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.
All the disallowances resulting from PSPP disallowances for these three counties were recovered.
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.
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.
Date of implementation is set for September 2015.
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.
Health Care Services indicated that it has not taken any action and will not do so until April 2015.
Agency responses received are posted verbatim.