California Government Code

§ 12528

GOV § 12528 Effective Jan 1, 2022Div. 3 · Title 2 · Part 2 · Ch. 6 · Art. 2

Statute text

(a)There is in the Office of the Attorney General the Division of Medi-Cal Fraud and Elder Abuse, which shall implement Sections 1903(a)(6), 1903(b)(3), and 1903(g) of the federal Social Security Act, as amended by the federal Medicare-Medicaid Anti-Fraud and Abuse Amendments (Public Law 95-142), and is authorized to conduct a statewide program for investigating and prosecuting, and referring for prosecution, violations of all applicable laws pertaining to fraud in the administration of the Medi-Cal program, the provision of medical assistance or medical supplies, or the activities of providers of medical assistance or medical suppliers under the Medi-Cal state plan. The investigation of fraud by beneficiaries of the Medi-Cal program shall be the responsibility of the Audits and Investigations Branch of the State Department of Health Care Services.

(b)The division shall also review complaints alleging abuse or neglect of patients in health care facilities receiving payments under the Medi-Cal state plan, and may review complaints of the misappropriation of patient’s private funds in those facilities and complaints of discriminatory treatment of Medi-Cal beneficiaries by those facilities.

(1)If the initial review indicates substantial potential for criminal prosecution, the division shall investigate the complaint or refer it to an appropriate criminal investigative or prosecutive authority.

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Legislative history

Amended by Stats. 2021, Ch. 554, Sec. 4. (SB 823) Effective January 1, 2022.