Medical Billing License Defense in California

Billing statement, stethoscope, and pen

How a License Defense Attorney Can Help with Medical Billing Disputes, Fraud, and Other BIlling Matters

As a medical professional, you’ve invested a significant amount of time, money, and effort into providing quality patient care. Your professional license is your livelihood — obtaining and maintaining that license is vital to practicing your profession in California. 

But errors and issues related to medical billing can threaten both your reputation and your license. Such matters can result in an investigation by the Medical Board of California (MBC) that can end with the revocation of your license and even criminal charges.

If you find yourself under investigation by the MBC, you need a medical billing license defense lawyer from S J Harris Law who is intimately familiar with California law and the MBC’s practices to help you protect what matters most to you.

An Experienced Lawyer with Knowledge of Medical Board Laws and Regulations

When your professional license is under threat from the MBC, it is crucial that you turn to a medical billing defense lawyer who understands the MBC’s complicated laws and regulations. Hiring an attorney who is not familiar with these legal authorities can cause a costly delay in the resolution of your matter.

The Medical Board of California is a part of the Department of Consumer Affairs, which also issues licenses to other skilled professionals, like architects, veterinarians, and dentists. 

The Board is tasked with maintaining publicly available information about the doctors it has licensed and investigating complaints against doctors. The MBC’s involvement with your practice can begin when it receives a complaint from a patient, an insurance company, or another concerned person. 

Such a complaint can allege irregularities or improprieties with how you bill patients, submit insurance claims, or keep patient records. The MBC is empowered to investigate these complaints and discipline you and your practice if violations are found.

Frequently Asked Questions

Why Your Medical License Might Be Investigated by the Medical Board of California (MBC) if Medical Billing or Coding Errors Occur

An investigation may commence after the Board receives a complaint that involves sexual impropriety, negligence, incompetence, or a physician’s incapacity to provide accurate care.

Medical billing and coding errors can also fall into this category of misconduct that warrants an investigation. For example, such an error can happen when you or your staff improperly enter a code describing a symptom, diagnosis, or course of treatment that was not found or pursued. 

When these erroneous codes are billed to a patient or sent to the patient’s insurance company for payment, your office is asking that the payor cover services that were not actually rendered. 

While this could be due to an innocent mistake, in the MBC’s mind, this error could also result from negligence in your office or a deliberate attempt to defraud someone, which would merit disciplinary action. An investigation by the MBC is meant to reveal your level of culpability.

Why a Proper Billing System Is Necessary

Running a medical practice today is infinitely more complicated than it was just a few decades ago. Many aspects of operating a medical practice have changed, including the way patients and insurance companies are billed for services. An updated billing system is essential to running a modern practice efficiently.

An up-to-date billing system on which your support staff is adequately trained can help you file claims more quickly, keep better track of invoices sent and payments received, and minimize the risk of information being manually copied or entered incorrectly. This, in turn, can reduce the likelihood of complaints being made to the MBC in the first place.

What Happens if a Patient’s Medical Records Are Lost

In today’s world, inadequate systems and controls can lead to losing a patient’s medical records. This situation harms the patient by depriving you, your staff, and any other provider of an accurate and complete picture of the patient’s health and course of treatment.

More than this, losing a patient’s records makes it difficult for you to substantiate why a particular course of treatment was pursued. And losing records violates regulatory and other laws that mandate you to keep these records. 

When a patient’s medical records are lost, even by accident, it is a serious matter that can expose you to various disciplinary actions and legal consequences.

Can Medical Billing Errors Cause a Loss of License?

Yes, medical billing errors can lead to a loss of your license. The MBC and the Office of the Attorney General are both tasked with protecting the public from unethical or incompetent healthcare practitioners. This mandate includes protecting the public from physicians who engage in fraud. 

If the Office of the Attorney General believes that your medical billing errors are the result of an intent to defraud a patient or insurance company, your license can be suspended or revoked.

How Does the Medical Board of California Respond to Claims or Accusations?

If the MBC receives a complaint of alleged misconduct that it believes could result in discipline if it were true, then the MBC may open an investigation into the matter. In investigating the claim, the Central Complaint Unit (CCU) and its officials will gather evidence and speak to potential witnesses. These investigative actions could include:

  • Speaking with the person who submitted the complaint
  • Speaking with you and your employees
  • Inspecting your clinic or office
  • Obtaining a search warrant for your business
  • Using undercover informants to gain information about your practice

Once the investigation is complete, if the CCU and MBC conclude that there is enough evidence to suggest a violation has occurred that requires discipline, the matter will be passed over to the Office of the Attorney General. 

The case may also be passed off to the local district attorney to pursue any criminal charges you are believed to have committed. 

You may have the right to participate in a hearing before an administrative law judge. This would allow you to defend yourself and explain any extenuating circumstances that lessen your culpability or any facts showing deficiencies in CCU’s investigation.

Why Is It Important to Involve a Defense Attorney Right Away?

You may be tempted to wait until you receive an adverse disciplinary action from the MBC and the Office of the Attorney General before seeking legal help. 

However, it is essential to consult experienced legal counsel immediately after receiving an accusation or claim, as you can significantly affect the outcome of your investigation with what you say or withhold from investigators. We can represent and defend your interests at S J Harris Law when you retain our services.

What Happens if the Case Is Closed

If investigators do not find enough evidence that you committed a medical billing violation, they may close your case. In this situation, you do not face any disciplinary actions, and the complainant will be notified. 

You should view this situation as an opportunity to review your policies and procedures to see if any deficiencies can give rise to confusion or potential complaints. Your medical billing defense lawyer can also help review your business practices and identify any potential liabilities.

What Happens If Your License Is Suspended Or Revoked

If the MBC takes action against your license and orders that it be suspended or revoked, you cannot practice medicine in the state until the suspension has expired or your license to practice is reinstated. Continuing to practice with a canceled or suspended license can lead to even more legal issues.

You may have the right to appeal certain aspects of your case or the discipline imposed. Your medical billing defense lawyer can determine your options in this complicated and time-sensitive situation.

Who We Help

At S J Harris Law, our dedicated team is committed to helping physicians and other licensed professionals in California keep their licenses to practice. Whether you are looking to acquire your first medical license or keep your existing one, we can assist. 

We also represent medical professionals under investigation for alleged billing errors. We can serve as your most aggressive advocate if you are accused of an error you didn’t commit — or if you did make a mistake.

How We Help

When you retain S J Harris Law, we will go to work immediately, no matter where you are in the investigation process. If you are being investigated, we can guide you on what to say to the investigator and present a compelling defense for your actions. 

As a professional medical license defense law firm, we can plan the most effective route to protect your reputation and preserve your license.

Protect and Safeguard Your License by Consulting a Medical Board License Defense Attorney

Facing an investigation and disciplinary action for an alleged medical billing error is no small matter. The laws and rules applicable to these disciplinary investigations and proceedings can be challenging to understand. 

You need the compassionate and knowledgeable team of S J Harris Law by your side to help you navigate this challenging situation. Contact us today to protect your reputation and the continued success of your medical career.

Get a 30-Minute Free Consultation

Fill out the form or call:

323-894-1095

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When dealing with these complex issues, you need legal representation that has a long track record of success in these types of cases. Scott Harris and the rest of our team at S J Harris Law will be ready to help you pursue any option available that allows you to keep your license and continue working, no matter what industry you are in.

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