Back to Stop Medi-Cal Fraud
The Staff at DHCS Stop Medi-Cal Fraud Intake Unit handle all inquiries regarding Medi-Cal Fraud. We receive hundreds of fraud complaints daily by e-mail, the Stop Medi-Cal Fraud and IHSS Fraud Hotlines, hard mail and directly from various other agencies.
- The Intake Unit responds to all inquiries, calls and e-mails
- Staff processes the information and inputs it into a tracking data base
- As needed, staff will contact the reporting party to verify, seek or clarify information
- Staff analyzes the complaint and determines if it should be referred to one of the regional Audits and Investigations offices for investigation and resolution.
- Investigators interview witnesses, evaluate claims data, conduct data searches and perform other investigation activities.
- If sufficient evidence exists, A&I will refer the case to the Department of Justice…
CLICK HERE to read the FULL How We Handle Complaints – DHCS – CA.gov article.
MANAGEMENT & CULTURE (THE “TONE AT THE TOP”)
Fraud thrives in “sloppy” environments where leadership ignores the rules.
- The Fraud Triangle: For fraud to occur, three elements must be present: Pressure (the need for money), Rationalization (thinking “I deserve this”), and Opportunity (weak controls). You can only control the Opportunity.
- Whistleblower Hotline: Provide an anonymous way for staff to report “odd behavior.” Most internal frauds are caught via tips, not audits.
- Background Checks: Conduct credit and criminal record checks for all employees in financial or data-sensitive roles.
- Annual Ethics Training: Make sure every staff member knows that the company has a Zero Tolerance policy toward “borrowing” from petty cash or fudging overtime.