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US California Medicaid Suspended and ineligible providers

Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.

This dataset contains information about individuals and entities suspended from the California State Medicaid Program. The following text extracted from their website explains the reasons a provider might be suspended and the provisions taken:

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.

Services rendered, prescribed or ordered by a suspended Medi-Cal provider shall not be covered by the Medi-Cal program while the suspension is in effect. California Code of Regulations, title 22, section 51303, subdivision (k), provides that at least fifteen (15) days written notice be given to all affected providers. This list constitutes such written notice. Although the period of suspension may have expired, reinstatement rights are not automatic. The provider must petition for reinstatement and re-enroll with DHCS before being reimbursed for services rendered. Providers suspended as a result of a Medicare action must appeal through the Medicare office before applying for re-enrollment with Medi-Cal.

In accordance with W&I Code, section 14043.61, subdivision (a), a provider of health care services shall be subject to suspension if claims for payment are submitted under any provider number used by the provider to obtain reimbursement from the Medi-Cal program for the services, goods, supplies or merchandise provided, directly or indirectly to a Medi-Cal beneficiary, by an individual or entity that is suspended, excluded or otherwise ineligible because of a sanction to receive, directly or indirectly, reimbursement from the Medi-Cal program and the individual or entity is listed on either the Medi-Cal Suspended and Ineligible Provider List (S&I List) published by DHCS to identify suspended and otherwise ineligible providers, or any list published by the federal Office of Inspector General regarding the suspension or exclusion of individuals or entities from the federal Medicare and Medicaid programs, to identify suspended, excluded or otherwise ineligible providers.

Data overview

Entities:
Total44,932
Searchable22,466
Targets22,184
Entity types:
People21,335
Companies849
Legal entities282
Countries:
United States22,466
Publisher:Department of Health Care Services (DHCS) · United States

The Department of Health Care Services (DHCS) is a department within the California Health and Human Services Agency that finances and administers a number of individual health care service delivery programs, including Medi-Cal, which provides health care services to low-income people.

Collections:in Debarred Companies and Individuals · OpenSanctions Default
Information:mcweb.apps.prd.cammis.medi-cal.ca.gov
Source data:mcweb.apps.prd.cammis.medi-cal.ca.gov · XLSX
Coverage:added · update frequency: daily
Last processed:2024-12-10 02:31:47
Last change:
Errors:1 Error

Bulk download

Downloads contain the full set of entities contained in this dataset. You can fetch a simplified tabular form, or detailed, structured data in JSON format. Updated files will be provided once a day at the same location.

File nameExport typeSize
entities.ftm.jsonFollowTheMoney entities24.21 MB
names.txtTarget names text file546.88 KB
senzing.jsonSenzing entity format12.71 MB
source.xlsxSource data2.16 MB
targets.nested.jsonTargets as nested JSON24.5 MB
targets.simple.csvTargets as simplified CSV6.03 MB

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Using the API

You can query the data in this dataset via the application programming interface (API) endpoints below. Please read the introduction for documentation and terms of service.

Use the Reconciliation API in OpenRefine:
For full-text search, use the /search endpoint:
For entity matching, use the /match endpoint:

Recent additions

The following targeted entities have been added to this data source most recently:

AddedNameTypeCountries
Stacy Sachiko HullPersonUnited States
Richard Cross Bennett, Jr.PersonUnited States
Allington Thacher HagenPersonUnited States
Alina Esther ZeidlerPersonUnited States
Denise Wynnet HendersonPersonUnited States
Shanelle Lynae FranksPersonUnited States
Shannon Marie RobinsonPersonUnited States
Susan Marie WildePersonUnited States
Lucas Joseph HerrmanPersonUnited States
Judy CruzPersonUnited States
Anil MehtaPersonUnited States
Michelle Denise WardPersonUnited States
Braden Carl AndersenPersonUnited States
Donna Lynn IrwinPersonUnited States
Louis Robert MandrisPersonUnited States