Medical Billing Fraud

Are you a licensed professional in California running your own business? Many California professionals operate essentially as sole practitioners. Even if these licensed professionals are set up legally as an LLC or Corporation, they essentially practice as independent professionals. Many dentists, pharmacists, chiropractors, insurance agents and brokers, optometrists, psychologists, clinical social workers (among others) practice independently. Because of this, many bill their clients based on hours expended for services rendered.

One of the biggest risks faced by these types of licensed business owners and entrepreneurs is the risk of committing medical billing fraud – whether it be deliberate or unintentional.

Billing fraud charges can be brought against a California professional as the result of them billing a client for services which were never rendered to the client as well as due to using the wrong billing code for services rendered. Billing fraud is a criminal charge and will be immediately visible to anyone conducting a simple background check. And all it takes is one client complaint to a licensing board to begin an investigation into a professional’s license.

There is no statute of limitation for the filing of a disciplinary action by a California licensing board. A single complaint about a professional delivering unnecessary services (over-billing) can trigger multiple investigations. This can be done by that professional’s insurance company, by their board of licensure, and by the police. Even if the charges start with the police, they will eventually also result in an investigation by the professional’s licensing board as by law, all criminal charges must be reported to a California licensing board within 30 days.

These investigations targeting licensed professionals often occur simultaneously and can be challenging to handle for anyone trying to defend themselves. All three investigations necessitate documentation submissions, audit requirements and interviews by investigators. A professional faced with billing fraud needs to understand the criminal and licensing implications of their specific case and how to best proceed so that both their professional license is defended and they successfully defend themselves against these criminal charges. A key consideration is what evidence to provide, how it is presented and the arguments which can be made when being interviewed by investigators. This is not a situation anyone should try to handle on their own without an experienced legal team skilled in both licensing law and criminal law.

At the law offices at Lucy McAllister Licensing Law, we handle hundreds of licensing cases throughout the state of California every year. One of our strengths is our extensive experience working in both Administrative Law and in Criminal Law, giving us unique edge when it comes to defending licensees with criminal charges and convictions.

The Law Offices of Lucy S. McAllister have successfully represented a wide range of California professionals across different professions and we are experienced in handling cases of medical billing fraud. We can defend you against both criminal charges such as overbilling or unnecessary billing as well as defend your professional license with your licensing board. Let us help you obtain, protect and defend your California licenses so that you can continue to practice the profession which you love.

For additional information or to schedule a consultation, please contact our California-wide law offices today at (877) 280-9944.