Letter To CalOptima From CMS Medicare Parts C & D Oversight & Enforcement Group Regarding Audit Findings

CalOptima, a county-operated health system serving Orange County, California, has delayed its participation in the state's MediConnect demonstration project to integrate care for dually eligible Medicare and Medicaid beneficiaries. Before it can participate, CalOptima must address 57 deficiencies in its OneCare, Medicare Advantage Special Needs Plan identified in a federal Medicare audit in November 2013, and must address deficiencies in its Medi-Cal program identified by the California Department of Health Care Services (DHCS) in a February audit triggered by the federal findings. The federal findings were announced in late January; the DHCS review outcomes were announced on . . .