Recent Blog Posts
How to Prevent Healthcare Fraud
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 »
Cardiopulmonary Exercise Testing Compliance Issues
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 »
Chronic Care Management (CCM) and Billing Compliance Rules
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 »
What Is the Federal Anti-Kickback Statute?
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 »
Healthcare Investigations: How Does an OIG Investigation Work?
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 »
How Upcoding Works and Why Your Healthcare Organization Should Avoid It
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 »
Prescription Fraud: Writing a False Prescription in CA – Misdemeanor Charge
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 »
Stages of a Federal Healthcare Fraud Prosecution
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 »
California Anti-Kickback Statute Rules You’ll Want to Know
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 »
Is Medicare Fraud a Felony?
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 »