Report 2013-119 Recommendation 30 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 #30 To: Health Care Services, Department of

To ensure that it appropriately and consistently reviews provider applications and conducts site visits, Health Care Services should ensure that supervisors perform detailed reviews of all provider applicants' files, including the application, disclosure statement, and checklists, and that they evidence their reviews by signing off on the appropriate forms.

6-Month Agency Response

DHCS will ensure that the Total Quality Management Unit (TQMU) staffs perform detailed reviews of all provider applicants' files, including the application, disclosure statement, and checklists, and that they evidence their reviews by signing off on appropriate forms. It is PED's process to forward all applications to the TQMU within PED, which is dedicated to re-reviewing all documents, research, and recommendations made by primary research analysts. All applications must be reviewed for accuracy and correctness, and signed by a TQM reviewer before being considered complete. All DMC recertification applications or applications for a new certification undergo the same process for quality control.

  • Completion Date: July 2013
  • Response Date: February 2015

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

Health Care Services provided a copy of its analyst review guide, which requires a primary and secondary reviewer's signature to indicate that all required elements have been reviewed and that the application has undergone supervisory review.


60-Day Agency Response

No update.

  • Completion Date: July 2013
  • 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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