Recent Blog Posts
A Growing Threat to California Providers: Independent “Investigators” Targeting Hospice and Home Health Agencies
Hospice and home health agencies in California are already operating under heightened scrutiny from federal and state regulators. In recent months, enforcement activity by agencies such as the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and the California Department of Justice has intensified, particularly in connection with suspected fraud, improper… Read More »
Understanding Stark Law and Anti-Kickback Statute Violations
Healthcare providers in California operate within a complex regulatory framework that strictly governs financial relationships, referrals, and compensation arrangements. Among the most important—and most frequently misunderstood—laws are the Stark Law and the Anti-Kickback Statute (AKS). Both are central to federal healthcare fraud enforcement and are often implicated in audits, civil investigations, and criminal prosecutions…. Read More »
How a Healthcare Defense Attorney Can Help You Survive an Audit
Healthcare providers who participate in Medicare or Medi-Cal understand that audits are a routine part of operating in a highly regulated industry. Federal and state agencies rely on audits to detect billing errors, recover overpayments, and investigate potential fraud or abuse. While some audits are limited in scope, others can escalate quickly, leading to… Read More »
When Medicaid Oversight Turns Criminal: Understanding the Escalation from Audit to Prosecution
A recent letter from CMS Administrator Dr. Mehmet Oz to Governor Gavin Newsom has placed California’s Medi-Cal program under a federal spotlight. For providers unfamiliar with the letter, it outlines concerns about significant growth in certain Medi-Cal-funded services, particularly hospice, and raises questions about compliance safeguards within the state’s system. The letter underscores that… Read More »
Hospice and Medi-Cal Under Scrutiny: What California Providers Need to Know Now
Healthcare providers across California should be paying close attention to a recent letter sent by CMS Administrator Dr. Mehmet Oz to Governor Gavin Newsom. The letter, which addresses concerns about California’s administration of its Medi-Cal program, signals heightened federal scrutiny, particularly in sectors such as hospice and other high-growth Medicaid-funded services. That heightened federal… Read More »
Federal Officials Escalate Healthcare Fraud Enforcement in California During Fiery Press Briefing
Federal healthcare fraud enforcement in California has suddenly entered a decidedly more aggressive phase. In a recent press briefing reported in the Los Angeles Daily Journal, First Assistant U.S. Attorney Bill Essayli appeared alongside Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (CMS), to announce an intensified crackdown on healthcare… Read More »
Defending Against Allegations of Billing Fraud in Healthcare
Allegations of billing fraud are among the most serious legal threats a healthcare provider can face. In California, these accusations often arise in connection with Medicare or Medi-Cal audits, whistleblower complaints, or investigations by state and federal enforcement agencies. Even when fraud is not intentional, billing errors or documentation deficiencies can quickly escalate into… Read More »
Why Small Practices Are Not Immune from Healthcare Audits
Many small healthcare practices operate under the assumption that government auditors focus their enforcement efforts on large hospitals, corporate healthcare systems, or multi-location provider groups. While it is true that large organizations generate higher volumes of claims, small practices in California are by no means immune from Medicare or Medi-Cal audits. In fact, solo… Read More »
Common Billing Practices That Can Lead to Fraud Accusations
Healthcare billing is complex, fast-paced, and highly regulated. Providers in California who participate in Medicare, Medi-Cal, or private insurance networks must deal with a dense web of coding rules, documentation requirements, and reimbursement policies. Even honest mistakes can be misconstrued as intentional misconduct, in this climate of aggressive enforcement, and with powerful federal and… Read More »
Common Red Flags That Trigger Healthcare Audits
Healthcare providers in California know that Medicare and Medi-Cal audits are an unavoidable part of modern medical practice. While many audits are routine, others are triggered by specific patterns or anomalies that raise suspicions of billing errors or fraud. Understanding what these red flags are and how to avoid them is essential for protecting… Read More »