Recurring Findings

Health Care: Recurring Significant Internal Control Deficiencies
Federal Program Issue First Year Reported
Department's Assertion Page Number
Medical Assistance Program Health Care Services is unable to reconcile the presumptive eligibility number against the enrollment listing filed with Health Care Services. 2005-06
Remains uncorrected/agree with finding. Health Care Services is pursuing an automated process to post the presumptive eligibility identification to the Stateís MEDS so that records for these recipients can be accessed to authenticate, reconcile, and prevent duplicate issuances of the presumptive eligibility number during the claims adjudication process. 301
SCHIP (State Children's Insurance Program) We were unable to verify the accuracy of detailed expenditures reported by line item or category of service. 2005-06
Partially corrected. CMS 21 accounting system design meetings have been ongoing, and system requirements have been identified. Design and development will continue until system is finalized and implemented. 310
Medical Assistance Program Drug utilization data was mailed to labelers 14 days late. 2006-07
Remains uncorrected/agree with finding. There exists a potential system logic change which will reduce the amount of manual review required for blood factor claims. The change is expected to be implemented in April 2009. In addition, Health Care Services has implemented a second printer so that the time required for printing the physical invoices is reduced by four days 279
Medical Assistance Program Federal expenditures noted in the quarterly Centers for Medicare and Medicaid Services (CMS) CMS-64, Quarterly Statement of Expenditures for the Medical Assistance Program reports are not traceable to individual claims. 2006-07
Remains uncorrected/agree with finding. The Fiscal Intermediary and Contracts Oversight Division has submitted a Systems Development Notice to redesign the system to incorporate the capability to trace summary reports back to individual claims. However, Health Care Services has instructed EDS to prepare an estimate for an alternate interim solution to achieve compliance 311
Medical Assistance Program Health Care Servicesí Provider Enrollment Division does not have a procedure in place to discontinue a provider number once a providerís license has expired. As such, providers may continue to receive Medi-Cal funds even if the provider does not have an active license. 2006-07
Partially corrected. PED continues to explore the possibility of participating in database file matches with the California Medical Board that would allow automated updates to physician records 324