Calif. Officials Overstated Number of Medi-Cal Providers in 2013
The California Department of Health Care Services' 2013 statewide Medi-Cal provider list included more physicians than were actually licensed to practice in the state that year, HealthyCal reports. Medi-Cal is California's Medicaid program.
In May, DHCS responded to a public records request and said that about 109,000 physicians accepted Medi-Cal in spring 2013, according to HealthyCal. The agency also said that the number of doctors who accept Medi-Cal decreased by 25% by spring 2014, totaling just 82,605.
However, the California Medical Association later noted that its 2012-2013 annual report found that there were only 104,422 licensed doctors in California in 2013. In addition, CMA said that a significant number of those doctors do not accept Medi-Cal.
According to HealthyCal, the state's list of Medi-Cal providers is used to determine whether there are enough physicians to serve the program's beneficiaries.
DHCS spokesperson Anthony Cava said the 2013 data it provided "did not reflect the ongoing efforts by DHCS to improve the provider list." He said the overstated provider list might have included:
- Deceased doctors;
- Duplicated names; and
- Retired doctors.
Cava noted that DHCS tracks physicians who begin participating in Medi-Cal, but providers are not required to notify the agency if they decide to no longer accept patients in the program.
He added that the agency has "conducted an extensive review of the list to remove providers who do not participate in Medi-Cal, such as those who have not billed the department for any services provided to members in a year."
CMA spokesperson Molly Weedn said her organization is troubled by the inaccurate 2013 provider list and now questions the accuracy of DHCS' 2014 provider data.
Weedn said the incident "highlights that [DHCS is] continuing to put out really inflated numbers and then say that it's OK to move forward with cuts (to the state's reimbursement rate to doctors) because there's plenty of physicians."
Chris Perrone, director of the health reform and public programs initiative at the California HealthCare Foundation, said the state's list of Medi-Cal providers is a "terrible" tool for knowing how many physicians accept Medi-Cal patients. CHCF publishes California Healthline.
However, Perrone added, "I'm hopefu[l] that it can be improved in the future."
CHCF is working with UC-San Francisco to analyze physician participation in Medi-Cal through 2013 and will release findings in late July (Guzik, HealthyCal, 7/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.