To ensure that Health Care Services and its fiscal intermediaries reimburse providers only for services rendered to eligible beneficiaries, Health Care Services should obtain Social Security's Death Master File and update monthly its beneficiary eligibility system with death information.
DHCS issued a letter on January 12, 2017 to all counties reaffirming the instruction to check MEDS alerts for SSN verifications that failed to match. The county must take appropriate steps to verify the accuracy of the SSN should it fail an electronic verification.
Health Care Services' response does not address obtaining Social Security's Death Master File. When we followed up with Health Care Services' staff, they asserted that Health Care Services now obtains a monthly update of the Death Master File, but it has not yet implemented a process to match its eligibility system against these updates.
DHCS-Eligibility Division is actively working towards the implementation of a monthly update from the SSA Death Master File. We believe the audit finding was caused by applicants using fraudulent or erroneous SSNs not the frequency of the death file from SSA. DHCS will issue a policy letter to counties reminding them to follow-up on MEDS alerts when SSNs fail verification. The anticipated completion date of this letter is December 19, 2016.
DHCS maintains its forecast that the improvements will be in place on or before April 30, 2016.
The Department of Health Care Services (DHCS) is continuing to work on improving the ability to detect unreported beneficiary deaths. Over the last 60 days, DHCS has identified and evaluated numerous federal, state, private, and direct reporting sources. Based on this evaluation, DHCS maintains its forecast that the improvements will be in place on or before April 30, 2016. These improvements include the acquisition, testing, and roll out of new sources and the improvement of existing sources.
DHCS intends to increase the frequency of updates to the Medi-Cal Eligibility Data System (MEDS) with the Social Security Administration's Death Master File from quarterly to monthly. The request to increase the frequency to monthly was already in progress and will most likely require an amendment to the existing DHCS/SSA information sharing agreement. The implementation date of April 30, 2016 accounts for the development and testing needed to complete this request.
†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.