Medical Board of California Physician License Discipline for Insurance Fraud

Medical Board of California Doctor Insurance Fraud Defense Attorney

The Medical Board of California, known as the MBC, vigorously investigates and disciplines Physicians accused of participating in Insurance Fraud. California law enforcement agencies heavily prosecute Doctors engaging in Insurance Fraud. Physicians in California participate in several common types of Insurance Fraud, including:

• Claim Mills
• Drug Detox Centers
• Drug Rehab Centers
• Medi-Cal Fraud
• Medicare Fraud
• Medical Mills
• Pain Management Center Fraud
• Pill Mills
• Prescription Pill Fraud
• Workers Compensation Insurance Fraud

Insurance Fraud committed by Physicians remains a top enforcement goal for the Medical Board of California and other law enforcement agencies. False and fraudulent billing for services allegedly rendered, as well as kickback schemes, are investigative priorities for law enforcement. The Medical Board of California also targets Doctors at Claim Mills and Medical Mills who prescribe unnecessary painkiller narcotics medications. Put another way, the Medical Board of California targets Physicians running Pill Mills that double as Insurance Claim Mills and Insurance Medical Mills. Common methods of Insurance Fraud committed by Doctors include, but are not limited to:

• Billing insurance companies for services not rendered
• Excessive Treatments
• False Medical Claims
• Gross Negligence in the Practice of Medicine
• Overbilling insurance companies for services rendered
• Kickbacks to insurers, medical suppliers, and Pharmacists
• Prescribing unnecessary pain management narcotics medication (Pill Mill)

Consequences of Insurance Fraud for Doctors can include Physician and Surgeon License revocation by the Medical Board of California, loss of hospital privileges and even criminal charges. California Physicians facing allegations related to Insurance Fraud should contact an experienced Medical Board of California License Defense Attorney for representation.

Medical Board of California Insurance Fraud Investigation Defense Lawyer

The majority of Medical Board of California Insurance Fraud Investigations begin with the filing of a consumer Complaint. However, Medical Board of California Insurance Fraud Investigations also occur through sting operations, criminal conviction referrals and criminal investigations. The Medical Board of California utilizes non sworn civilian investigators to conduct non criminal investigations. The California Department of Consumer Affairs employs sworn Peace Officer Investigators to conduct criminal Insurance Fraud Investigations against Doctors. These employees investigate criminal and administrative law violations related to Insurance Fraud committed by Physicians. Administrative Law Due Process Rights differ substantially from the Due Process Rights accorded in criminal law.

It is important to have an attorney that understands issues faced by Physicians facing disciplinary action for Insurance Fraud. At the conclusion of a Medical Board of California investigation, the Board has several options. The Board can choose to close the Complaint. The Board can choose to issue a Citation. The Board can also choose to refer the matter to the California Attorney General’s Office. The Attorney General’s Office will determine whether cause exists to file a formal disciplinary Accusation. The Board may also refer the case to the District Attorney’s Office for criminal prosecution. If you are a Physician facing a Medical Board of California Investigation for Insurance Fraud, contact a California Physician License Defense Attorney for representation.

California Physician License Insurance Fraud Accusation Defense Attorney

A formal Accusation served on a California Physician serves as notice to a Physician that the Medical Board of California intends to revoke the Physician License. A substantiated allegation of Insurance Fraud by a Doctor almost always results in the filing of a disciplinary Accusation.

An Accusation is a serious matter that can result in the suspension or revocation of a Physician License in California. In many cases, it is possible for Doctors to reach a Stipulated Agreement with the Attorney General’s Office and Medical Board of California. A Stipulated Agreement is a formal term for a settlement agreement. If a Stipulated Agreement cannot be reached, the parties will proceed to a formal Hearing before the California Office of Administrative Hearings (OAH). Disciplinary Accusations involving Insurance Fraud can result in revocation of a Physician and Surgeon License by the Medical Board of California. Doctors facing a Medical Board of California Accusation should contact an experienced California Physician License Defense Attorney for representation.

California Physician License Hearing For Insurance Fraud

The California Office of Administrative Hearings, also known as OAH, maintains several Court Hearing locations. These Court locations are in Los Angeles, Oakland, Sacramento and San Diego. In some instances, Hearings may be held offsite in Bakersfield, Fresno, Orange County, Riverside, San Bernardino, San Francisco, San Jose or Ventura. The Administrative Law Hearing is a formal Hearing before an Administrative Law Judge.

The Administrative Law Judge, or ALJ, will issue a written Proposed Decision approximately 30 days after the Hearing. The Medical Board of California can adopt, modify or reject the ALJ’s Proposed Decision. The Medical Board of California’s action is called the Final Decision and Order. There are two main rights of Appeal of a Final Decision and Order. California Government Code § 11521 allows a Doctor to file a Petition for Reconsideration prior to the effective date of the Final Decision and Order. Pursuant to California Code of Civil Procedure § 1094.5, the Physician can also file a Petition for Writ of Mandamus in Superior Court. A Writ must be filed within 30 days of the effective date of the Final Decision and Order. California Physicians facing a Medical Board of California Administrative Law Hearing need effective representation from a Medical Board of California License Defense Lawyer.

California Physician Insurance Fraud Criminal Charges and Medical Board of California Discipline

The Medical Board of California can discipline Doctors for Insurance Fraud that rises to the level of criminal activity, but violates an Administrative Law regulation. The Medical Board of California disciplinary process is separate from the Criminal Law process. The Medical Board of California can discipline Doctors for certain criminal convictions. Medical Board of California Physician discipline occurs for criminal convictions that are substantially related to the duties, functions and qualifications of a Physician. All Insurance Fraud crimes are substantially related to the duties, functions and qualifications of a Doctor.

The Medical Board of California and other law enforcement agencies often conduct criminal investigations against Physicians for Insurance Fraud. In serious criminal cases against Doctors pending in Criminal Court, the Medical Board of California and the California Attorney General’s Office may seek a California Penal Code § 23 Order against the Physician. A California Penal Code § 23 Order seeks to suspend a Physician License in Criminal Court. Doctors facing criminal charges and Physicians who are convicted of criminal offenses need an experienced California Physician License Defense Attorney for representation in disciplinary proceedings before the Medical Board of California.