LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 106.09 Removing Names of Sanctioned Individuals from the Rendering Provider List
 
Policy Category:  Administrative
Distribution Level:  Directly-Operated Programs
Responsible Party:  Compliance, Privacy, and Audit Services
 
Approved by Marvin J. Southard, DSW, Director, on August 1, 2011
 
I.  PURPOSE
 
To provide guidance to Los Angeles County Department of Mental Health (DMH/Department) regarding the authority to request the removal of sanctioned individuals from the rendering provider list.
 
II.  DEFINITIONS
 
Sanctioned Individual: A sanctioned individual is a person whose name appears on any governmental list of individuals who have been debarred or otherwise made ineligible to provide services or claim for reimbursement under federally-funded health care programs, including but not limited to Medicare and Medi-Cal. Sanctions may be imposed against direct service providers as well as management and indirect/overhead staff. (Refer to DMH Policies 106.03 and 106.04 for further discussion of health care sanction lists). The most frequently reviewed government sanction lists are:
  • Federal level: Health and Human Services, Office of the Inspector General maintains the List of Excluded Individuals and Entities (LEIE).
     
  • State level: Department of Health Care Services (DHCS) maintains the list of individuals and entities barred from claiming to Medi-Cal in the List of Suspended and Ineligible Providers (S&I).
Sanctioned Entity: A corporation, company, or public institution may be sanctioned in the same manner as an individual. The LEIE and S&I contain names of individuals and private and public institutions.
 
III.  POLICY
 
Sanctioned agencies or individuals shall not deliver services or cause to be submitted claims for services to a federally funded health care program through DMH.

DMH will not knowingly enable a sanctioned agency or individual to submit claims to a federally funded health care program through the Department.

As DMH maintains a list of authorized rendering providers for the Department and contractor agencies on its data management and information system, DMH staff and managers are authorized to submit requests to remove confirmed sanctioned names from the rendering provider list.

Names being removed due to their sanctioned status must be confirmed by Compliance, Privacy, and Audit Services (CPAS) prior to removing the name from the rendering provider lists.
 
IV.  PROCEDURES
 
V.  AUTHORITY
 
VI.  ATTACHMENT