California Drug Medi-Cal Program To Implement Risk-Based Provider Organization Utilization Reviews

The California Department of Health Care Services (DHCS) is implementing risk-based provider organization utilization reviews as a strategy to reduce fraud and overbilling in the Drug Medi-Cal program that provides Medicaid addiction treatment services.  DHCS will determine provider organization risk levels based on past review deficiencies, complaints, suspensions, data mining, investigator recommendations, findings from county audits, funding levels, patient caseloads, and significant change in billing or service trends.

The risk based reviews were among 32 recommendations of the DHCS Audits & Investigations Division in Cal Program Limited Scope Review." The review was conducted after oversight of the Drug . . .