Photograph by Vivian Lowe
Medi-Cal law, Welfare and Institutions Code (W&I Code), sections 14043.6 and 14123, mandate that the Department of Health Care Services (DHCS) suspend a Medi-Cal provider of health care services (provider) from participation in the Medi-Cal program when the individual or entity has:
- Been convicted of a felony;
- Been convicted of a misdemeanor involving fraud, abuse of the Medi-Cal program or any patient, or otherwise substantially related to the qualifications, functions, or duties of a provider of service;
- Been suspended from the federal Medicare or Medicaid programs for any reason;
- Lost or surrendered a license, certificate, or approval to provide health care; or
- Breached a contractual agreement with the Department that explicitly specifies inclusion on this list as a consequence of the breach.
https://files.medi-cal.ca.gov/pubsdoco/SandILanding.asp MEDI-CAL Exclusion List
WWW.PEDCorr@dhcs.ca.gov
If you are on the Medi-Cal Provider Exclusion list contact the Medi-Cal Provider Enrollment Division
916-323-1945 Option 4, Option 3 voice mail, Option 2 email
http://www.dhcs.ca.gov/provgovpart/Pages/ContactPED.aspx
Department of Health Care Services
Provider Enrollment Division
MS 4704
P. O. Box 997412
Sacramento, CA 95899-7412
Write to request your name be removed from the Medi-Cal Provider Exclusion list. It requires a petition be sent to:
Medi-Cal Office of Legal Services MS011
Deputy Director / Chief Counsel of the California Dept. of Health Care Services. Leanne Yu Attorney
P.O. Box 997413
Sacramento, Ca. 95899-7413
ph 916-440-7700 (a phone message may be left) fax 916-440-7712
Once a request for removal of one’s name from the Medi-Cal Exclusion list is received by the Medi-Cal Legal Services Office, the case is sent to an attorney who reviews it. The attorney then sends it on to the Department of Health Care Services (DHCS) Investigation Office. Even though the BRN has already done an investigation, the DHCS needs to do their own secondary investigation. Although the nurse may have received a bill for the BRN’s investigation, often costing thousands of dollars, they will not be charged for the DHCS investigation.
As part of the investigative process, the nurse may be interviewed by 1-2 investigators in their home or other private location. Required paperwork will be provided by the investigators. Collateral interviews of friends, family, and colleagues will be done. The completed investigation will be returned to the DHCS Attorney’s office where a determination will be made whether or not to reinstate the nurse’s Medi-Cal provider privileges. Once a decision has been made to remove the nurse’s name from the exclusion list, the update will appear in the following month’s updated website list. The process for withdrawing a nurse’s name from the Medi-Cal Exclusion List can take up to 1 1/2 years. Cooperation, patience, and perseverance are requisites.
Eureka, Ca. Coastline. Photograph by Keith Cooper http://www.northlight-images.co.uk/gallery.html