of January 1, 2014. Health Care Services also stated that the enrollment division will complete its alignment of the program certification process with the Medi-Cal fee-for-service provider enrollment process by mid-year 2015. Estimated completion date is July 2015.

C. Health Care Services stated that currently all program providers are in the PRIMe system. The licensing and certification portion of PRIMe was released on June 12, 2014. PRIMe is not capable of accepting applications for the DUI programs. In addition, data from the non-eligible provider list(s) from the enrollment division is not in PRIMe; this information is stored in a different database— Short Doyle Medi-Cal ADP Remediation Technology 6i. Estimated completion date is June 2016.

  • Response Type†: 6-Month
  • Estimated Completion Date: June 2016
  • Response Date: February 2015

California State Auditor's Assessment of Status: Pending


Agency Response*

A. On June 25, 2014, Health Care Services used its emergency regulatory authority to amend Title 22 of the California Code of Regulations to clarify the responsibilities of program providers and other provider personnel. Health Care Services is in the process of aligning program certification standards with the enrollment requirements for the Medi-Cal fee-for-service providers and is in the process of drafting regulatory changes to accomplish this alignment. Health Care Services anticipates implementing the new requirements by mid-year 2015.

B. Health Care Services stated that its enrollment division assumed responsibility of all program certifications as of January 1, 2014. Health Care Services also stated that the enrollment division will complete its alignment of the program certification process with the Medi-Cal fee-for-service provider enrollment process by mid-year 2015.

C. Health Care Services stated that currently all program providers are in the PRIMe system. The licensing and certification portion of PRIMe was released on June 12, 2014. PRIMe is not capable of accepting applications for the DUI programs. In addition, data from the non-eligible provider list(s) from the enrollment division is not in PRIMe; this information is stored in a different database— Short Doyle Medi-Cal ADP Remediation Technology 6i.

  • Response Type†: 60-Day
  • Estimated Completion Date: June 2016
  • Response Date: October 2014

California State Auditor's Assessment of Status: Pending

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


All Recommendations in 2013-119

†Response Type refers to the interval in which the auditee is providing the State Auditor with their status in implementing recommendations made in an audit report. Auditees must submit a response regarding their progress in implementing recommendations from our reports at three intervals from the release of the report: 60 days, six months, and one year or subsequent to one year.

*Agency responses received after June 2013 are posted verbatim.


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