MedicaidAdministrativeMedium impact
20-401 Fraud, Waste and Abuse Responsibilities
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net has updated their fraud, waste and abuse (FWA) responsibilities policy, requiring delegated physician groups to maintain compliance programs and report suspected FWA cases within 10 calendar days. The policy defines fraud, waste, and abuse with specific examples and establishes reporting procedures through Health Net's Special Investigations Unit.
Action Required
Immediately: Billing and compliance teams must ensure FWA reporting procedures are in place. Report any suspected fraud, waste, or abuse cases to Health Net Special Investigations Unit within 10 calendar days at 1-866-685-8664. Review billing practices to ensure compliance with examples outlined (proper documentation, appropriate service levels, no duplicate billing). Delegated PPGs must maintain compliance programs meeting Title 42 CFR section 438.608(a) requirements.