Where To Report Waste

Fraud, Abuse, Or Retaliation

California Made Almost $16 Million in Unallowable Capitation Payments for Beneficiaries With Multiple Client Index Numbers

Submitting OIG:

Department of Health & Human Services OIG

Date Issued:

Tuesday, October 25, 2022

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-04-21-07097

Component, if applicable:

Centers for Medicare & Medicaid Services

Centers for Medicare and Medicaid Services

External entity, if applicable:

California Department of Health Care Services

Location(s):

CA,

United States

Type of Report:

Audit

Questioned Costs:

$15,722,587

Funds for Better Use:

$0

Number of Recommendations:

5

View Document:

Attachment	Size
42107097.pdf	2.21 MB

Related Open Recommendations

Recommendation Number	Recommendation Status	Significant Recommendation	Additional Details
23-A-04-006.01	Open	No
We recommend that the California Department of Health Care Services refund to the Federal Government $15,722,587 in unallowable payments.
23-A-04-006.02	Open	No
We recommend that the California Department of Health Care Services review capitation payments that fell outside of our audit period and refund any unallowable payments.
23-A-04-006.03	Open	No
We recommend that the California Department of Health Care Services ensure that the algorithm used to create its revised Beneficiary Name and DOB Match Reports is effective at detecting individuals with multiple records.
23-A-04-006.04	Open	No
We recommend that the California Department of Health Care Services require county staff to review training materials on the prevention of issuing multiple CINs.
23-A-04-006.05	Open	No
We recommend that the California Department of Health Care Services enhance its controls to ensure that no beneficiary is issued multiple CINs.