California Medi-Cal Suspended and Ineligible Providers List

The California Medi-Cal Suspended and Ineligible Provider List, known as the S&I List, is the public registry the Department of Health Care Services (DHCS) uses to identify every provider barred from billing the Medi-Cal program. It is published through the Medi-Cal provider portal and can be searched by provider name, license number, or National Provider Identifier.¹ If a provider’s name appears there, no claim for their services will be paid, and any entity that submits one anyway is exposed to steep penalties.

Where to Find the List and How It Works

The S&I List lives on the Medi-Cal website and is updated as DHCS processes suspensions. Publication on the list does double duty. It is the public registry healthcare organizations use for screening, and it is also the legally required written notice to the suspended provider. California regulations require at least 15 days’ written notice to suspended providers, and appearing on the published list satisfies that notice requirement.¹

The list reflects state action only. A separate federal registry, the Office of Inspector General’s List of Excluded Individuals/Entities (LEIE), covers exclusions from Medicare and all state Medicaid programs. A provider can appear on one, the other, or both, and screening against both is the standard practice for any entity that bills federal or state health programs.

Who Lands on the List

Most placements are automatic. Under Welfare and Institutions Code section 14123, DHCS must suspend a provider when any of several events occur:²

Conviction of a felony, or a misdemeanor involving fraud, patient abuse, or conduct related to the provider’s professional duties.
Revocation, suspension, surrender, or loss of a professional license by any state or federal licensing authority. The suspension takes effect on the date of the license action, with no grace period.¹
Receipt by DHCS of written notice from the U.S. Department of Health and Human Services that the provider has been suspended from Medicare or Medicaid in any state.
Breach of a contractual agreement with DHCS that names inclusion on the suspended list as a consequence.¹

The statute uses “shall,” not “may.” For these triggers, DHCS has no discretion.

Outside the automatic categories, the DHCS director can suspend a provider for violating any Medi-Cal program rule. Discretionary suspensions can run for a fixed or indefinite term, can carry conditions, and can be stayed or placed on probation.² If the director believes immediate action is needed to protect public welfare or program integrity, a temporary suspension can be imposed before any hearing, with the formal accusation served at the same time as the suspension notice.

Why Employers and Billing Entities Must Screen It

No provider or entity may bill or submit a Medi-Cal claim for services rendered in whole or in part by a suspended provider during the suspension period.³ The exposure falls on the entity that submits the claim, which is why screening is not optional for Medi-Cal billing organizations.

Any person or entity that submits a Medi-Cal claim knowing the provider has been suspended faces a state civil money penalty of up to three times the amount claimed for each item or service. For intentional violations that continue over time, the treble penalty can be assessed for each day the violation persists.⁴ On the federal side, the OIG can impose penalties of up to $25,595 per false claim for violations involving excluded providers, based on 2025 inflation-adjusted figures.⁵

Employer liability under the federal Civil Monetary Penalties Law attaches even when the organization did not know the person it hired was excluded. The practical rule for any Medi-Cal billing entity is simple: check every new hire and contractor against both the state S&I List and the federal LEIE before onboarding, and recheck periodically. Organizations that discover they have been employing an excluded person can use the OIG’s Provider Self-Disclosure Protocol, which has historically produced lower penalties than government-initiated investigations.⁶

What a Listed Provider Loses

The immediate loss is total: no Medi-Cal reimbursement for anything the suspended provider does, and recovery of any payments issued before the suspension was processed. A Medi-Cal suspension also commonly triggers federal exclusion by the OIG. Once a provider appears on the LEIE, no federal healthcare program nationwide will reimburse for the provider’s services or prescriptions, regardless of the payment method the program uses.⁷

The prescription impact reaches patients directly. Medicare Part D plans reject pharmacy claims for drugs prescribed by a provider on the federal preclusion list, and Medicare Advantage plans must deny Part B drugs prescribed by precluded providers.⁸ For dual-eligible patients, a denied Medicare claim does not cross over to Medicaid for payment.

Appeal and Reinstatement

Appeal rights depend on how the suspension was imposed. A provider suspended automatically because of a conviction, license action, or federal exclusion is not entitled to a hearing under the California Administrative Procedure Act.¹ DHCS treats the underlying event as already adjudicated. A provider facing a discretionary suspension does have hearing rights, with an administrative law judge taking evidence and the DHCS director making the final decision. Judicial review in court is available after that.

Reinstatement to federal programs is not automatic when an exclusion period ends. The provider must submit a written application to the OIG, and the earliest it will be considered is 90 days before the exclusion period expires. Earlier requests are not reviewed.⁹ Providers excluded for license revocation face an indefinite exclusion and can apply once they regain the license named in the exclusion notice. In some cases a different healthcare license in the same state or any healthcare license in another state may qualify, evaluated case by case. Without any valid license, the provider must wait at least three years before applying.

One point worth flagging because providers often get it wrong: obtaining a new Medicare provider number or Medicaid enrollment does not reinstate an excluded provider. Only written notice from the OIG granting reinstatement restores participation. Returning to Medi-Cal after a state suspension generally requires a fresh enrollment application through DHCS once the underlying problem is resolved, and DHCS can impose conditions or deny re-enrollment based on the provider’s history.

If Your Provider Is on the List

Medi-Cal patients whose provider has been suspended need to find a new one, because the suspended individual can no longer bill the program for any service. DHCS and the beneficiary’s managed care plan share responsibility for the transition, and federal regulations require beneficiary notification when a state initiates an exclusion.¹⁰

The Continuity of Care protections that let a Medi-Cal managed care member keep seeing an out-of-network provider for up to 12 months do not apply here.¹¹ Those rules cover network changes, not suspensions, and a suspended provider is prohibited from rendering services billable to Medi-Cal at all. The most useful step for an affected patient is to call the managed care plan promptly so a replacement provider can be arranged without a gap in care.

1
Medi-Cal Providers. Suspended and Ineligible Provider List
2
California Legislative Information. California Welfare and Institutions Code 14123
3
Cornell Law School. California Code of Regulations Title 22 51484 – Billing for Suspended Provider
4
California Legislative Information. California Welfare and Institutions Code 14123.2 – Suspension and Exclusion of Providers
5
Federal Register. Annual Civil Monetary Penalties Inflation Adjustment
6
U.S. Department of Health and Human Services Office of Inspector General. Self-Disclosure Information
7
Office of Inspector General. Special Advisory Bulletin on the Effect of Exclusions From Participation in Federal Health Programs
8
Centers for Medicare & Medicaid Services. Preclusion List Frequently Asked Questions
9
U.S. Department of Health and Human Services Office of Inspector General. Applying for Reinstatement
10
eCFR. Part 1002 – Program Integrity – State-Initiated Exclusions from Medicaid
11
Department of Health Care Services (DHCS). Continuity of Care