| Medical Assistance Program |
Adequate controls do not appear to be in place to ensure findings noted on OMB Circular A-133 audit reports are addressed in a timely manner. |
2005-06 |
| 2007-002 corrective action completed. 2008-002 corrective action plan in place. |
320 |
| Medical Assistance Program |
Because a Health Care Services contractor does not document or track the reasons it overrides a suspended claim, we could not identify which claims were paid using the flawed procedure that could result in duplicate payments. Until Health Care Services increases its quality control over the claims override function, it has no way of knowing if duplicate payments are being made to providers for medical, outpatient, and vision services. |
2005-06 |
| Partially corrected. Health Care Services has requested an estimate for the creation of a new report that will consolidate and track the progress of Erroneous Payment Correction actions in an easily accessible format. |
77 |
| Medical Assistance Program |
We reviewed the summary of findings cited in the third annual Medi- Cal Payment Error Study (MPES) performed during fiscal year 2005-06. We found that, based on the error percentage related to Medi-Cal payments and incorrect eligibility determinations, the risk of noncompliance with allowable costs and activities and eligibility is material. |
2005-06 |
| Partially corrected. The MPES has aided Health Care Services in determining the areas most vulnerable to abuse and has aided in the allocation of resources to the vulnerable areas, increasing their oversight. Health Care Services has continuously implemented the corrective action steps outlined in the MPES from 2006. Based on those findings, vulnerable providers have been identified, and new procedures have been developed to ensure payments are made for allowable services and for eligible beneficiaries |
283 |
| Medical Assistance Program |
2007: We were unable to determine the medical necessity of five of the 50 fee-for-service claims sampled. 2008: In our sample of 50 fee-for-service claims, six did not appear to be for an allowable service. |
2006-07 |
| Partially corrected. Health Care Services is in the process of drafting letters requesting repayment from the providers for the noted exceptions. In addition, civil money penalty letters will be issued to all five providers citing
the findings of the Bureau of State Audits’ review. Subsequent reviews are also planned for three of the providers to ensure they are properly billing the program |
280 |
| Medical Assistance Program |
Health Care Services does not have adequate controls in place to monitor compliance with required disclosures in subgrant agreements. |
2006-07 |
| Corrective action plan is in place. |
319 |
| Medical Assistance Program |
Health Care Services' Provider Enrollment Division did not retain federally require provider agreements and its related disclosures for some of the providers selected. |
2006-07 |
| Partially corrected; agrees with plan. HCS continues its plan to re-enroll all Medi-Cal providers as a continuous process. HCS' PED continues to collect provider agreements to keep records current. PED entered into agreement with L&C to ensure that it obtains appropriate certifications and agreements. |
322 |
| Medical Assistance Program |
Our review of the accuracy of the Medicaid Eligibility Quality Control system revealed several cases where ineligible recipients or beneficiaries received full-scope Medicaid benefits. |
2006-07 |
| The 2007-002 findings are partially corrected, and Health Care Services has a corrective action plan in place for the 2008-002 finding. |
297 |
