State of and Human Services Agency 5 Department of Health Care Services CONFIDENTIAL mav DOUGLAS EDMUND G. BROWN JR. Director Governor July 17, 2013 Dear - DRUG PROVIDER NUMBER: - NATIONAL PROVIDER IDENTIFIER ANY OTHER PROVIDER OR NATIONAL PROVIDER IDENTIFIER ISSUED TO You The Department of Health Care Services (DHCS) Medi-Cal Program is taking the following actions regarding your Medi-Cal services: (1) temporarily withholding 100% payment to you effective the date of this letter, and (2) suspending and deactivating your Drug Medi~Ca| (DMC) Provider nuInber(s) and National Provider ldentitier number(s), effective July 27, 2013. The withhold applies to the following DMC Provider number-nd NPI number The DHCS conducted an unannounced site visit on July 11, 2013, at' associated with Drug Medi--Cal number' The review reveae owing: During the unannounced site review, it was determined that patients do not meet medical rieoessity {or substance use disorder treatment services. lack of medical oversight was provided, provider staff were unable to provide patient records in a timely manner, treatment plans were missing, and there was a lack of documented services. The evidence set out above, which includes evidence of fraud, leads the Medical Program to conclude that you may have committed fraud and/ or willful misrepresentation against the Medical program. The temporary suspension and deactivation applies to the following DMC Provider numberjand NPI number Audits investigations Division, Medical Review Branch PO Box 997413. samamento. CA 95599-7413 Telephone Number (915) 440-7450 -- FAX Number (915) 323-3441 lrltemet Address' dries ca gov Page 2 JUL 1 7 M3 The DHCS is temporarily suspending and deactivating your Provider number and National Provider identifier number in accordance with California Welfare and Institutions Code Section 14043 36 The basis of this action is because you are under investigation by the Department of Justice, During an unannounced site review on--July 11, 2013, evidence was foundto indicate credible allegation of fraud. abuse and wiilfui misrepresentation to the DHCS. The actions set forth above are not final adverse actions and will not be reported to the Healthcare Integrity Protection Data Bank (Code of Federal Regulations, Title 45, section 61 1). Appeal Rights If you disagree with this action, you have the right to appeal the withhold, temporary suspension and deactivation pursuant to Welfare and institutions Code, section 14043.65 This appeal procedure does not include a formal administrative hearing underthe Administrative Procedure Act. An appeal will not result in the reactivation of any deactivated DMC provider number(s) and NPI numberts) during the appeal process . If you decide to appeal the temporary suspension and deactivation, you must submit a written appeal including all pertinent documents and all other relevant evidence for consideration by the Department of Health Care Services, Medi-Cal Program within 60 days of the date of this notification letter. Please submit your original appeal request, all pertinent documents and all other relevant written evidence to. Deputy Director, Mental Health and Substance Use Disorder Services Department of Health Care Services 13.0. Box 997413, MS 2601 Sacramento, CA 958997413 Please also submit a copy of your appeal request, all pertinent documents and all other relevant written evidence to: . Department of Health Care Services Audits and investigations Medical Review Branch P.O Box 997413, MS 2303 Sacramento, CA 95899-7413 CONFIDENTIAL ge JUL 2013 Upon receipt of all pertinent documents and all other relevant evidence supporting an appeal, the director or the director's designee shall review all the relevant materials submitted and shall issue a decision within 90 days of the receipt of the appeal, This decision shall be final. The paymentwithhold, temporary suspension and deactivation will continue until Medi- Cal determines that you are no longer under investigation for fraud or abuse, or after legal proceedings related to the alleged fraud or abuses are completed. This action will result in deactivation 01 your DMC Provider number(s) and number(s) noted above and any other Provider number(s) and NPI number(s) issued to you. During the time you are temporarily suspended from the Medi--Cal Program, sen/ices rendered by you may not be billed to the Medi-Cal Program, either by you or anyone else, and no business owned by you may bill Mecli-Cal. You may not participate in the Medi--Cal Program during this suspension, including being prohibited from acting in a capacity which facilitates the generation of claims, directly or indirectly, to Medi-Cal. Please be advised that submission of claims for items or services which were not provided as claimed, are not reimbursable under the Medi-Cal Program, or which were claimed in violation of an agreement with the State via a contract with the County of Los Angeles. may subiect you and/or your organization to Civil Money Penalty (CMP) in accordance with Welfare and lnstitutions Code. sections 14123 2 and/or 14123.25 If you believe that the information on which the Medi-Cal Program is relying to support its payment withhold and temporary suspension is erroneous, you may request a Meet and Confer with representatives of the DHCS by completing the enclosed form Submit the completed form and any additional information to the following: Marisa Razo, Chief Administrative Sanctions Unit Department of Health Care Seivioes Audits Investigations Medical Review Branch PO. Box 997413, MS 2303 Sacramento, CA 95899-7413 Alter receiving your request, a DHCS representative will contact you to schedule a Meet and Confer. This Meet and Confer is independent of vour appeal riqhts. You are not required to schedule a Meet and Confer and if you do not do so itwill not limit vour right to challenge the DHCS action in an appeal. CONFIDENTIAL JUL 1] 2013 Mr. davekneilsen, Division Chief SUD Prevention, Treatment and Recovery Services Division Ms. Susan King, Branch Chief - Fiscal Management and Accountability Branch SUD Prevention, Treatment and Recovery Services Division Mr] Jeffery Sandman, Chief Financial Audits Branch 1500 Capitol Avenue, MS 2100 Sacramento, CA 95899-7413 Ms. Caitlin Furtek Associate Governmentai Program Analyst investigations Branch PO Box 997413, MS 2200 Sacramento, CA 95899-7413 [send via email] Mr. BiI|Aiameda -- 'Assistant Deputy Director Audits and Investigations 1500 Capitol Avenue. MS 2000 Sacramento, CA 95899-7413 CONFIDENTIAL