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healthcare fraud

How to Prevent Healthcare Fraud

By Art Kalantar |

Healthcare fraud is an issue that can result in serious legal consequences, financial loss, and damage to a healthcare provider’s reputation, not to mention the loss of a medical license and even jail time. If you’re a California doctor, pharmacist, or other healthcare provider, it’s crucial to be proactive about preventing healthcare fraud in… Read More »

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Medical doctors in sports science lab measuring performance cardiorespiratory of athlete. Team of researcher monitoring vo2 of sportsman running on cross trainer equipped with electrodes and mask

Cardiopulmonary Exercise Testing Compliance Issues

By Art Kalantar |

Cardiopulmonary exercise testing (CPET) is a powerful tool for diagnosing critical health issues, but the cost of a CPET evaluation can easily run to thousands of dollars. Medicare reimbursement is available, but only if the patient’s medical record is well-documented to substantiate the medical necessity of the service. Failing to comply with applicable rules… Read More »

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Unrecognizable male doctor of medicine showing a cardio app to remote patient. Healthcare concept for telemedicine, wearable technology, medical check-up via conference call and telepresence.

Chronic Care Management (CCM) and Billing Compliance Rules

By Art Kalantar |

Chronic Care Management (CCM) is a vital component of healthcare, particularly for the care of patients with multiple chronic conditions. It provides a structured approach to help patients manage their health conditions more effectively, reducing the risk of hospital admissions and improving one’s overall quality of life. As beneficial as CCM is, its provision… Read More »

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federal anti-kickback

What Is the Federal Anti-Kickback Statute?

By Art Kalantar |

The anti-kickback statute (AKS) is one of the federal government’s most powerful enforcement mechanisms for federal healthcare fraud and abuse laws. Agencies including the Department of Justice (DOJ), the Department of Health & Human Services Office of Inspector General (HHS-OIG), and the Centers for Medicare & Medicaid Services (CMS) can use the AKS to… Read More »

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A young female doctor inquires about personal information of a contented senior at home. Medical care for the elderly, elderly illness, and nursing homes, home care.

Healthcare Investigations: How Does an OIG Investigation Work?

By Art Kalantar |

The Department of Health and Human Services Office of the Inspector General (HHS-OIG, or OIG) is the principal federal agency responsible for investigating potential healthcare fraud and abuse. If you’re under investigation by the OIG, it’s important to understand the process, your responsibilities, and how best to respond. Failing to appreciate the gravity of… Read More »

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Doctors, thinking or laptop in night teamwork, medical research or surgery planning in wellness hospital. Talking, nurse or healthcare women on technology for collaboration help or life insurance app.

How Upcoding Works and Why Your Healthcare Organization Should Avoid It

By Art Kalantar |

Healthcare fraud can take many forms. Healthcare regulators are champing at the bit to pursue any possible fraud concerns, especially if the defrauded party is the government. Often, the discovery of a simple mistake can lead to a full regulatory investigation. If the investigation uncovers intentional conduct–even if the perpetrators were unaware they were… Read More »

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Medicine and health concept. A stethoscope and ampoules lie on a white background, the doctor holds a business card with the inscription - FALSE

Prescription Fraud: Writing a False Prescription in CA – Misdemeanor Charge

By Art Kalantar |

California law makes it a crime to falsify or forge a prescription for a narcotic drug. Depending on the drug prescribed and other factors, the crime can be charged as a misdemeanor or felony, and one of several different statutes may apply. Even as a misdemeanor, writing a false prescription is a serious offense… Read More »

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healthcare fraud concept

Stages of a Federal Healthcare Fraud Prosecution

By Art Kalantar |

Prosecution for healthcare fraud can start with something as simple as an accusation by someone at your office who thinks improper billing practices are going on. This can spur an investigation by a federal agency like Health and Human Services’ Office of Inspector General or the FBI, or the Bureau of Medi-Cal Fraud and… Read More »

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California Anti-Kickback Statute Rules You’ll Want to Know

By Art Kalantar |

The Anti-Kickback Statute and the Stark Law are laws aimed at ensuring that medical decision-making is premised entirely upon what is best for the patient, rather than based on the influence of monetary gain. The laws impose harsh penalties for medical professionals who accept kickbacks, pay for referrals, or otherwise give providers reason for… Read More »

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Medical fraud wording with stethoscope and gavel. Law concept

Is Medicare Fraud a Felony?

By Art Kalantar |

Medicare fraud is an extremely serious charge. If you or your medical practice is under investigation for or otherwise facing allegations of Medicare fraud, you need to act quickly to protect your rights, your practice, and your freedom. Depending upon the circumstances, you may face serious penalties including fines, license suspension, and even prison… Read More »

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