Medi-Cal Fraud & Abuse |
800.822.6222 |
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| DHCS MEDI-CAL FRAUD HOTLINE
The Department of Health Care Services asks that anyone who observes or has knowledge of suspicious health care activity to call the DHCS Medi-Cal Fraud Hotline telephone number, 1-800-822-6222, to report it. The recorded message may be heard in English and four other languages: Spanish, Vietnamese, Cambodian, and Russian. The call is free and the caller may remain anonymous. You can also e-mail us at stopmedicalfraud@dhs.ca.gov
Medi-Cal fraud is an intentional attempt by some providers, and in some cases beneficiaries, to receive unauthorized payments or benefits from the program. This fraud can take many forms, but the most common involve providers knowingly billing for unnecessary services, for services not performed, or for more expensive services than they actually provide. |
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The California Department of Health Care Services (DHCS) has made significant strides toward detecting and preventing Medi-Cal fraud. Staff in Audits and Investigations (A&I), a DHCS program, are using new auditing and investigative procedures to monitor the practices and billing activity of providers. They work to assure quality care is provided, reduce the occurrence of fraud, uncover instances of provider and beneficiary identity theft and make referrals for criminal investigation and prosecution. New provider enrollment procedures used by the Payment Systems Division (PSD) of DHCS, include more extensive application packages, provider background checks, and onsite reviews, as well as moratoriums on enrollment of new durable medical equipment and laboratory providers. DHCS has also created a new unit, the Medi-Cal Fraud Prevention Bureau (MFPB), which has developed and is using provider fraud risk assessment surveys to detect, document, and refer fraud for criminal investigation and prosecution.
Since 1999 a tremendous amount of resources have been put forth to combat Medi-Cal fraud. Fraud is a key issue to the State of California and a special group has been formed, the Governor's Medi-Cal Fraud Task Force, which is chaired by the Director of DHCS, to improve communication and cooperation among agencies that investigate and prosecute individuals suspected of Medi-Cal fraud. The group includes the Department of Health Care Services (DHCS), the State Department of Justice (DOJ), the State Controller's Office (SCO), the Federal Bureau of Investigation (FBI), the Office of Inspector General, the U.S. Attorney's Office, Employment Development Department (EDD), Department of Consumer Affairs Medical Board, Health Authority Law Enforcement Team (HALT) and the Centers for Medicare and Medicaid Services (CMS).
To address health care concerns, DHCS formed the Medical Implications of Healthcare Fraud Task Force which is chaired by A&I. Staff from the Dental Board, Pharmacy Board, DOJ, A&I and local law enforcement agencies consult on health issues that could result in serious health care concerns for Medi-Cal beneficiaries
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