Medicaid Audit Intelligence

CA · Medicaid jurisdiction

California Medicaid audit evidence

Review reports connected to California Medicaid oversight, ordered by publication date.

Evidence register

6 reports

Published
Jun 2026
Jurisdiction
California
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 162

California's Medicaid Reimbursements for Clinical Diagnostic Laboratory Services

The State agency did not always claim Federal Medicaid reimbursement for clinical diagnostic laboratory services in accordance with Federal and State requirements, resulting in overpayments totaling $13.9 million (Federal share) and potentially $29.3 million (Federal share not…

Findings
4
Recommendations
4
Open evidence record
Source status
Original source
Published
Feb 15, 2024
Jurisdiction
California
Publishing agency
California State Auditor
Report ID
REPORT 39

The Comprehensive Perinatal Services Program

The State has provided limited oversight of the Comprehensive Perinatal Services Program and has not meaningfully improved the program. Data limitations and insufficient oversight hinder the ability to determine whether Medi-Cal members receive CPSP services as intended or whe…

Findings
8
Recommendations
9
Open evidence record
Source status
Original source
Published
Nov 28, 2023
Jurisdiction
California
Publishing agency
California State Auditor
Report ID
REPORT 38

Children Enrolled in Medi‑Cal Face Challenges in Accessing Behavioral Health Care

The departments can do more to detect and address access challenges faced by children in Medi-Cal seeking behavioral health services. Current monitoring and survey practices have significant weaknesses, and regional disparities and provider shortages exacerbate access issues.…

Findings
4
Recommendations
5
Open evidence record
Source status
Original source
Published
Nov 29, 2022
Jurisdiction
California
Publishing agency
California State Auditor
Report ID
REPORT 106

Proposition 56 Tobacco Tax The Department Of Health Care Services Is Not Adequately Monitoring Provider Payments Funded By Tobacco Taxes

Overall, the audit found significant control weaknesses in how Proposition 56 funds and OTP taxes were administered: DHCS did not adequately monitor supplemental payments or provider suspensions in Medi-Cal, CDTFA did not consistently verify wholesale costs for OTP tax calcula…

Findings
6
Recommendations
9
Open evidence record
Source status
Original source
Published
Jul 8, 2021
Jurisdiction
California
Publishing agency
California State Auditor
Report ID
REPORT 116

Despite the COVID-19 Public Health Emergency, the Department Can Do More to Address Chronic Medi-Cal Eligibility Problems

Health Care Services halted efforts to resolve hundreds of thousands of known Medi-Cal eligibility discrepancies during the public health emergency, leading to a growing backlog and increased risk of improper payments and federal penalties; some emergency waivers and communica…

Findings
6
Recommendations
6
Open evidence record
Source status
Original source
Published
Jan 5, 2021
Jurisdiction
California
Publishing agency
California State Auditor
Report ID
REPORT 113

Proposition 56 Tobacco Tax State Agencies’ Weak Administration Reduced Revenue by Millions of Dollars and Led to the Improper Use and Inadequate Disclosure of Funds

The audit concludes that inaccuracies in CDTFA’s tax rate calculation and insufficient safeguards and public disclosure across several agencies impeded program integrity, resulting in potential revenue losses and misallocation of Prop 56 funds intended for health and public he…

Findings
5
Recommendations
8
Open evidence record
Source status
Original source