Recent Blog Posts
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 »
How Breaching HIPAA Could Impact Your Professional Practice
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that governs how private healthcare information must be maintained, including how it can be stored and transferred. HIPAA sets a host of requirements for healthcare practices, including training, data security, and private health information (PHI) disclosure. The requirements are strict, and violating… Read More »
Red Flags That Can Trigger DEA Investigations (Raids) on Your Healthcare Practice
Healthcare practices are subject to a laundry list of regulations at the local, state, and federal levels. Any misstep can lead to oversight and investigations by an alphabet soup of regulatory agencies. Regulatory and legal compliance is key to maintaining best practices and avoiding the unnecessary stress, money, effort, reputational damage, and potential liability… Read More »
Civil Monetary Penalties: What Should Providers Do When DOJ Imposes Monetary Penalties
When the Department of Justice (DOJ) has evidence of unlawful conduct–whether that takes the form of unlawful kickbacks, billing fraud, illegal prescribing, or other fraud and compliance issues–they may pursue an enforcement action. If the DOJ finds that their allegations are justified, they may impose significant civil penalties on healthcare entities and/or individual owners… Read More »
How Regulation Influences Health Policy
Healthcare providers deal with more regulation than professionals in just about any other industry. What are the effects of that regulatory system? Does the heavy-handed approach to medical regulation serve to increase the quality of care to patients, or to expand access to healthcare for people across the country? Below, we review the effects… Read More »