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.
Insurance fraud involves making false or exaggerated claims to an insurance provider.
- Hard Fraud: Someone deliberately causes a loss (e.g., setting fire to a warehouse or staging a car accident) specifically to collect a payout.
- Soft Fraud: More common and often viewed as “victimless” by the perpetrator. It involves exaggerating a legitimate claim, such as overstating the value of stolen items in a home burglary to cover the deductible.