Recent Blog Posts
How Whistleblower Claims Can Lead to Federal Investigations
Healthcare providers often associate federal investigations with audits, billing reviews, or direct inquiries from government agencies. However, many of the most significant healthcare fraud investigations begin in a very different way with a whistleblower complaint filed by a current employee, former employee, contractor, competitor, or business associate. In today’s healthcare enforcement environment, whistleblower allegations… Read More »
How to Respond to a Records Request from CMS or the OIG
For healthcare providers, receiving a records request from the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), or one of their contractors can be an alarming experience. Whether the request arrives through a Medicare audit, a Medi-Cal investigation, a program integrity review, or a fraud inquiry, providers often find… Read More »
What Triggers a Healthcare Audit? Common Red Flags for California Providers
Healthcare audits rarely occur without a reason. While some audits are conducted on a random basis, many are initiated because government agencies, contractors, or insurance payors have identified patterns that suggest potential billing errors, compliance issues, or fraudulent activity. For California healthcare providers, understanding what triggers an audit can be an important part of… Read More »
How to Minimize Criminal Exposure During an Audit Investigation
For healthcare providers in California, an audit can quickly evolve from an administrative review into something far more serious. What may begin as a request for records from Medicare, Medi-Cal, or a private contractor can escalate into allegations of fraud, false claims, kickbacks, or other criminal violations. In today’s aggressive enforcement climate, providers must… Read More »
Best Practices for Medi-Cal Providers to Avoid Billing Errors and Allegations of Healthcare Fraud
Medi-Cal providers in California operate in one of the most heavily regulated reimbursement environments in the country. Because Medi-Cal is jointly funded by state and federal dollars, billing practices are closely monitored by the California Department of Health Care Services (DHCS), the California Department of Justice, and federal oversight agencies. While most providers strive… Read More »
What to Do During a Healthcare Audit
For healthcare providers in California, receiving notice of a Medicare or Medi-Cal audit can be unsettling. Whether initiated by a Recovery Audit Contractor (RAC), Unified Program Integrity Contractor (UPIC), Medicaid Integrity Contractor (MIC), or another agency, an audit is more than just a paperwork exercise. It is often the first step in a process… Read More »
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 »