Tactics – Strategic Thinking – Planning
Physicians have sacrificed years of their lives to gain the knowledge and skills that distinguish their profession from any other. The trust between a physician and patient is now often broken by medical corporations, insurance companies and physician groups that put profit before the profession. We represent the physicians who are faced with the machine of peer review, discipline, medical board inquires and contract disputes.
Peer Review meetings are scheduled with lighting speed even when they are a long time in preparation. They are often used to target and damage a physician who no longer “fits the mold” or no longer fits the business plan for an existing medical group. The results in terms of state board and national database reporting can damage careers. We know the in’s and out’s and can advise you on the proper response to these attacks on your personal and career integrity.
What Do You Do When the Medical Board Reaches Out to You ?
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.
It is a policing agency and its primary goal is to protect the public. As such, your interests as a caring physician may be represented in the abstract but when the focus is on your individually, you need experienced, professional representation.
The Board itself has 15 members. Eight of the Medical Board members are physicians. Five are public members. The Board is completely political. It 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. The Board itself is overseen by the Attorney General and any Accusation that is filed is reviewed by a Deputy Attorney General.
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 “Lawyers in Lafayette”
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. Our group has two former top prosecutors. Doug MacMaster was the interim District Attorney of Contra Costa County and Tom Kensok was the Chief Assistant. Daniel Horowitz has represented physicians nationwide for over 40 years.
MEDICAL FRAUD ALLEGATIONS
- 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.