MEDI-CAL FRAUD AND ABUSE - AUDITS & INVESTIGATIONS
DHCS MEDI-CAL FRAUD HOTLINE
The Department of Health Care Services (DHCS) 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.
REPORT MEDI-CAL FRAUD ELECTRONICLY
You can e-mail us at firstname.lastname@example.org or complete the Online Complaint Form.
What is Fraud?
Medi-Cal fraud is an intentional attempt by some providers, and in some cases beneficiaries, to receive unauthorized payments or benefits from the Medi-Cal 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.
How DHCS Stops Fraud
DHCS has made significant strides toward detecting and preventing Medi-Cal fraud. Staff in Audits and Investigations 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.
Provider enrollment procedures used by the Provider Enrollment Division to help prevent fraud include:
- more extensive application packages
- provider background checks
- onsite reviews
- Suspension (moratoriums) on enrollment of new adult day health care centers,clinical laboratories and durable medical equipment providers located outside of California and in Los Angeles, Orange, Riverside and San Bernardino Counties
- As well as, non-chain, non-pharmacist owned pharmacies in Los Angeles County.
Governor's Medi-Cal Fraud Task Force
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 partnership witth the State Department of Justice, the State Controller's Office, the Federal Bureau of Investigation, the Office of Inspector General, the U.S. Attorney's Office, Employment Development Department, Department of Consumer Affairs Medical Board, Health Authority Law Enforcement Team, and the Centers for Medicare and Medicaid Services.
» Audits & Investigations
» Examples of Medi-Cal Fraud
» Administrative Sanctions
» Criminal Convictions
» Stop Medi-Cal Fraud Campaign
» Report IHSS Fraud
Last modified on:
8/15/2014 8:13 AM