To prevent the certification of ineligible providers, Health Care Services should immediately instruct its staff to compare the names of the managing employees whom applicant providers identify in their program applications to those whom they identify in their disclosure statements.
DHCS has instructed and will continue to instruct staff to compare the names of managing employees on providers' applications and disclosure statements. This process has been applied to DMC provider recertification applications for over a year.
Since disclosure statements became a requirement, it has always been the PED's standard process to compare all names of managing employees that are identified throughout the application with those listed on the Disclosure Statement in all fee-for-service (FFS) application reviews. These same review standards have been applied to DMC providers targeted for continued certification since July 2013 and for all other DMC providers requesting new certification effective January 2014, including backlog assumed by PED. PED researches any conflict in names or information and addresses the discrepancies via a deficiency letter, an onsite visit, or both.
Health Care Services provided a copy of its Analyst Review Guide, in which analysts are instructed to use a list of databases to search for all staff listed in the Disclosure Statement, as well as any other supporting documents. If Health Care Services' analysts review the names of all employees listed on those supporting documents, such as the application form and the disclosure statement, then it would adequately address this recommendation.
Although Health Care Services indicated that it has fully implemented this recommendation, it has not provided any information to indicate that it has taken any action on this recommendation.
Agency responses received are posted verbatim.