Kevin Cauley, P.C.
Kevin Cauley, P.C.

Healthcare License Defense

Defending professionals against Medi-Cal fraud allegations

Health care professionals in California may be particularly concerned about allegations of Medi-Cal fraud. Medi-Cal is the state's Medicaid program, providing health coverage to around one-sixth of all of California's residents. It is designed to ensure that children, people with disabilities and those with low incomes can receive adequate care to protect their health even when they do not have appropriate coverage through an employer. Medi-Cal expenses amount for around 25% of the state's budget, so significant scrutiny is placed on the use of Medi-Cal funds to reimburse health care providers.

Some allege that the state of California loses $1 billion each year to fraudulent Medi-Cal claims. In most cases, these claims arise from allegations that health care providers engaged in false or misleading billing. Doctors, hospitals and laboratories have all been charged with Medi-Cal fraud for services that were not provided or were billed at a higher level than the actual procedures performed. While cutting down on Medi-Cal fraud is an understandable priority for state regulators, it can also hurt innocent health care providers.

Spotlight on the California Medical Board

The Medical Board of California is an official regulatory body of the state that commands broad oversight and related powers relevant to licensed California physicians. It serves as a repository of public information/data regarding doctors, and also has a decidedly robust presence in the realm of physician discipline.

That latter role – overseer of complaints and investigator of alleged negligence or other wrongdoing by a medical professional – is obviously of concern to all practicing California physicians.

Could a night out on the town put your career at risk?

As a medical professional, you studied for many years to get where you are. Regardless of your job title, you dedicated your efforts, time and resources to earn the privilege of practicing medicine. But could one wrong move make you lose it all?

Although working in the medical field might be your life's dream, to some extent it could seem like you have many restrictions. You might feel like you're not able to enjoy something as common as a night out with friends during your free time for fear of an arrest for driving under the influence (DUI), which could affect your medical license. However, that is not necessarily the case.

California Implements AB 2396: Expungement Now Relieves Some of Their "Convictions" for Professional Licensing Purposes

Under California criminal law, an individual may withdraw a plea of guilty or nolo contendere (no contest) and enter a plea of not guilty once they have completed probation, or waited a year after a conviction for which no probation was ordered.  This process is referred to as "expungement" or "dismissal" of the conviction.  Expungement is also available to those who served time for their conviction in jail, but not for those who served in state prison.  Only a judge may grant an expungement.

Legislator Calls for Audit of California Board of Registered Nursing

Last fall, the Department of Consumer Affairs (DCA) implemented BreEZe, an electronic processing system designed to streamline the licensing process for approximately 37 professional licensing boards, including the California Board of Registered Nursing (BRN). However, the process has not gone well and nursing applicants are experiencing significant delays.

What You Should Know Before Entering into a Physician Provider Contract or Agreement with an Insurance Company

Another lawsuit--litigated this time all the way up to the U.S. Supreme Court--demonstrating why it is imperative to obtain legal advice before entering into a Physician Provider Contract or Agreement with an Insurance Company.

California Legislators Consider Abolishing Medical Board of California

California lawmakers are considering a bill (SB 304) that would strip the Medical Board of California's ability to investigate alleged physician wrongdoing and impose penalties. Instead, the Attorney General's Office would be responsible for investigating physician misconduct and the Medical Board would deal primarily with licensing issues for doctors.  This would have a significant impact on the management of physician complaints in California.

DEA Investigation Triggers

The Drug Enforcement Administration (DEA) was formed with the primary purpose of enforcing the Controlled Substances Act (CSA).  The DEA investigates doctors, nurses, veterinarians, dentists, and other medical registrants who are authorized to dispense controlled substances for potential violations involving these drugs. Several different events can trigger an investigation by the DEA Office of Diversion Control.

Medicare & Medi-Cal Audits, Appeals & Fraud Prosecutions

Healthcare reform is currently at the forefront of both the Federal and State governments' agendas. In an effort to curtail government spending on federal healthcare programs, the government has stepped up enforcement by increasing provider audits in order to collect payments it feels were erroneously paid to healthcare providers. Healthcare providers and facilities, especially those located in Los Angeles, have reported a surge in audit notices from Recovery Audit Contractors (RAC) working for the Center for Medicare and Medicaid Services (CMS).

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Office in Los Angeles
One Wilshire Building
624 South Grand Avenue
22nd Floor
Los Angeles, CA 90017

Phone: 213-465-1153
Fax: 213-814-2557
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