Report 2013-119 Recommendation 1 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 #1 To: Health Care Services, Department of

To ensure that the providers receive reimbursement for only valid services, Health Care Services should immediately coordinate with the appropriate counties to recover inappropriate payments to ineligible providers and for services purportedly rendered to deceased beneficiaries.

Annual Follow-Up Agency Response From August 2017

The FY 2013-2014 cost report for Los Angeles County, which included recoupment of this final amount, was settled on March 2, 2017.

Status and Implementation Date: Fully Implemented, 3/2/2017.

  • Completion Date: March 2017

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

Health Care Services provided a copy of Los Angeles County's fiscal year 2013-14 cost settlement letter, which included recoupment of the final amount due for inappropriate payments for services to dead beneficiaries.

Annual Follow-Up Agency Response From October 2016

All the inappropriate payments have been recouped with the exception of $36.16 from Los Angeles County which will be recovered in their FY 2013-14 cost report, expected to be settled by January 1, 2017

  • Estimated Completion Date: January 2017

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

1-Year Agency Response

For the dead beneficiaries identified in the CSA report, FMAB has determined that providers were inappropriately paid for services provided to beneficiaries after their date of death. FMAB has begun to take action to recoup the overpayments through the Fiscal Year 12-13 cost report settlement process or through the established accounts receivable recoupment process (if services were provided prior to FY 12-13). This is expected to be complete by January 2016 (when the FY 12-13 cost reports are settled).

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

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

Date of implementation is set for January 2016.

6-Month Agency Response

The Department of Health Care Services submitted a Public Records Act request to CSA in order to obtain the claims detail data for the high risk payments identified in the CSA report. DHCS received the data and it is currently being reviewed by the FMAB to determine if recovery of funds is required.

  • Estimated Completion Date: June 30, 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.