Legal · CA
California Auditor Finds DHCS Left 26,000 High-Risk Providers Uninvestigated
A report released by California State Auditor Grant Parks finds the Department of Health Care Services has failed to investigate 26,000 of the 28,000 Medi-Cal providers it classifies as highest-risk for fraud, waste and abuse. The audit cites specific examples, including two providers that billed nearly $1.6 million despite having been deemed program-ineligible years earlier, and a transportation provider that claimed implausible mileage while collecting more than $11 million in 2024-25. The report reaffirms DHCS's long-standing "high-risk" designation, first applied in 2007. DHCS disputes the findings, saying the report omits context and relies on isolated anecdotes rather than system-wide data showing effective controls.
Why it mattersThe findings signal heightened scrutiny and potential corrective-action requirements for California's Medicaid program integrity operations, with implications for provider enrollment screening and managed care plan oversight obligations statewide.