California Suspended and Ineligible Provider List

Medi-Cal law (Welfare and Institutions Code, sections 14043.6 and 14123) mandates that the California Department of Health Care Services (DHCS) suspends a Medi-Cal provider when he/she (a) has been convicted of a felony, (b) has 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, (c) has been suspended from the federal Medicare or Medicaid programs for any reason, (d) has lost or surrendered a license, certificate, or approval to provide health care, or (e) has breached a contractual agreement with the Department that explicitly specifies inclusion on this list as a consequence of the breach.

• Why it matters: Services ordered, referred, or rendered by excluded parties are non‑payable; employing or contracting with excluded providers risks recoupment and civil monetary penalties.
• What to verify: Legal name and aliases, NPI/Medicaid ID, license/board status, date of birth (if available), last known city/state, and exclusion effective/end dates.
• Update cadence: Typically updated monthly by the state. Record the file’s “as of” date and screen at hire and monthly thereafter.
• Compliance tips:
  • Cross‑check with OIG LEIE and SAM.gov and retain dated evidence of each search.
  • Add system blocks to prevent ordering/prescribing by excluded providers.
  • Document remediation steps for positive matches (schedule removal, claim holds, notifications).