Report 2013-119 Recommendation 23 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 #23 To: Health Care Services, Department of

To prevent the certification of ineligible providers, Health Care Services should immediately develop policies and procedures for its program recertification process.

Agency Response*

DHCS has developed new policies and procedures for the DMC recertification process, and will continue to update these policies and procedures as warranted. DHCS has developed a DMC enrollment and certification section whose sole purpose is to conduct continued certification and certification functions for all DMC provider applicants. PED staff work collaboratively with SUDS' staff and the A&I staff in implementing its policies and procedures.

Additionally, in January 2014, the department began the process of implementing emergency regulations regarding the enrollment of DMC providers with a targeted effective date of July 1, 2015. As part of the emergency regulation package, all DMC providers will be required to adhere to current CCR Title 22 requirements used to enroll and revalidate fee-for-service providers.

  • Response Type†: 6-Month
  • Completion Date: January 2014
  • Response Date: February 2015

California State Auditor's Assessment of Status: Fully Implemented

Health Care Services provided a copy of its procedures for recertifying program providers.

Agency Response*

No update.

  • Response Type†: 60-Day
  • Completion Date: January 2014
  • Response Date: October 2014

California State Auditor's Assessment of 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

†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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