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California Department of Health Care Services: Its Failure to Properly Administer the Drug Medi-Cal Treatment Program Created Opportunities for Fraud
Elaine M. Howle (ed)
This report examined the Calif. Dept. of Health Care Servicesäó» administration of the Drug Medi-Cal Treatment Program (program), which provides substance abuse services to Medi-Cal beneficiaries when physicians determine they are medically necessary. To provide these services, Health Care Services must coordinate with the counties and certify substance abuse clinics, which are referred to as providers. The program provides 5 types of services, including outpatient drug-free treatment services (drug-free services), which are the focus of this report. Before July 2012, Health Care Services negotiated an interagency agreement with the Calif. Dept. of Alcohol and Drug Programs (ADP) to administer the program. Effective July 1, 2012, state law transferred to Health Care Services the responsibility of administering the program. This report concludes that Health Care Servicesäó» and ADPäó»s failure to properly administer the program created opportunities for fraud. It identifies $93.7 million in payments that Health Care Services and ADP authorized for more than 2.6 million outpatient drug-free services that are potentially indicative of fraudulent activity. Tables. This is a print on demand report.
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