Recent Blog Posts
Hospice and Medi-Cal Under Scrutiny: What California Providers Need to Know Now
Healthcare providers across California should be paying close attention to a recent letter sent by CMS Administrator Dr. Mehmet Oz to Governor Gavin Newsom. The letter, which addresses concerns about California’s administration of its Medi-Cal program, signals heightened federal scrutiny, particularly in sectors such as hospice and other high-growth Medicaid-funded services. That heightened federal… Read More »
Federal Officials Escalate Healthcare Fraud Enforcement in California During Fiery Press Briefing
Federal healthcare fraud enforcement in California has suddenly entered a decidedly more aggressive phase. In a recent press briefing reported in the Los Angeles Daily Journal, First Assistant U.S. Attorney Bill Essayli appeared alongside Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (CMS), to announce an intensified crackdown on healthcare… Read More »
Defending Against Allegations of Billing Fraud in Healthcare
Allegations of billing fraud are among the most serious legal threats a healthcare provider can face. In California, these accusations often arise in connection with Medicare or Medi-Cal audits, whistleblower complaints, or investigations by state and federal enforcement agencies. Even when fraud is not intentional, billing errors or documentation deficiencies can quickly escalate into… Read More »
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 »