Report 2013-119 Recommendation 9 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 #9 To: Health Care Services, Department of
To ensure that the providers receive reimbursement for only valid services, Health Care Services should immediately ensure that Fresno County strengthens its provider contract monitoring process, including revising its report format and conducting follow-up visits to providers.
1-Year Agency Response
The County Monitoring Unit provided technical assistance to the County on consistent reporting formats, Title 22 (DMC) deficiencies, federal block grant fund deficiencies, and provider monitoring tools during this review. Fresno County submitted their first sub-contractor monitoring report on January 13, 2015. Since then Fresno County has submitted to DHCS eight Title 22 reports of DMC sub-contracted providers, four federal block grant funded reports of sub-contracted providers and four Corrective Action Plan on-site review follow-up reports of sub-contracted providers.
- Completion Date: September 2014
- Response Date: August 2015
California State Auditor's Assessment of 1-Year Status: Fully Implemented
DHCS provided a copy of the corrective action plans that it issued to Fresno County in response to DHCS' SAPT Block Grant and State-County Contract Compliance review. DHCS provided copies of Fresno County's subsequent status updates that describe the county's implementation of those corrective action plans, which would address deficiencies identified within the county's contract monitoring process.
6-Month Agency Response
A monitoring review of Fresno County was conducted in September, 2014. The County Monitoring Unit provided technical assistance to the County on consistent reporting formats during this review. Fresno County submitted their first sub-contractor monitoring report on January 13, 2015. The report is currently being evaluated for procedural adequacy.
See Attachment A
- Completion Date: September 2014
- Response Date: February 2015
California State Auditor's Assessment of 6-Month Status: No Action Taken
Although Health Care Services indicated that it has fully implemented this recommendation, it did not provide us sufficient documentation to support its claim.
- Auditee did not substantiate its claim of full implementation
60-Day Agency Response
Several questions requiring documentation that demonstrates County provider monitoring procedures including follow up with providers have been added to the 14/15 County Monitoring Instrument (attached and beginning on page 38). The review of Fresno County has been scheduled for September 23 - 26, 2014. The County Monitoring Unit will provide technical assistance to the County on consistent reporting formats during this review. Also the DHCS follow up with Fresno County occurred on August 22, 2014.
- Estimated Completion Date: September 30, 2014
- 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.