Report 2021-046 Recommendation 5 Responses

Report 2021-046: Proposition 56 Tobacco Tax: The Department of Health Care Services Is Not Adequately Monitoring Provider Payments Funded by Tobacco Taxes (Release Date: November 2022)

Recommendation #5 To: Health Care Services, Department of

To comply with state law, reduce the amount of time it takes to suspend providers from delivering Medi-Cal services, and better protect Medi-Cal beneficiaries from potentially ineligible providers, DHCS should, by June 2023, begin issuing temporary provider suspensions or temporary payment suspensions when permissible or required by state law while it engages in the process of issuing a mandatory provider suspension.

1-Year Agency Response

The DHCS MSD has revised its suspension process. When MSD receives a notification of loss of license or conviction, MSD personnel will determine whether the activity contained in the notification constitutes a basis for the imposition of a temporary provider suspension under the statute. If it does, the information will be referred to the sanctions section within A&I for priority processing as a temporary suspension.

DHCS has met with the Department of Medi-Cal Fraud and Elder Abuse (DMFEA) and reached agreement to implement notifications to DHCS when charges are filed against a Medi-Cal provider. DHCS and DMFEA are currently formalizing this process for inclusion into each department/division's respective policies and procedures.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

Health Care Services did not submit a response to this recommendation.

California State Auditor's Assessment of 6-Month Status: No Action Taken

60-Day Agency Response

Health Care Services did not submit a response to this recommendation.

California State Auditor's Assessment of 60-Day Status: No Action Taken

All Recommendations in 2021-046

Agency responses received are posted verbatim.