Drug Medi-Cal Financial Audits Sample Clauses

Drug Medi-Cal Financial Audits. A. In addition to the audit requirements set forth in Exhibit D(F), State may also conduct financial audits of DMC programs, exclusive of NTP services, to accomplish any of, but not limited to, the following audit objectives: 1. To review reported costs for validity, appropriate allocation methodology, and compliance with Medicaid laws and regulations; 2. To ensure that only the cost of allowable DMC activities are included in reported costs; 3. To determine the provider’s usual and customary charge to the general public in accordance with CMS (The Medicare Provider Reimbursement Manual) (CMS- Pub.15), which can be obtained from the Centers for Medicare & Medicaid Services, Baltimore, Maryland, or xxx.xxx.xxx.xxx, for comparison to the DMC cost per unit; 4. To review documentation of units of service and determine the final number of approved units of service; 5. To determine the amount of clients’ third-party revenue and Medi-Cal share of cost to offset allowable DMC reimbursement; and, 6. To compute final settlement based on the lower of actual allowable cost, the usual and customary charge, or the maximum allowance, in accordance with Title 22, Section 51516.1. B. In addition to the audit requirements set forth in Exhibit D(F), State may conduct financial audits of NTP programs. For NTP services, the audits will address items A(3) through A(5) above, except that the comparison of the provider’s usual and customary charge in A(3) will be to the DMC USDR rate in lieu of DMC cost per unit. In addition, these audits will include, but not be limited to: 1. For those NTP providers required to submit a cost report pursuant to W&IC Section 14124.24, a review of cost allocation methodology between NTP and other service modalities, and between DMC and other funding sources; 2. A review of actual costs incurred for comparison to services claimed;