Investigations Division
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The Investigations Division is comprised of three branches: Peace Officer Investigations Branch, Provider Investigations Branch, and Data Analytics and Case Development Branch.
Within the Peace Officer Investigations Branch, investigators are sworn law enforcement officers whose authority extends throughout the State. Investigators conduct criminal and administrative investigations into various types of suspected Medi-Cal and other Department of Health Care Services (DHCS) program fraud. This fraud may involve beneficiaries who fraudulently obtain benefits, fraud committed by providers and providers/recipients of In-Home Supportive Services benefits.
The Provider Investigations Branch is responsible for conducting investigative audits of providers who are suspected of committing fraud, waste, and/or abuse against Medi-Cal and any other programs administered by the DHCS. The branch also conducts program integrity audits for the Medi-Cal dental program.
The Data Analytics and Case Development Branch is responsible for conducting data and fraud analytics to identify fraud trends and leads; receiving and processing fraud complaints and leads from the general public, managed care plans, the DHCS fiscal intermediary and other government agencies; researching the fraud complaints and leads received to determine if investigations are warranted; the implementation of sanctions and utilization controls on Medi-Cal providers; and coordinating the exchange of evidence with our partner law enforcement and prosecutorial agencies.
Resources
Reporting Medi-Cal Fraud
Health Care Fraud is a Crime.
File a Citizen Complaint
If you have concerns regarding your interaction with any Investigations Division investigator (peace officer), the Department offers you the ability to file a Citizen Complaint.
Contact Information
Investigations Division (ID)
Department of Health Care Services
1500 Capitol Avenue, MS 2200
PO Box 997413
Sacramento, CA 95899-7413
Phone: (916) 750-1169
Email: IDInquiry@dhcs.ca.gov
