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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: 
AttachmentSize
PDF icon 42107097.pdf2.21 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
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.
Displaying 4 of 4 Recommendations