LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 813.05 Reporting Overpayments Resulting from Waste, Fraud, and Abuse
 
  PROCEDURES
  1. Completing the Overpayment Report
    1. Legal entity and Fee-for-Service contract providers must use the web-based Void Claim Reason Collection (VCRC) application to report all voids submitted to the Los Angeles County Department of Mental Health (DMH).
      1. The VCRC application will contain all claims that need to be reported for the specified reporting period.
        1. DMH will include detailed claim information in VCRC that will allow providers to identify each claim and void request included in the reporting period. The following is the minimum information to be included in VCRC for each claim:
          • Void Claim Submitter ID
          • Original Claim Submitter ID
          • Service Date
          • Procedure Code
          • Units
          • Amount
          • Client ID
          • Rendering Provider Name
          • Service Location Name
          • Void Submit Dt
          • Claim Submit Dt
          • Claim ID
          • DMH PCCN
          • State PCCN
          • Void Claim Status
          • Void Status
      2. Providers are to enter a brief statement describing the reason claims were voided into the Void Reason field.
        1. Each Void Reason must be categorized by the provider as Fraud, Waste, Abuse, or Other by selecting the appropriate category from the dropdown menu.
  2. Submitting the Report
    1. Once completed, providers must sign an Attestation for the report affirming that all voids submitted for the time period are included in the report and that the determination of whether the void was the result of fraud, waste, or abuse is true and accurate.
      1. Attestations must be signed by someone included in the contract as authorized to sign on behalf of the agency.
        1. CBO will only accept Attestations signed by an Authorized Signer.
        2. Individual Fee-for-Service providers may arrange to have a biller sign documents (i.e., contracts, agreements, etc.) on their behalf.  In the absence of such an arrangement, the individual Fee-for-Service provider is the Authorized Signer.
      2. Upload the signed Attestation to VCRC.
        1. Unsigned Attestations will be returned to the Legal Entity or Fee-for-Service provider.
        2. Attestations signed by someone not listed as an Authorized Signer for the agency or provider will be returned for a new signature.
      3. Reports are not considered complete until CBO accepts the report and Attestation.
  3. Reporting Overpayments to the State
    1. As the Mental Health Plan for Los Angeles County, each fiscal year, DMH must report all approved Medi-Cal claims that were voided. The void is considered a reversal of an overpayment to the provider.  CBO will create a report listing all voided Medi-Cal claims using the template from the California Department of Health Care Services (DHCS) attached to this policy.
    2. The report to DHCS must be in an Excel spreadsheet and include the following information for each claim:
      1. Payer Claim Control Number
      2. Client Index Number
      3. Health Care Provider National Provider Identifier
      4. Payment Amount
      5. Federal Financial Participation Amount
      6. Recovery Type Classification
        1. 42 CFR, section 438.608(d), or
        2. All other Medi-Cal
  4. Report Retention
    1. Contract providers shall retain the report submitted to DMH for a period of 10 years from the most recent date of service included in the report, the final date of the contract period between the plan and the provider, or from the date of completion of any audit, whichever is later.
    2. CBO shall retain the compiled report that is submitted to DHCS MHSUDS for period of 10 years from the most recent service date on the report or from the date of completion of any audit, whichever is later.