Report 2021-046 Recommendation 6 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 #6 To: Health Care Services, Department of

To prevent providers from billing for services performed by other providers that have been suspended, DHCS should, by June 2023, revise its policies and billing system to assess all service-rendering providers included in claim data and verify that they have not been suspended.

1-Year Agency Response

Although DHCS was not able to identify any billing providers whom the Fiscal Intermediary paid while they were suspended, DHCS did identify that restitution payments did not check against providers under mandatory suspension. DHCS is conducting additional research to identify system checks used for restitution to learn where the breakdown occurred and will then issue policy guidance to implement edits, so that the system for restitution payments will check for suspended providers.

DHCS will also make an additional data run regarding identification of suspended rendering providers on claims prior to payment.

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.