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Investigative Medical Surveys

Investigative medical surveys are designed to be responsive to and address pressing concerns related to the delivery of health care and services. The goal is to initiate timely investigation, gather the facts and perform analysis in order to make compliance determinations and provide meaningful and useful reports on the particular issue. These survey reports are also open to the public.

Some examples of when the DMHC may choose to initiate an investigative survey:

  1. A plan has been non-compliant with written instructions from the Department.


  2. The Department suspects a violation of California managed care laws.


  3. An investigation is necessary into Plan acts or omissions constituting grounds for disciplinary action.


  4. Verification is needed to confirm Plan representations in response to a letter of deficiency.

Compliance with Section 1389.3; Post Claims Underwriting PDF Help


    Blue Cross of California Final Report and Plan Response

    Post Claims Underwriting - 08/29/08

      Follow-up Survey To Be Scheduled in Calendar Year 2010

    Blue Shield of California Final Report and Plan Response

    Post Claims Underwriting - 08/29/08

      Follow-up Survey To Be Scheduled in Calendar Year 2010

    Health Net of California Final Report and Plan Response

    Post Claims Underwriting - 08/29/08

      Follow-up Survey To Be Scheduled in Calendar Year 2010

    Kaiser Foundation Health Plan, Inc. Final Report and Plan Response

    Post Claims Underwriting - 08/29/08

      Follow-up Survey To Be Scheduled in Calendar Year 2010

    PacifiCare of California Final Report and Plan Response

    Post Claims Underwriting - 08/29/08

      Follow-up Survey To Be Scheduled in Calendar Year 2010
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Investigative Medical Surveys - Plan Final Reports PDF Help


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Whistleblower IssuesPDF Help