Suspension of Entities Submitting Claims for Suspended Providers

Thursday, Aug. 5th 2010 6:07 AM

The July Update is a list of providers who have been added to or removed from the Medi-Cal Suspended and Ineligible Provider List (S&I List) for the month of July. New providers have been added in bold and reinstated providers were removed from the following lists: susp A, susp C, susp E, susp G, susp J, susp P, susp R, susp S, susp T and susp U. Always refer to the S&I List when verifying provider ineligibility.

Eligibility or ineligibility must also be verified through the Health and Human Services (HHS) Office of Inspector General (OIG) List of Excluded Individuals/Entities.

Suspension of Entities Submitting Claims for Suspended Providers

Entities submitting claims for services rendered by a health care provider suspended from Medi-Cal or excluded from Medicare or Medicaid by the Federal Office of Inspector General are subject to Medi-Cal suspension.

Welfare and Institutions Code (W&I Code), Section 14043.61(a), states, in relevant part, that “a provider shall be subject to suspension if claims for payment are submitted under any provider number used by the provider to obtain reimbursement from Medi-Cal for the services, goods, supplies or merchandise provided, directly or indirectly, to a Medi-Cal recipient by an individual or entity that is suspended, excluded, or otherwise ineligible because of a sanction to receive, directly or indirectly, reimbursement from Medi-Cal and the individual or entity is listed on either the Medi-Cal Suspended and Ineligible Provider List 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.”

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Posted on Thursday, Aug. 5th 2010 6:07 AM | by Share of Cost | in Medi-Cal | 1 Comment »

One Comment on “Suspension of Entities Submitting Claims for Suspended Providers”

  1. Dan W Says:

    Independent Living Update: U.S. Departments of Housing & Urban Development (HUD) and Health & Human Services (HHS) Announce Effort to Move Persons with Disabilities from Institutions to Independence: HUD Secretary Shaun Donovan and HHS Secretary Kathleen Sebelius have announced a partnership to help nearly 1,000 non-elderly Americans with disabilities leave nursing homes or other facilities to live independently. HUD and HHS are offering rental assistance, health care and other supportive services targeted to this population. The two agencies also launched the Housing Capacity Building Initiative for Community Living Project to help seniors and people with chronic conditions find suitable housing and live more independent lives.

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