An Introduction to the Medi-Cal Exclusion List

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The Medi-Cal Exclusion List is California’s state exclusion source under the Medicaid health program, Medi-Cal. It’s a large exclusion source and one in which we often find matches with providers working in states outside California. Matching provider data with the Medi-Cal exclusion list can be challenging because the source publishes few unique identifiers (the data points necessary to know conclusively determine an exclusion. In this post, we provide an overview of this exclusion source, its challenges, and the quality of the data it contains.

Screening for Exclusions in California

To ensure that healthcare employees are not on any exclusion lists, Medicaid providers are expected to screen all of their employees prior to and regularly throughout employment. The bottom line is that exclusion monitoring is one way that healthcare organizations can protect patient safety. If payments are made to a provider on an exclusion list or an entity with an excluded employee, payers will pursue reimbursement and providers could be liable for significant civil monetary penalties.

Searching the Medi-Cal Exclusion List

To search the Medi-Cal Exclusion List, visit the Medi-Cal website. At the bottom of the page, click on “Medi-Cal Suspended and Ineligible Provider List.”

Verifying Matches on the Medi-Cal Exclusion List

When investigating whether or not an individual or entity is on an exclusion list, healthcare companies must be aware of a significant obstacle to certainty: aliases (AKAs). Unfortunately, excluded providers use aliases to conceal their identity and status on exclusion lists. ProviderTrust’s Smarter Monitoring does all this work for you through data enrichment and exact matches. If you’re manually checking for exclusions, make sure that you rule out matches based on several identifying data points (such as SSN and NPI), not just by name and birthdate.

Another unusual feature of the Medi-Cal list is that a relatively large number of the addresses associated with excluded providers are located outside the state of California. This is another reason why every healthcare organization should check the Medi-Cal list every month, regardless of state.

Data Completeness

As far as the numbers go, you might wonder how complete the Medi-Cal Exclusion List is. Here are our findings:

  • 99% have addresses, city, or state information
  • 71% have a license number only
  • 10% have a National Provider Identifier (NPI)
  • 0% have DOB

Because high-confidence, high-quality exclusion matches are only possible by matching uniquely identifying data (such as a SSN or NPI), it can be difficult and time-consuming to manually confirm California exclusions and catch bad actors who may be using a different name or license.

Reporting Timeline

While it’s unknown how often California updates its Medi-Cal Exclusion List, we do know that in the last two years, the average delay shown for California reporting an exclusion to the OIG is 202 days. Recently, that delay has continued to grow to 209 days.

We also know that out of 19,214 exclusions, 7,742 exclusions match an exclusion on the OIG list. While the Medi-Cal Exclusion List and the LEIE are managed separately, they update on different schedules. LEIE updates once a month routinely, around the 5th-10th. The Medi-Cal Exclusion List updates once a month also but on a bit more of a random schedule. It’s challenging for those trying to closely monitor the Medi-Cal Exclusion List, especially since there’s no notification system in place for when the list is updated.

California Exclusion List FAQ

Besides the Medi-Cal Exclusion List, you should also check the two main federal exclusion lists (LEIE and SAM) mentioned above.

To resolve potential matches, you can look up a license to get more information. You should also look up all associated addresses to see if you can find a date of birth, age, or any other type of information that may help in your investigation.
Currently, there is no notification system in place.

The following states currently maintain a separate excluded provider list:

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky. Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey (Consolidated Debarment and Medical Fraud), New York, North Carolina, North Dakota, Ohio, Oregon Pennsylvania, South Carolina, Tennessee, Texas, Vermont, Washington (HCA & DSHS), Washington, DC, West Virginia, and Wyoming.

See our interactive exclusion map to view exclusions by state.

The New Standard for Exclusion Monitoring

At ProviderTrust, we deliver healthcare’s most trusted ongoing state and federal Medicaid exclusion list monitoring, thoughtfully engineered for every unique population. Our exclusion monitoring solution is fully automated – we can screen your employees, providers, and vendors against every state and federal exclusion source up-to-daily. From OIG exclusions to licenses and credentials, our healthcare monitoring and verification platform goes beyond good enough.

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