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Medical Review Branch

The Medical Review Branch

Audits and Investigations

Department of Health Care Services

 

The Medical Review Branch (MRB) focuses on maintaining program integrity within the Medi-Cal program through reviews, audits, inspections and surveys of non-institutional providers. Non-institutional providers include physicians, physician groups, laboratories, pharmacies, durable medical equipment providers and other allied health entities. Branch activities are designed to assure that state and federal dollars spent for services and goods in the Medi-Cal program are used for essential healthcare benefits in compliance with program rules, regulations and law.

 

Corrective actions may range from the application of utilization controls to the imposition of administrative sanctions. The Branch may also recover overpayments and apply civil money penalties where appropriate. Further, the MRB conducts pre and post enrollment inspections at the behest of the Provider Enrollment Division as well as annual medical audits of managed care plans for the Medi-Cal Managed Care Division. The reports from contract compliance audits are posted on the Managed Care Quality and Monitoring Division’s website.

 

MRB publishes two biennial reports – the Medi-Cal Payment Error Study (MPES) and the Legislative Anti-Fraud Report. These reports are posted on the MRB website. The MPES report measures the overpayments in fee-for service Medi-Cal and estimates the percentage of fraudulent billing. This report helps establish Branch goals in its ongoing program integrity efforts. The Legislative Anti-Fraud Report summarizes the effectiveness of Medi-Cal fraud control initiatives and activities within the Branch.

 
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Contact Information

Medical Review Branch
Audits and Investigations
Capitol Avenue – MS 2303
P. O. Box 997413
Sacramento, CA 95899-7413
(916) 440-7460

 

Mark P. Mimnaugh, R.N., CCRN, M.P.A., Branch Chief

Winston Mesaku, M.P.A., Assistant Branch Chief

Kelly Molohan, Assistant Branch Chief

 

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Last modified on: 10/31/2016 4:43 PM