Non-Routine Audits and Investigations

Managed Healthcare Unlimited (MHU) has a stellar reputation for its focused investigations of key issues brought to the attention of regulatory agencies by consumers, providers, the legislature, watchdog groups, and other stakeholders. MHU’s highly competent staff and consultants provide rapid response and maintain maximum operational flexibility during the course of the investigative process.

The following special audits and investigations exemplify MHU’s breadth and depth of experience. Please contact MHU for a complete listing of projects.

  • MHU conducted quarterly reviews of four health plans selected by the California Department of Health Care Services to implement the Medi-Cal Managed Health Care Expansion into Rural Counties and the Medi-Cal Managed Care Program. The purpose of the program was to improve the availability and accessibility of Medicaid services to underserved rural areas in 28 counties of the state.
  • MHU investigated a health plan’s quality of care issues in response to enrollee complaints involving healthcare delivery. As a result of this investigation, a corrective action plan was developed for the plan in order to resolve the cited deficiencies identified during the investigation.
  • MHU investigated a major health plan’s kidney transplant program following a negative newspaper article alleging inappropriate handling of transplant candidates. The investigation resulted in discontinuation of the program.
  • MHU investigated a health plan’s emergency room claims denial practices in response to provider grievances. The investigation led to the plan’s implementation of new processes and establishment of best practices.
  • MHU audited a major health plan’s behavioral health accessibility and availability based on enrollee complaints and issues uncovered in multiple routine audits. The investigation resulted in the plan’s reorganization of its behavioral health practices and policies and a levy of a multi-million-dollar penalty.


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