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Where To Report Waste
Fraud, Abuse, Or Retaliation
Where To Report Waste Fraud, Abuse, Or Retaliation
Recommendation Details
Text of Recommendation
We recommend that the State agency ensure that CalHEERS and SAWS have the system functionality to: deny or discontinue Medicaid for an ineligible beneficiary after a previous determination has already been made on the basis of the beneficiary’s MAGI, properly process cases for beneficiaries who were formerly in the foster-care youth program, use SSA data to verify whether a beneficiary is entitled to or enrolled in Medicare, properly redetermine eligibility when a beneficiary is no longer a child, and retrieve and use information from the Department of Homeland Security to determine whether a beneficiary has met the 5-year-bar requirement to be eligible to receive full-scope Medicaid services.
Recommendation Number
262773
Recommendation Status
Open
Significant Recommendation
No
Recommendation Questioned Costs
$0
Recommendation Funds for Better Use
$0