MedicaidAdministrativeMedium impact
20-402 Fraud, Waste and Abuse Responsibilities
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net has issued new fraud, waste and abuse reporting requirements for Medi-Cal providers in three California counties. All providers must report suspected fraud cases within 10 calendar days and maintain compliance programs with specific detection mechanisms.
Action Required
Immediately: All staff must be trained on fraud, waste and abuse definitions and reporting procedures. Establish internal compliance monitoring processes and maintain documentation logs. Report any suspected fraud to Health Net Special Investigations Unit at 1-866-685-8664 within 10 calendar days of discovery. Review and update compliance policies to meet Title 42 CFR section 438.608(a) requirements.