Report 2022-112 Recommendation 7 Responses

Report 2022-112: CalOptima Health: It Has Accumulated Excessive Surplus Funds and Made Questionable Hiring Decisions (Release Date: May 2023)

Recommendation #7 To: CalOptima Health

To help ensure the maintenance of an atmosphere free from fear of retaliation for reporting misconduct, by October 2023 and annually thereafter, CalOptima should conduct or contract for an anonymous survey of staff and contractors to determine whether they understand how to make such reports and feel comfortable doing so.

1-Year Agency Response

At its April 4, 2024, meeting, the Board approved modifications to CalOptima Health Policy HH.3012: Non-Retaliation for Reporting Violations to add contractors as participants of CalOptima Health's annual, anonymous employee survey (Attachment A1). Subsequently, CalOptima Health launched its second annual Compliance survey as part of its Great Place to Work Survey. The Compliance survey questions (Attachment A2) were distributed to all CalOptima Health employees (Attachment A3) on April 8, 2024, and to contractors (Attachment A4) on April 10, 2024, and was open for responses through April 22, 2024. In addition, in compliance with Policy HH.3012, a question was added to this year's survey (and will be included in all future surveys) to explicitly ask whether the employee/contractor feels comfortable reporting an ethical or compliance concern without fear of retaliation.

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

Since its six-month response, CalOptima has updated its survey policy to address contractors, and it has added a question to its survey to ask respondents whether they feel comfortable reporting their concerns.

6-Month Agency Response

CalOptima Health updated policy HH.3012: Non-Retaliation for Reporting Violations (Attachment A5). This policy has been updated to include a requirement for conducting an annual survey for all staff. CalOptima Health's Board of Directors approved the implementation of this policy on September 7, 2023.

In addition to the updated policy, CalOptima Health submits the requested completion analysis for the 2023 Best Places to Work Survey launched in March 2023 (Attachment A6).

California State Auditor's Assessment of 6-Month Status: Partially Implemented

CalOptima has not addressed key aspects of our recommendation. First, CalOptima's policy requiring an annual survey applies only to employees and does not address contractors, who like employees can and must report misconduct under CalOptima's policies. Second, CalOptima's survey asked employees about their understanding of the mechanisms and requirements for reporting non-compliance, fraud, waste, abuse, or misconduct and the consequences of retaliation, but crucially it did not ask whether they feel comfortable reporting these concerns. Although CalOptima's actions represent an improvement, they do not address all aspects of our recommendation. Absent an evaluation of whether employees feel comfortable reporting these types of concerns, CalOptima lacks information about whether it has established and is maintaining an atmosphere free from fear of retaliation for reporting misconduct.

60-Day Agency Response

CalOptima Health launched a 2023 Best Places to Work Survey in March, 2023. An announcement was sent on March 15, 2023 to "All Email Users" stating that we would be participating in the 2023 Best Places to Work Survey from March 31, 2023 - April 21, 2023 (Attachment A1). This survey included questions developed by CalOptima Health's Compliance and Human Resources departments regarding retaliation (Attachment A2). In the weekly "Week Ahead" emails starting March 27th CalOptima Health's Human Resources sent an email to "All Email Users" encouraging employees to participate in the survey (Attachment A3). As of April 21st, CalOptima Health had a completion rate of 66% (Attachment A4). CalOptima Health will not know the final completion rate of the survey until late July.

CalOptima Health is in the process of updating CalOptima Health policy HH. 3012 Non-retaliation for Reporting Violations to include a requirement for conducting an annual survey for all staff. This policy remains on track for October 2023.

California State Auditor's Assessment of 60-Day Status: Pending

We look forward to reviewing the results of CalOptima's survey and its updated policy.

All Recommendations in 2022-112

Agency responses received are posted verbatim.