LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 106.09 Removing Names of Sanctioned Individuals from the Rendering Provider List
 
  PROCEDURES
  1. Removing a sanctioned name
     
    1. Los Angeles County Department of Mental Health (DMH/Department) staff and managers who intend to remove the name of a sanctioned individual from the DMH list of rendering providers shall complete the Suspension and/or Exclusion Notification Form and submit the form to Compliance, Privacy, and Audit Services (CPAS) for a confirmation process and signature.
       
    2. CPAS staff shall also complete the Suspension and/or Exclusion Notification Form and provide a confirmation signature.
       
    3. CPAS will forward an approved Suspension and/or Exclusion Notification Form to the Department Information Security Officer (DISO) following confirmation and signature for implementation.
       
      1. CPAS will notify the applicable District Chief and Deputy Director of the confirmed identification of a suspended and/or excluded person. 
         
      2. CPAS will notify the applicable District Chief and Deputy Director if any claims were submitted since the effective date of a confirmed suspension and/or exclusion and an overview of corrective actions, if applicable.
         
      3. CPAS will notify DMH Revenue Management Division (DMH-RMD) regarding the potential loss of revenue associated with a confirmed exclusion and/or suspension.
         
    4. The DISO, or designated staff, will take the necessary steps to prevent sanctioned individuals and entities from billing through the Department by:
       
      1. Coordinating with data systems managers and staff to ensure that sanctioned names are removed from the appropriate location(s) in the data system.
         
      2. Completing such other tasks as deemed necessary to prevent sanctioned individuals or entities from filing unauthorized claims.
         
  2. Reinstating or appealing a sanctioned name
     
    1. A rendering provider whose name has been removed from the rendering provider list due to a confirmed sanctioned status may appeal that removal by contacting the DMH Compliance Officer and providing written evidence that:
       
      1. Definitively distinguishes his/her identity from the sanctioned individual, and/or
         
      2. A formal reinstatement letter has been received from ALL applicable sanctioning agencies involved in the case. (It should be noted that reinstatement letters could be received before the sanctioning agency has updated the sanction lists as most are updated on monthly schedule.) 
         
        1. It must be understood that all persons who have been excluded by the Office of Inspector General (OIG) and/or another federal agency and suspended by the California Department of Health Care Services (DHCS) must be reinstated by the applicable federal agency(ies) prior to requesting reinstatement by DHCS.
        2. It must be further understood that none of the sanctioning federal or State agencies have an automatic reinstatement process. Reinstatement requires formal action by the individual or entity and is not complete until a formal reinstatement letter has been received.