State of California California Department of Consumer Affairs

Medicaid

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The Medicaid is a jointly-funded, Federal-State health insurance program for certain low income and needy people. It covers approximately 37 million individuals including children, the aged, blind, and/or disabled, and people who are eligible to receive federally assisted income maintenance payments. The Health Care Financing Administration (HCFA), a federal agency, mandates certain eligibility classes and quality of care standards with the bulk of the administrative functions being carried by the State.



Administers the Medicaid program at the federal level and provides general Medicaid information for consumers and beneficiaries:

US Department of Health and Human Services
Center for Medicare and Medicaid Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
(877) 696-6775

www.os.dhhs.gov


Medi-Cal is California’s Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes.


State of California Department of Health Services, Medical Care Services:

Local County Welfare/Social Services Departments manage Medi-Cal eligibility determinations. For complete Medi-Cal Eligibility information or other health-related services consumers should contact their nearest County Social Services Office. Consult local telephone book or Medical Care Services’ online directory.

www.dhs.ca.gov


How to Report Medicaid Fraud and Who to Contact:

The primary contact for reporting suspected fraud, whether perpetrated by an individual or agency is the California Department of Health Services (DHS). DHS is the state agency responsible for policing fraud in the Medicaid program.


Department of Health Services
Medical Care Services
P.O. Box 997413 MS 4000
Sacramento, CA 95899-7413
(916) 440-7805 Fax
www.dhs.ca.gov


A second, less direct contact, is the U.S. Department of Justice, Office of Inspector General's National Fraud Hotline to report both Medicaid and Medicare Fraud.


US Department of Justice
Office of Inspector General's National Fraud Hotline
(800) 869-4499
www.usdoj.gov


Before you write the California Department of Health Services or call the National Fraud Hotline, have as much of the following claim information as possible:


  1. Recipient's name
  2. Recipient's Medicaid number
  3. Provider's name
  4. Date of service
  5. Amount approved by Medicaid
  6. Description of fraudulent or abusive acts


See:
Medi-Cal
Medicare



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