A Medi-Cal provider may face suspension, revocation, or surrender of their Medi-Cal provider license if:
- Convicted of a felony;
- A misdemeanor involving misappropriation of funds, fraud or abuse of a patient;
- A conviction that is substantially related to the qualifications, functions, or duties of a provider;
- Suspension by the Federal Medicare program or another state Medicaid program; or
- Express breach of a contractual obligation with the Department as specified in the Agreement with the Department.
California Welfare & Institutions Code Section 14043.6 states the department shall automatically suspend, as a provider in the Medi-Cal program, any individual who, or any entity that, has a license, certificate, or other approval to provide health care, which is revoked or suspended by a federal, California, or another state’s licensing, certification, or approval authority, has otherwise lost that license, certificate, or approval, or has surrendered that license, certificate, or approval while a disciplinary hearing on that license, certificate, or approval was pending. The automatic suspension shall be effective on the date that the license, certificate, or approval was revoked, lost, or surrendered.
If a Medi-Cal Provider’s license has been suspended, the 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. Moreover, reinstatement rights are not automatic. The provider is best served by hiring a qualified attorney to petition for reinstatement and to have the provider re-enroll with the Department. Individuals names that are placed on the Office of Inspector General (OIG) list will not be allowed to participate in the Medi-Cal program.
If your facility, pharmacy, or nursing home is under investigation for falsification of Medi-Cal records, elder abuse, fraud, misappropriation of funds, false claims, kick-backs, or bribes, call the Khachatourians Law Group for a defense consultation.