DEFENDING DOCTORS

DEFENDING DOCTORS 

The image is a chess board with the two queens off to the left but no other moves made. It is centered on the page and illustrates the point that Medical Doctor defense is a chess game. This is anImage of chessboard to illustrate point of article 3d chess board image

Tactics – Strategic Thinking – Planning

Lawyers in Lafayette is a team of criminal defense specialists, former prosecutors, a licensed chiropractor and an MBA .

What is the Medical Board of California ?

The Medical Board of California is the State Agency that oversees physicians and physician licensing.  It is the entity that handles ethics and discipline for doctors.  The Board maintains a website with information regarding the current license status of physicians, public discipline and educational background.  Physician responses to basic scope and type of practice survey questions are included.

The Board itself has 15 members.  Eight of the Medical Board members are physicians.  Five are public members.  The Board is appointed by the Governor except that one public member is appointed by the Speaker of the Assembly and one public member appointed by the Senate Rules Committee.  This group oversees discipline and policy.  Regulations that govern the practice of medicine are discussed and voted on by the Board.

Who Supervises the Medical Board of California ?

The California Medical Board is directly supervised by the California Department of Consumer Affairs.   This is important because the attorneys representing the Board are highly qualified both intellectually and they are broadly versed in both administrative law and criminal law.

As the Attorney General controls the boards, even an administrative inquiry carries the potential threat of criminal prosecution.  The lawyers who investigate for the Boards are usually DAG’s (Deputy Attorney General)’s and their academic and practical experience levels are high.

 Why Hire a “SPECIALIST” to Defend Against Allegations ?

As in the medical field, the word “specialist” is regulated and has specific meaning.  There is no State of California “specialist” designation for people who defendant physicians.  There are levels of “expertise” but the State Bar of California, Board of Legal Specialization allows the “specialist” designation only with respect to medical malpractice defense and not to Medical Board work.  Four attorney’s associated with Lawyers in Lafayette (3 specialists at our Lafayette location, one in Vallejo), are certified by the State Bar of California as Criminal Defense Specialists.  A large number of Medical Board Accusations have a criminal law aspect to them.  There are allegations of billing fraud, Stark Violations, self referral issues, misconduct with staff that lead to a wide overlap in the Accusation (administrative) areas of physician defense and the criminal areas.

Lawyers in Lafayette began their involvement with Board defense and the defense of physicians over 38 years ago when Dan Horowitz represented a medical practice in Oakland.  Over the years a seemingly increasing focus has been on billing codes, ICD codes as they relate to treatment choices and billing and length of face to face time with patients as a primary focus of acceptable CPT coding.  Compounding pharmacy referrals, urine testing, referral for in-house testing and other financial related complaints have far overcome quality of care complaints.

Our physician advocates are dedicated to defending doctors, medical groups, and medical service professionals.  We are physician partisans and we remember the time that medicine was a profession and not a commodity.


What is health care fraud and abuse?
It does not matter whether you personally “feel” that you run your practice properly.  Those days are gone along with handwritten chart notes (which although allowed, leave you very vulnerable to standard of care criticism).   Look at the “big guys” to get a sense of what standard you will be held to in your practice.
Johns Hopkins Healthcare LLC describes Fraud as “any deliberate and dishonest act committed with the knowledge that it could result in an unauthorized benefit to the person committing the act or someone else who is similarly not entitled to the benefit.”   The website is instructive because it openly describes the process by which Johns Hopkins looks for fraud.  They say “the JHHC Corporate Compliance Department investigates all detected outliers and other deviations from standard practice as well as all allegations of health care fraud and abuse that it receives from recipients and others.” 
So computer programs track “outliers” based upon expected frequencies of diagnosis, severity, comorbidity and other objective factors.  Deviations from standard practice are usually computer tracked as the types of treatments and frequency of utilization of higher cost treatments are computer assessed.  The other factor are complaints – usually patient or disgruntled employee complaints.
From these sources, come the claims of fraud and abuse.  In other words, differences in diagnosis, causation assessments and treatment protocols can be deemed fraud if there is a potential financial benefit in deviating from what JHHC (or insurance companies in general), deem to be usual and normal.
Once potential fraud is identified, it is put into buckets, these are essentially categories of alleged wrongdoing that they fit the more general definition of fraud.  The website (which can be found here) lists the following types of frauds.
What Conduct Can be Called Health Care Fraud?
  • Misrepresentation of the type or level of service provided;
  • Misrepresentation of the individual rendering service;
  • Billing for items and services that have not been rendered;
  • Billing for services that have not been properly documented;
  • Billing for items and services that are not medically necessary;
  • Seeking payment or reimbursement for services rendered for procedures that are integral to other procedures performed on the same date of service (unbundling);
  • Seeking increased payment or reimbursement for services that are correctly billed at a lower rate (up-coding).

