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.

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.

  • Response Type†: 1-Year
  • Completion Date: June 2015
  • Response Date: August 2015

California State Auditor's Assessment of 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.


Agency Response*

All counties will be reviewed by June 30, 2015.

See Attachment A

  • Response Type†: 6-Month
  • Estimated Completion Date: June 30, 2015
  • Response Date: February 2015

California State Auditor's Assessment of Status: Pending


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

  • Response Type†: 60-Day
  • Estimated Completion Date: September 30, 2015
  • Response Date: October 2014

California State Auditor's Assessment of Status: Pending

We agree that it has adjusted the county monitoring instrument as indicated; however, Health Care Services has not yet implemented 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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