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Fraud, Abuse, Or Retaliation
Where To Report Waste Fraud, Abuse, Or Retaliation

California Improperly Claimed at Least $23 Million of $260 Million in Total Medicaid Reimbursement for Opioid Treatment Program Services

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Wednesday, April 20, 2022
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-09-20-02009
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
California Department of Health Care Ser
Location(s): 
CA,
United States
Type of Report: 
Audit
Questioned Costs: 
$23,139,767
Funds for Better Use: 
$0
Number of Recommendations: 
9
View Document: 
AttachmentSize
PDF icon 92002009.pdf1.36 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
22-A-09-051.02 Open No
We recommend that the California Department of Health Care Services verify that deficiencies identified during annual provider-licensing inspections were corrected and that OTPs implemented their corrective action plans
22-A-09-051.03 Open No
We recommend that the California Department of Health Care Services consider performing additional postservice prepayment monitoring and postservice postpayment utilization reviews.
22-A-09-051.04 Open No
We recommend that the California Department of Health Care Services implement a system edit for identifying claims with an unreasonable number of counseling service units in 1 day and take appropriate action for the claims identified
22-A-09-051.05 Open No
We recommend that the California Department of Health Care Services revise the Drug Medi-Cal Billing Manual or provide additional guidance to OTPs regarding the allowable number of counseling service units and work with counties to ensure that their OTP billing manuals do not conflict with State regulations
22-A-09-051.06 Open No
We recommend that the California Department of Health Care Services take actions to ensure that OTPs comply with Federal and State requirements for providing and claiming reimbursement for OTP services.
22-A-09-051.07 Open No
We recommend that the California Department of Health Care Services take actions to ensure that OTPs provide the number of counseling services specified in a beneficiary’s treatment plan or document the reasons that counseling services were not provided as specified in the treatment plan.
22-A-09-051.08 Open No
We recommend that the California Department of Health Care Services take actions to ensure that OTPs maintain documentation supporting that a complete physical evaluation of a patient was performed, including the results of drug use, tuberculosis, and syphilis tests and the identity of the person who performed the physical evaluation.
22-A-09-051.09 Open No
We recommend that the California Department of Health Care Services take actions to ensure that OTPs have their physicians review and countersign beneficiaries’ treatment plans within the 14-day period as required.
Displaying 8 of 8 Recommendations