Report 2013-119 Recommendation 18 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 #18 To: Health Care Services, Department of

To prevent the certification of ineligible providers, Health Care Services should immediately ensure that its enrollment division conducts LEIE and EPLS database searches of program providers at least monthly.

Annual Follow-Up Agency Response From August 2017

DHCS and the Medi-Cal Fiscal Intermediary currently conduct monthly searches of all program providers listed in the Provider Master File (PMF) against the LEIE and EPLS databases. When staff conduct their full analysis of submitted provider applications, these database checks occur again.

Status and Implementation Date: Fully Implemented, 7/1/2014.

  • Completion Date: July 2017

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

Although Health Care Services asserts that it fully implemented this recommendation, it did not provide any documentation to support its assertion.

  • Auditee did not substantiate its claim of full implementation

Annual Follow-Up Agency Response From October 2016

The enrollment division currently conducts monthly searches of program providers in the LEIE and EPLS databases. Currently, DHCS and the Fiscal Intermediary conduct monthly downloads of the LEIE and EPLS databases for comparison against all providers in the PMF. As DMC providers are approved through continued certification or certification, they are added to the PMF so the required monthly screening can occur. With respect to pending DMC applications, DHCS compiled all names and conducted a search of the LEIE and EPLS for those names and as staff conduct their full analysis, these database checks occur again. In addition, as soon as the automated enrollment system is implemented, this will become an automated process

  • Completion Date: July 2014

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

Although Health Care Services asserts that it fully implemented this recommendation, it did not provide any documentation to support its assertion.


1-Year Agency Response

The enrollment division conducts monthly searches of program providers in the LEIE and EPLS databases. Currently, DHCS and the Fiscal Intermediary conduct monthly downloads of the LEIE and EPLS databases for comparison against all providers in the PMF. As DMC providers are approved through continued certification or certification, they are added to the PMF so the required monthly screening can occur. With respect to pending DMC applications, DHCS compiled all names and conducted a search of the LEIE and EPLS for those names and as staff conduct their full analysis, these database checks occur again. In addition, as soon as the automated enrollment system is implemented, this will become an automated process

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

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

DHCS provided a copy of its procedures for processing monthly matches to its internal Monthly Excluded Providers Report; however, DHCS did not provide evidence that the report was generated using the LEIE and EPLS databases.

  • Auditee did not substantiate its claim of full implementation

6-Month Agency Response

No update, previously reported as fully implemented.

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

California State Auditor's Assessment of 6-Month Status: Partially Implemented

Health Care Services provided a copy of its notice to the contractor responsible for maintaining the California Medicaid Management Information System, informing it that the system must be updated to incorporate the required LEIE and EPLS verification.


60-Day Agency Response

No update.

  • Completion Date: November 2014
  • Response Date: October 2014

California State Auditor's Assessment of 60-Day Status: No Action Taken

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.


All Recommendations in 2013-119

Agency responses received are posted verbatim.


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