DEFENDING DOCTORS

DEFENDING DOCTORS 

The image 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 .  We are dedicated to defending doctors, medical groups, and medical service professionals.  We are physician advocates, or to paraphrase poet Michael McClure, we are “Physician Patriots”.  We remember when a physician was a respected community leader and resource rather than a target of politicians and cost cutting corporations.

Our defense focuses on medical board defense and criminal defense of physicians.  We do not defend medical malpractice cases but we are often consulted as medical malpractice allegations sometimes expand into criminal charges against doctors.  We work with transactional lawyers and lawyers who develop medical practices, acquisitions and compliance.  However, our aspect of that work is confined to referrals and to consulting on criminal law, medical fraud and similar issues that develop.  We are also retained by physicians and medical practice attorneys to handle the actual trial of cases.

When lawyers are hired for medical board or criminal defense matters, beware of claims by firms that they are “specialists”.  Criminal defense whether it is of accused murder clients or in the defense of doctors is a specialty defined by the California Rules of Court.  The use of the phrase, criminal defense specialist in legal advertising is not just a word or phrase.  It is intended to be used for people who qualify under the California Rules of Court as certified specialists.  See: California Rule of Court – Rule 9.35. Certified legal  bear with state bar of california certification as criminal defense specialist and link to news article on horowitz if you click the picture

(a) Definition

A “certified specialist” is a California attorney who holds a current certificate as a specialist issued by the State Bar of California Board of Legal Specialization or any other entity approved by the State Bar to designate specialists

We are genuine specialists, with three people in our a group of associated lawyers  certified as criminal defense specialists by the State Bar of California, Board of Legal Specialization.  Beware of any “specialist” claims that lack a State Bar certification.

What is health care fraud and abuse?
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.
  • 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 Johns Hopkins promotes certain types of “alternative medicine” that is either proven to be fraudulent or unproven.  Their site promotes appointments in

  • Ayurveda
  • Homeopathy
  • Naturopathy

All of the above are widely considered fraudulent, not helpful and potential dangerous to patients.

Our point – Health Care Fraud is often decided by the powerful and inflicted on the treating doctors.

To see more about Johns Hopkins alternative medicine promotion –

 

CLICK HERE

Other fraud and abuse websites include:

Total Health Care Fraud Site

Revcycle Healthcare Management

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.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

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