Recurring Findings

Health Care: Recurring Significant Internal Control Deficiencies
Federal Program Issue First Year Reported
Department's Assertion Page Number
Medical Assistance Program Health Care Services lacks sufficient internal controls to obtain and track the enrollment presumptive eligibility identification numbers issued to prevent unauthorized use of identification numbers. Health Care Services does not perform procedures to authenticate the existence of the recipient, prevent duplicate issuances, and reconcile the presumptive eligibility numbers with the recipient enrollment listing filed during the claims adjudication process. 2005-06
Health Care Services lacks the necessary resources needed to develop and implement automated systems to address this finding. However, Health Care Services believes that the Patient Protection and Affordable Care Act (PPACA) of 2010 provides an ideal opportunity to implement a solution to this problem as we implement the requirements of federal health care reform. 139
Medical Assistance Program Health Care Services does not ensure that drug utilization data are provided to drug manufactures/labelers on a timely basis. 2006-07
Health Care Services has modified the Rebate Accounting Information System (RAIS) to allow the invoicing process to be more efficient and require less manual review, thus allowing for the timely mailing of invoices. However, recent events (specifically state employee furloughs and data arriving late to Health Care Services) have impacted Health Care Services' ability to mail the utilization reports timely. 129
Medical Assistance Program Health Care Services lacks sufficient internal controls to ensure provider claims forms are properly signed by providers. One out of 25 provider claim forms could not be located. 2008-09
Social Services is moving forward with a new Case Management Information and Payroll System to enhance controls related to the Personal Care Services Program. 131
© 2013, California State Auditor | Privacy Policy | Conditions of Use | Download Adobe PDF Reader