Audits & Investigations - Financial Audits Branch

Audits and Investigations, Financial Audits Branch (FAB) is responsible for providing program integrity of many of the healthcare programs administered by the California Department of Health Care Services (DHCS).

To accomplish this, FAB ensures through financial audits that payments to Medi-Cal Providers or other State or federally funded health care programs are in accordance with the applicable laws, regulations, and program intent.

Providers subject to audit include acute care inpatient hospitals, long-term care facilities (such as skilled nursing and intermediate care), Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC), home offices related to the above categories of providers, and public health programs such as Maternal Child Health and Office of AIDS.

For acute care and long term care, providers are required to file annual Medi-Cal cost reports. The purpose of these cost reports is to report to the Department the reimbursable cost of providing care to Medi-Cal beneficiaries. These cost reports are required to be filed with the Department within 150 days after the providers fiscal year ends.

For FQHC and RHC clinics, no mandatory annual Medi-Cal cost report is required. Cost reports and other reporting forms are to be filed as needed by clinics for establishing Prospective Payment System (PPS) rates, or modifying such rates. Annual PPS reconciliation reporting forms are required to be filed with the Department. The purpose of these forms is to reconcile PPS rates and resulting reimbursement with amounts received from other funding sources such as Medi-Cal Managed Care and Medicare Crossovers. These forms are required to be filed with the Department 150 days after the close of the provider's fiscal year end.

AUDIT REPORTS

To search for completed audit reports conducted by the Finacial Audits Branch please visit our data and stastics webpage.