To prevent the certification of ineligible providers, Health Care Services should immediately instruct its enrollment division to conduct all required database searches of individuals that provider applicants identify as their owners or managing employees.
DHCS has instructed its enrollment division to conduct all required database searches of such individuals. It is PED's standard process to conduct all federally required database searches of all individuals found in the application package at the time of screening, which includes all owners and managing employees. PED has been searching MED/PECOS since April 2013 and the MCSIS since January 2013. Effective July 2013 for DMC recertification applications and effective January 2014, for new DMC certification applications PED staff conduct all required database searches for DMC to the Provider Master File (PMF) providers. DHCS has also begun adding all individuals identified as owners, managers, and controlling interest holders to enable monthly database checks. Currently, DHCS and the Fiscal Intermediary conduct monthly download of the LEIE, SAM/EPLS, and MCSIS in order to check them against the providers in the PMF.
In the near future PED will utilize an automated enrollment system and these database checks will become an automated process.
Health Care Services provided a copy of its Drug Medi-Cal program training presentation that describes performing required database searches for the names of listed individuals.
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.