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.
False allegations borne out of personal problems, overzealous investigators looking to make a career or simple mistakes could lead to a conviction that could end a professional’s medical career. If convicted of Medi-Cal fraud or Medicare fraud, a health professional could face prison time, costly fines and the suspension or withdrawal of a medical license. Various administrative sanctions, including ongoing audits and suspension of payments, can also accompany allegations of Medi-Cal fraud.
The health care attorneys at Kevin Cauley, P.C., have extensive experience with defending health care professionals accused of criminal activity, including Medi-Cal fraud. A qualified attorney may provide guidance throughout the process from the first days of an initial investigation. To learn more about dealing with these kinds of allegations, you can consult our page on Medi-Cal fraud.