California audit: 26,000 high-risk Medi-Cal providers not investigated for fraud

California's state auditor found that 26,000 of 28,000 high-risk Medi-Cal providers remain uninvestigated. The $200bn programme serves 14 million residents.

State auditor flags sweeping fraud oversight failures in Medi-Cal

California has failed to investigate 26,000 of its 28,000 highest-risk Medi-Cal providers for fraud, according to a report released Thursday by state auditor Grant Parks, as calmatters.org reports.

The audit concluded that the Department of Health Care Services is ill-equipped to curb pervasive abuse within Medi-Cal, a programme covering roughly 14 million Californians that pays out $200 billion annually.

Parks' report described a "history of concern" surrounding the department's oversight of Medi-Cal providers and formally classified it as "high-risk" for fraud, waste and abuse. The department first received that designation in 2007, initially over concerns about organisational restructuring and calls from policymakers for greater accountability and programme effectiveness.

The department pushed back against the findings, stating the report "omits critical information and context, resulting in an incomplete analysis." Officials added that it highlights "isolated anecdotes while ignoring system-wide data showing effective systems and controls."

The audit listed several specific examples of concern, though the department maintained its existing oversight mechanisms are adequate. The clash between the auditor's conclusions and the agency's response leaves unresolved the question of whether California's largest health programme has sufficient safeguards against financial misconduct.

Source: Google News MT — Crime (en)