§ 12305.84
319 words·~1 min read·
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(a)Upon enactment of this section, the department shall convene a stakeholder group and begin a process with this group to develop and issue a report evaluating the implementation of the quality assurance and fraud prevention and detection activities enacted from 2004 to the present. The department shall include and collaborate with the State Department of Health Care Services, the California State Association of Counties, the County Welfare Directors Association, and stakeholders representing consumers and providers.
(b)The department shall provide this report to the Legislature on or before December 31, 2010.
(c)The stakeholder group shall:
(1)Review the annual error reports issued and state-level quality assurance activities to date required by Section 12305.7 and review and evaluate the implementation of county quality assurance activities required by Section 12305.71, including a review of the number of instances, amounts, and causes of overpayments and underpayments identified by quality assurance activity at the state and county level from enactment to date.
(2)Review information available regarding prevention and early detection of fraud, the latter as defined by Section 12305.81.
(3)Collect and review information regarding referrals of suspected fraud to the State Department of Health Care Services pursuant to Section 12305.82, and subsequent investigative efforts, including cost-benefit information regarding these efforts, as well as the number of fraud cases handled locally.
(4)Collect and review information regarding final convictions for fraud, including all of the following:
(A)The amount of funds involved in the conviction.
(B)The basis of the fraud conviction, including whether it involved services not provided or falsified consumers or providers, or both.
(C)Aggregate information regarding the number and source of individuals responsible, including, but not limited to, state employees, IHSS providers, consumers, county workers, or others.
(5)Provide recommendations on options for preventing errors and fraud for both the state and county levels, and recommendations for early detection strategies to combat fraud in the program.