PROTECT YOUR HEALTH
by Knowing Your Providers

Many healthcare providers, such as doctors, nurses, and dentists, are required to have a professional license through the state they practice.  Even if your insurance gives you with a list of providers that are covered (considered in-network) by your plan, this does not mean they are licensed to practice.

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VERIFY YOUR HEALTHCARE PROVIDER

To verify if a healthcare provider has a license to practice in the State of California, visit: https://search.dca.ca.gov/results and follow the instructions below.

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STEP 1

Click the 'Boards and Bureaus' drop down menu and select the appropriate one for your provider. 

For example, here are a few of the options and what types of providers they include.

-  Board of Behavioral Sciences includes Marriage & Family Therapists, Clinical Social Workers, Psychologists

-  Dental Board of California includes Dentists, Oral Surgeons, Registered Dental Assistant

-  Medical Board of California includes Physicians, Surgeons, Licensed Midwives

-  Board of Optometry includes Optometrists, Registered Contact Lens Dispensers, Registered Dispensing Optician

-  Board of Registered Nursing includes Clinical Nurse Specialists (CNS), Nurse Anesthetists, Nurse Practitioner, Registered Nurse

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If you are not sure which one your provider is under, leave this section blank and move on to Step 2.

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STEP 2

Once you select the Board or Bureau, type your provider's first and last name in the search boxes. 

One thing to note, some providers may not list their full name on insurance carrier lists or on their practice's website.  When possible, check to get the full legal name of the healthcare provider to be sure you are able to search for the correct person.  It can also help to check if they have a middle name to be able to narrow your search down further.

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STEP 3

Click 'Search.'

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STEP 4

Review the results to find your provider.

If there are multiple providers that come up in your search, try narrowing it down by:

• Verifying the middle name

• Verifying the practice locations listed (check if the location you are scheduled to go to is listed on the provider's license).

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If no results appear, or you cannot find your provider on the list, check the spelling of the provider's first and last name once again. 

After doing this, if your provider is NOT listed, this is a potential red flag that this individual is providing services unlicensed.

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For smaller medical offices and clinics, you may also want to search for the business license of the office/clinic.

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To lookup State of California business licenses visit: https://businesssearch.sos.ca.gov/

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COMPLAINTS AGAINST PROVIDERS

If you have experienced problems with the care you, or a loved one, received from any healthcare provider, you may want to file a complaint with your insurance carrier and/or the Board or Bureau they are licensed under.

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To file a complaint against a Medi-cal or Denti-cal provider visit: https://www.dmhc.ca.gov/FileaComplaint.aspx

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If you suspect you, or a loved one, are a victim of fraud by a Medi-cal provider visit: https://apps.dhcs.ca.gov/stopfraud/Default.aspx

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Some examples of fraud include: 

-  Recruits and pays patients money or offers gifts in exchange to participate in the Medi-Cal program.

-  A provider charging a Medi-Cal patient for the difference between the Medi-Cal reimbursement rate (the amount Medi-Cal pays for a service) and the customary charge for a service (the amount the provider bills the service at, which is typically higher than what the insurance pays).

-  Providers ordering unnecessary lab tests

-  Dentists performing unnecessary teeth extractions on both adults and children 

-  Medical supply companies billing for equipment and products that were neither ordered nor delivered

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STEP 1

Enter the security code that appears on screen and click 'Validate.'

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STEP 2

Select whether you want to remain anonymous or not.  Enter your information. 

Select 'Provider' for who is your complaint against.  Enter your provider's information. 

Lastly, enter information you have about the suspected fraud and click 'Submit Complaint.'

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COMPLAINTS WITH THE BOARD (E.G., DENTAL BOARD, MEDICAL BOARD, ETC.)

To file a complaint with the board or bureau the provider is licensed under, visit https://www.breeze.ca.gov/datamart/loginCADCA.do​

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STEP 1

Under 'For Consumers' click on 'File a Complaint.'

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STEP 2

Select the board your provider is licensed under by clicking the drop down menu.

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STEP 3

Continue to enter the requested information and click next until you reach the confirmation page (5th tab on the left).

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You will have the option to attach any files such as medical records, pictures, and more.

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After filing a complaint, you should receive follow up with a case or reference number to track your complaint.  You will typically need to sign an Authorization to Release Records to the board/bureau as well.