Recent Blog Posts
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 »
How the False Claims Act Impacts Healthcare Providers in California
Healthcare providers in California face significant legal risk under the False Claims Act (FCA), both at the federal and state levels. Whether you’re a hospital, clinic, physician, or ancillary provider, missteps—whether intentional or due to negligence—can lead not only to civil liability, but in some cases criminal exposure as well. Understanding how the FCA… Read More »
How to Prepare for a Medicare or Medi-Cal Audit Before It Happens
Healthcare providers in California operate in one of the most highly regulated environments in the country. Medicare and Medi-Cal audits are routine tools used by federal and state agencies to detect overpayments, billing errors, and possible fraud. While many audits are triggered by data anomalies rather than intentional misconduct, the results can still be… Read More »
What Constitutes Healthcare Fraud Under Federal and California Law?
Healthcare fraud is a serious offense that carries significant civil and criminal penalties under both federal and California law. For healthcare providers, understanding what actions can be considered fraudulent is essential not only to maintain compliance but also to safeguard a career and livelihood built on patient care. Unfortunately, providers can find themselves facing… Read More »
Understanding the Different Types of Healthcare Audits and Auditors: RAC, UPIC, ZPIC, and More
For healthcare providers in California, few things are as daunting as receiving notice of an impending audit. The healthcare system in the state is heavily regulated, and both Medicare and Medi-Cal are subject to extensive oversight aimed at preventing fraud, waste, and abuse. Government agencies employ various audit programs to detect improper billing, ensure… Read More »
What Is the “Corporate Practice of Medicine?”
In California, as in many other states, the practice of medicine is tightly regulated to ensure that clinical decisions remain in the hands of qualified, licensed professionals—not corporations or non-medical business entities. This foundational principle is known as the “corporate practice of medicine” doctrine. It plays a crucial role in preserving the integrity of… Read More »
Common Reasons for Professional License Suspension and How to Avoid Them
In California, healthcare professionals—doctors, nurses, pharmacists, and others—work under strict regulations to maintain their licenses. The stakes are high: even a single misstep can lead to license suspension, threatening your livelihood, reputation, and ability to practice. At the Law Offices of Art Kalantar, we help healthcare providers defend their professional licenses and navigate the… Read More »
Protecting Your Practice: How to Avoid Common Pitfalls in Medicare and Medi-Cal Audits
As a healthcare provider in California, your practice is subject to strict oversight from state and federal government agencies that administer Medicare and Medi-Cal. Routine audits are an integral part of these programs to ensure compliance and prevent fraud. However, even honest mistakes can lead to severe consequences, including fines, recoupments, and even criminal… Read More »