Report 2013-119 Recommendation 8 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 #8 To: Health Care Services, Department of
To ensure that the providers receive reimbursement for only valid services, Health Care Services should immediately ensure that each county has a process in place to follow up on their providers' implementation of corrective action plans aimed at resolving program deficiencies.
1-Year Agency Response
The statement, "Describe the County's process for ensuring that provider's corrective action plans are submitted and implemented as required. Please provide documentation that demonstrates the County's monitoring process for provider corrective action plans." (pg. 40, question 9 & 9a) was added to the 14/15 County Monitoring Instrument. Fifty-seven county reviews to the State-County contract were completed by June 30, 2015. Twenty-five counties had effective CAP monitoring systems in place while all remaining counties were provided technical assistance to strengthen their system or create one. DHCS staff created a form available on the Department's website for county staff to complete and submit to DHCS via email certifying Drug Medi-Cal CAPs have been implemented by their programs.
- Completion Date: June 2015
- Response Date: August 2015
California State Auditor's Assessment of 1-Year Status: Fully Implemented
DHCS provided documentation showing that it updated its County Monitoring Instrument with instructions for counties to demonstrate their process for monitoring corrective action plans. In addition, DHCS now requires counties to certify that Drug Medi-Cal providers have fully implemented all corrective actions designed to resolve program deficiencies.
6-Month Agency Response
All counties will be reviewed by June 30, 2015.
See Attachment A
- Estimated Completion Date: June 30, 2015
- Response Date: February 2015
California State Auditor's Assessment of 6-Month Status: Pending
60-Day Agency Response
The statement "Describe the County's process for ensuring that provider's corrective action plans are submitted and implemented as required. Please provide documentation that demonstrates the County's monitoring process for provider corrective action plans." (pg. 40, question 9) has been added to the 14/15 County Monitoring Instrument (attached). Reviews of county compliance with ensuring their DMC providers' CAPs are implemented will begin in September 2014
- Estimated Completion Date: September 30, 2015
- Response Date: October 2014
California State Auditor's Assessment of 60-Day Status: Pending
We agree that it has adjusted the county monitoring instrument as indicated; however, Health Care Services has not yet implemented this recommendation.
Agency responses received are posted verbatim.