Report 2013-119 Recommendation 11 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 #11 To: Health Care Services, Department of

To ensure that the providers receive reimbursement for only valid services, Health Care Services should immediately ensure that Sacramento County strengthens its provider contract monitoring process, including tracking provider deficiencies and conducting follow-up visits to providers.

1-Year Agency Response

DHCS conducted a county monitoring on-site review on October 28-30, 2014 which included a thorough review of Sacramento County's provider monitoring process. The Department's report documented the county's deficiencies and required the county to submit a Corrective Action Plan (CAP). DHCS received the CAP in March 2015 and has been providing on-going technical assistance to county personnel to improve their monitoring tools, monitoring procedures, and sub-contractor CAP process. Sacramento County is scheduled for FY 15-16 on-site monitoring review in October 2015 to ensure implementation of their CAP and adherence to the State County contract.

  • Completion Date: April 2015
  • Response Date: August 2015

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

DHCS provided a copy of the corrective action plans that it issued to Sacramento County in response to DHCS' SAPT Block Grant and State-County Contract Compliance review. DHCS provided a copy of Sacramento County's subsequent status update that describes the county's implementation of those corrective action plans, which would address deficiencies identified within the county's contract monitoring process

6-Month Agency Response

DHCS County Monitors conducted their site review October 28-30, 2014 which included a thorough review of Sacramento County's provider monitoring process.

  • Completion Date: October 2014
  • Response Date: February 2015

California State Auditor's Assessment of 6-Month Status: No Action Taken

Although Health Care Services indicated that it has fully implemented this recommendation, it did not provide us documentation to support its claim.

  • Auditee did not substantiate its claim of full implementation

60-Day Agency Response

Several questions requiring documentation that demonstrates County provider monitoring procedures including follow up with providers have been added to the 14/15 County Monitoring Instrument (attached and beginning on page 38). The review of Sacramento County will be conducted in October 2014. As a component of this review, the County's provider contract monitoring process will be reviewed with a focus on their tracking of provider deficiencies and conducting follow up provider visits.

  • Estimated Completion Date: October 31, 2014
  • Response Date: October 2014

California State Auditor's Assessment of 60-Day Status: Pending

We agree that it has adjusted the county monitoring instrument as indicated; however, Health Care Services has not yet implemented this recommendation.

All Recommendations in 2013-119

Agency responses received are posted verbatim.