Dental Board of California Dental License Discipline for Insurance Fraud

Dental Board of California Dentist Insurance Fraud Defense Attorney

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

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

Insurance Fraud committed by Dentists remains a top enforcement goal for the Dental 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 Dental Board of California also targets Dentists at Claim Mills and Dental Mills who prescribe unnecessary painkiller narcotics medications. Put another way, the Dental Board of California targets Dentists running Pill Mills that double as Insurance Claim Mills and Insurance Dental Mills. Common methods of Insurance Fraud committed by Dentists include, but are not limited to:

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

Consequences of Insurance Fraud for Dentists can include Dental License revocation by the Dental Board of California and even criminal charges. California Dentists facing allegations related to Insurance Fraud should contact an experienced Dental Board of California License Defense Attorney for representation.

Dental Board of California Insurance Fraud Investigation Defense Lawyer

The majority of Dental Board of California Insurance Fraud Investigations begin with the filing of a consumer Complaint. However, Dental Board of California Insurance Fraud Investigations also occur through sting operations, criminal conviction referrals and criminal investigations. The Dental 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 Dentists. These employees investigate criminal and administrative law violations related to Insurance Fraud committed by Dentists. 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 Dentists facing disciplinary action for Insurance Fraud. At the conclusion of a Dental 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 Dentist facing a Dental Board of California Investigation for Insurance Fraud, contact a California Dental License Defense Attorney for representation.

California Dental License Insurance Fraud Accusation Defense Attorney

A formal Accusation served on a California Dentist serves as notice to a Dentist that the Dental Board of California intends to revoke the Dental License. A substantiated allegation of Insurance Fraud by a Dentist 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 Dental License in California. In many cases, it is possible for Dentists to reach a Stipulated Agreement with the Attorney General’s Office and Dental 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 Dental License by the Dental Board of California. Dentists facing a Dental Board of California Accusation should contact an experienced California Dental License Defense Attorney for representation.

California Dental 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 Dental Board of California can adopt, modify or reject the ALJ’s Proposed Decision. The Dental 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 Dentist 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 Dentist 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 Dentists facing a Dental Board of California Administrative Law Hearing need effective representation from a Dental Board of California License Defense Lawyer.

California Dentist Insurance Fraud Criminal Charges and Dental Board of California Discipline

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

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