California Department of Healthcare Services

Medical Review Branch

The Audits and Investigations, Medical Review Branch (MRB), performs medical and financial audits and federally mandated post service, post payment utilization reviews of non-institutional Medi-Cal providers, including laboratories and pharmacies.  The audits conducted by MRB provide a vehicle to investigate suspected violations of Medi-Cal laws and regulations, aggressively recover public funds spent inefficiently or illegally, and detect new fraud and abuse trends that impact the DHCS Medi-Cal Anti-Fraud program.

MRB has successfully employed several anti-fraud strategies.  One of those strategies, the Medi-Cal Payment Error Study (MPES), was first conducted in Fiscal Year 2003-04.  The primary objective of the MPES is to identify where the Medi-Cal program is at greatest risk for payment errors.  Each year, the MPES findings are provided to the State Legislature to show DHCS’ continuing efforts to detect, identify, and prevent fraud and abuse in the Medi-Cal program, gauge the seriousness of the problem, and develop appropriate fraud control strategies.