Report 2013-119 Recommendation 21 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 #21 To: Health Care Services, Department of

To prevent the certification of ineligible providers, Health Care Services should immediately identify and perform an immediate recertification of providers that signed the Compliance Agreement to ensure that these providers are currently meeting all program requirements.

Agency Response*

DHCS is 95.6% completed with the continued certification efforts for all providers that were identified as billing or could bill in the fiscal year 2012-13. DHCS expects to finalize the continued certification efforts in January 2017 or sooner.

  • Response Type†: Annual Follow Up
  • Estimated Completion Date: January 2017
  • Response Date: October 2016

California State Auditor's Assessment of Status: Not Fully Implemented


Agency Response*

DHCS has already implemented a recertification process that will capture all providers that signed the Compliance Agreement. In July of 2013, DHCS began a recertification process of all DMC providers that billed or could bill for services during fiscal year 2012-13, regardless of their original enrollment method. The continued certification process is required of all DMC providers; therefore, providers that signed the Compliance Agreement are required to submit a current and complete application package, including all attachments and disclosure information. They will also be subject to an onsite inspection.

  • Response Type†: 1-Year
  • Estimated Completion Date: March 2016
  • Response Date: August 2015

California State Auditor's Assessment of Status: Pending

Date of implementation is set for March 2016.


Agency Response*

DHCS has already implemented a recertification process that will capture all providers that signed the Compliance Agreement. In July of 2013, the department began a recertification process of all DMC providers that billed or could bill for services during fiscal year 2012-2013, regardless of their original enrollment method. The current continued certification process is required of all DMC providers therefore providers that signed the Compliance Agreement are required to submit a current and complete application package, including all attachments and disclosure information. They will also be subject to an onsite inspection.

  • Response Type†: 6-Month
  • Estimated Completion Date: November 2015
  • Response Date: February 2015

California State Auditor's Assessment of Status: Pending


Agency Response*

No update.

  • Response Type†: 60-Day
  • Estimated Completion Date: November 2015
  • Response Date: October 2014

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

Based on its response, the department has not yet implemented this recommendation. In addition, it has not provided any information to indicate that it has taken any action on this recommendation.


All Recommendations in 2013-119

†Response Type refers to the interval in which the auditee is providing the State Auditor with their status in implementing recommendations made in an audit report. Auditees must submit a response regarding their progress in implementing recommendations from our reports at three intervals from the release of the report: 60 days, six months, and one year or subsequent to one year.

*Agency responses received after June 2013 are posted verbatim.


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