Repayment for Medical Services

Individuals must be advised that if they receive insurance payments from their private coverage for a service which has been paid by MC, they must repay MC.

Provider Overpayments (OP) Program

Any health insurance payments received by individuals for services covered by Medi-Cal must be reported and repaid to DHCS.

Individuals should provide the following information in the endorse section of any checks from insurance carriers as follows:

Name of Payee—Name and signature of the individual who received the check.
Medi-Cal Identification Number of Recipient—This may be a different person than the one who received the check.
“For Deposit Only to Health Care Deposit Fund”—This will ensure that the check will be properly applied to the state fund only.
Date(s) of service, the provider's name, and a daytime phone number where the individual can be reached.

DHCS Recovery

DHCS will recover payments made for MC services that should be paid by the client's OHC.

DHCS distributes OHC payments collected which exceed both the MC payments for the service and the administrative costs in collecting the payment as follows:

The difference between the provider's billing and the amount paid by MC must be paid to the provider, subject to the amount of the excess available.
Funds remaining must be paid to the legally entitled person or entity.

Repayment for Medical Services

Provider Overpayments (OP) Program

DHCS Recovery

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