Recent Blog Posts
Compliance With Anti-Kickback Statute and Stark Law: What California Healthcare Providers Need to Know
Medical providers in California must comply with a long list of state and federal laws that touch every aspect of their practice. These laws can be intricate and complex, and legal violations can be costly. One of the more intricate areas with steep fines per violation involves the Anti-Kickback Statute and Stark Law. These… Read More »
Protecting Your Practice: Proactive Measures to Prevent Healthcare Fraud
An allegation of healthcare fraud, if proven, could mean the end of your medical practice, the loss of your medical license, and countless other adverse consequences. Even without an employee committing outright intentional fraud, a pattern of mistakes or questionable activities can bring your practice under unwanted scrutiny and force you on the defensive…. Read More »
Terminating a Physician-Patient Relationship
The physician-patient relationship is a cornerstone of healthcare, built on trust, mutual respect, and professional integrity. However, there may be circumstances when a physician wishes to terminate this relationship. In California, the process is governed by specific legal and ethical guidelines to protect both parties and avoid liability for patient abandonment. Read more about… Read More »
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 »