Administrative Sanctions

Back to Stop Medi-Cal Fraud 

The Department of Health Care Services (Department) has the authority under the Welfare and Institutions Code to impose administrative sanctions on Medi-Cal providers. Two of the most common sanctions are Payment Suspension and Temporary Suspension.​

​​​​Payment Suspension

A Payment Suspension involves withholding reimbursement for claims submitted. When providers are placed on Payment Suspension, they may continue to bill the Medi-Cal program for services provided. The reimbursement they claim is withheld and placed in a special holding account, pending the outcome of further investigation of their Medi-Cal practices. 

Upon receipt of a Credible Allegation of Fraud and pending an investigation against a Medi-Cal provider, the Department may suspend payment for any goods or services, or any portion thereof (Welfare and Institutions Code, Section 14107.11).

​​Temporary Suspension​

​​​​​​A Temporary Suspension allows the Department to temporarily suspend a provider from the Medi-Cal Program. Providers placed on Temporary Suspension are not entitled to reimbursement for any services provided to Medi-Cal beneficiaries. 

If it is discovered that a provider is under investigation by the Department or any state, local, or federal government law enforcement agency for fraud and abuse, that provider shall be subject to Temporary Suspension from the Medi-Cal program, which shall include temporary deactivation of all provider numbers used by the provider to obtain reimbursement from the Medi-Cal program (Welfare and Institutions Code, Section 14043.36). ​​​