MedicaidAdministrativeHigh impact
23-1348m Your Role in Following the False Claims Act
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
This policy update reinforces compliance requirements with federal and state False Claims Act laws for all healthcare providers. It establishes mandatory reporting procedures for fraud, waste, and abuse, requiring providers to promptly report violations to the Plan's Compliance Department and cooperate with investigations.
Action Required
Immediately: All staff must be trained on False Claims Act requirements and reporting procedures. Billing team must implement written policies detailing FCA compliance for all employees and subcontractors. Post the FWA hotline number (866-685-8664) prominently and ensure all staff know to report suspected fraud, waste, or abuse violations promptly to avoid civil penalties and liability.