Abuse is defined as practices that are inconsistent with accepted sound fiscal, business, or medical practices, and result in an unnecessary cost or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.

  • Misusing codes on a claim;
  • Charging excessively for services or supplies; and
  • Billing for services that were not medically necessary.

Now why did we list Johns Hopkins in such detail?  Because the hypocricy of Johns Hopkins underscores just how money and power can protect the powerful and target the normal practictioner.

The esteemed “Johns Hopkins” promotes the pseudo science of “alternative medicine” including those practices that are fraudulent and/or unproven.  Their site promotes appointments in:

At best, these are placebo.  At worst, they misdirect patients from real medical care.  If an individual promoted this type of medicine, a Board Complaint might follow.  But an “esteemed institution” can publish these “practices” on its website.

Our legal practice believes in evidence based medicine and a profession that respects physician judgment and experience.  If you practice fake, alternative medicine, we are not the law firm for you.  If you are a skilled and dedicated practitioner who is caught up in floods of the ever changing political tides – we are an excellent match.

Other fraud and abuse websites include:

Total Health Care Fraud Site

Revcycle Healthcare Management

Contra Costa County Fraud Units

Many district attorney’s offices have discreet units that focus on medical fraud.  Orange County is well known for their fraud units but Contra Costa County also has a strong consumer fraud division.   Like Alameda and Orange County, Contra Costa County has a focus on Worker’s Compensation Fraud.   That unit has a small website unit but of note is their solicitation of complaints from employees and the promise that “Employees who report fraud by their employers may be protected from retaliation by California’s whistleblower statute in Labor Code section 1102.5.”

PHYSICIAN ADVOCATES

As Physician Advocates and lawyers for the medical profession, we support the tradition of a medical degree signifying a sacred place in our society.  We are “Juris Doctors” but we do not call ourselves, “Dr. Horowitz” or “Dr. Kensok”.  To our firm, the title “Dr.” (doctor) signifies a special set of achievements, years of sacrifice and the title Dr. is entitled to a special dignity and respect.

As advocates for physicians, we pride ourselves on maintaining the highest level of training and expertise.  Lawyers for doctors must be aware that even a simple DUI (Driving Under the Influence) conviction can impact job prospects, hospital privileges and destroy a career.red circle with av rating meaning the highest ethical rating for attorneys Martindale Hubbell highest rating a for excellence and v for highest ethics.https://www.tmz.com/videos/0_tgm8r7op/

As associated lawyers we have separate practices but form teams of lawyers best suited to meet the needs of your case.  Some cases need a former top prosecutor (Tom Kensok) who has filed medical fraud charges and has a very detailed knowledge of the inner workings of the charging process.  Other cases utilize our trial lawyers, who have the experience of taking hundreds of cases to trial.  For business issues, our paralegal with an MBA will be part of the team.  Each case is unique and each doctor gets a custom team of qualified professionals.

When you get a “specialist” on your medical case, that person is always a State Bar certified criminal defense specialist.  That person has met strict experience standards, undergo rigorous peer review, judicial review and then pass a complex written examination.  There are also enhanced continuing education requirements to maintain “specialist” certification.

Having a specialist is critical in meeting charges against doctors at the prefiling stage. Our former prosecutors know how to resolve cases against doctors before charges are filed. Our experience in the courtroom allows us to see in advance the way a case against a doctor may develop. We create strategies to stop the investigation and to protect the doctor’s reputation and practice.

Call       925-283-1863

Photo of medical doctor lawyer, Daniel Russo (Dan Russo) in front of law books at his Vallejo officePhysician Defense lawyer Daniel Horowitz shown on television with host "Nancy Grace" on the "Nancy Grace Show" . the caption is "Jackson Molestation Case" where horowitz and grace debate opening statementsTom Kensok is a physican defense lawyer and this shows him with a smiling face, blue shirt, blue and silver time

Ratings and Reviews

10.0Daniel Horowitz
Daniel HorowitzReviewsout of reviews
Top 1 percent logo horowitz is a member of the national association of distinguished counsel
National Trial lawyers logo horowitz has been named a top 100 trial lawyer