Recurring Findings

Health Care: Recurring Material Internal Control Deficiencies
Federal Program Issue First Year Reported
Department's Assertion Page Number
Medical Assistance Program Adequate controls do not appear to be in place to ensure findings noted on OMB Circular A-133 audit reports are addressed in a timely manner. 2005-06
2007-002 corrective action completed. 2008-002 corrective action plan in place. 320
Medical Assistance Program We reviewed the summary of findings cited in the third annual Medi- Cal Payment Error Study (MPES) performed during fiscal year 2005-06. We found that, based on the error percentage related to Medi-Cal payments and incorrect eligibility determinations, the risk of noncompliance with allowable costs and activities and eligibility is material. 2005-06
Partially corrected. The MPES has aided Health Care Services in determining the areas most vulnerable to abuse and has aided in the allocation of resources to the vulnerable areas, increasing their oversight. Health Care Services has continuously implemented the corrective action steps outlined in the MPES from 2006. Based on those findings, vulnerable providers have been identified, and new procedures have been developed to ensure payments are made for allowable services and for eligible beneficiaries 283
Medical Assistance Program 2007: We were unable to determine the medical necessity of five of the 50 fee-for-service claims sampled. 2008: In our sample of 50 fee-for-service claims, six did not appear to be for an allowable service. 2006-07
Partially corrected. Health Care Services is in the process of drafting letters requesting repayment from the providers for the noted exceptions. In addition, civil money penalty letters will be issued to all five providers citing the findings of the Bureau of State Auditsí review. Subsequent reviews are also planned for three of the providers to ensure they are properly billing the program 280
Medical Assistance Program Health Care Services does not have adequate controls in place to monitor compliance with required disclosures in subgrant agreements. 2006-07
Corrective action plan is in place. 319
Medical Assistance Program Health Care Services' Provider Enrollment Division did not retain federally require provider agreements and its related disclosures for some of the providers selected. 2006-07
Partially corrected; agrees with plan. HCS continues its plan to re-enroll all Medi-Cal providers as a continuous process. HCS' PED continues to collect provider agreements to keep records current. PED entered into agreement with L&C to ensure that it obtains appropriate certifications and agreements. 322
Medical Assistance Program Our review of the accuracy of the Medicaid Eligibility Quality Control system revealed several cases where ineligible recipients or beneficiaries received full-scope Medicaid benefits. 2006-07
The 2007-002 findings are partially corrected, and Health Care Services has a corrective action plan in place for the 2008-002 finding. 297