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Federal and State Program Integrity in California

California does not have extensive regulations concerning fraud and abuse of health care programs.  However, the law does require providers  to reimburse the Department of Health Services for any Medicaid funds that are acquired using false or incomplete information.1

 

Footnotes

  • 1. Welfare & Inst. Code 14043.3

 

Federal and State Program Integrity in California

Subtopic Statute/Regulation Description
Federal and State Program Integrity Medi-Cal Beneficiary Privacy and Fraud Reduction-Cal. Welf. & Inst. Code § 14045 Medi-Cal beneficiary social security numbers cannot be transferred by providers if the beneficiary has a personalized Medi-Cal identification card...
Fraud and abuse provisions about Medicaid or Medicare: Anti-kickback laws Reimbursement of Medicaid Funds Due To Nonreported or Falsely Reported Information – Cal. Welf. & Inst. Code § 14043.3 A provider is required to reimburse Medicaid funds acquired using false or incomplete information to the Department of Health Services. Definitions...
Fraud and abuse provisions about Medicaid or Medicare: False claims submitted to Medicaid or Medicare Reimbursement of Medicaid Funds Due To Nonreported or Falsely Reported Information – Cal. Welf. & Inst. Code § 14043.3 A provider is required to reimburse Medicaid funds acquired using false or incomplete information to the Department of Health Services. Definitions...
Fraud and abuse provisions about Medicaid or Medicare: Laws prohibiting self-referrals Reimbursement of Medicaid Funds Due To Nonreported or Falsely Reported Information – Cal. Welf. & Inst. Code § 14043.3 A provider is required to reimburse Medicaid funds acquired using false or incomplete information to the Department of Health Services. Definitions...