Laws and Regulations of the Medical Board of California Regarding Medical Billing

Doctors and surgeons are no strangers to working with a large volume of information. And considering the myriad of laws, rules, and regulations with which doctors and surgeons in California must comply, this can prove to be an essential skill when it comes to safeguarding the future of your medical career. 

The Medical Board of California (MBC) is a 15-member board created by the Medical Practice Act and tasked with enforcing its provisions. Some of the provisions of this and other laws that the MBC and its associated agencies enforce include laws pertaining to:

Unlicensed Practice of Medicine

The Medical Practice Act governs the licensing of people to practice medicine as well as how medicine is to be practiced in the state. Found in California’s Business and Professions Code, Section 2052 makes it unlawful for someone to practice, attempt to practice, or hold themselves out to be able to practice:

  • A system or mode of treating sick individuals
  • Diagnosing, treating, operating, or prescribing for any illness, disease, or disorder 
  • Without a valid, unrevoked, and unsuspended medical license or another appropriate certificate under some other section of the law

Such an offense is punishable by up to $10,000 and up to one year in the county jail.

Section 2504 of the Business and Professional Code also prohibits someone from using doctor-specific titles like “doctor,” “physician,” or “M.D.” if they do not have a valid license or certificate to practice medicine.

Healthcare Fraud

California’s healthcare fraud statute is another example where a doctor or surgeon who violates its provisions can face severe criminal penalties. Once its investigation is complete, the MBC may turn over its findings to the local district attorney and recommend that criminal charges be filed and prosecuted.

Penal Code section 550 defines what constitutes healthcare fraud, including the following:

  • The doctor or surgeon submitted or caused to be submitted a false claim
  • At the time you submitted the claim, you knew that you were submitting a claim that contained false information
  • You submitted the false claim with the intent to defraud the recipient of the claim, such as the insurance company

The statute does not limit or restrict criminal liability based on the nature of the falsehood. Any claim that contains any false information, when submitted with knowledge of its falsity and done so with the intent to defraud another, can result in criminal liability.

A claim might be false and subject the doctor or surgeon to criminal liability if the claim:

  • Requests payment for a service that was never performed on the patient
  • Demands payment for a procedure that is more expensive than the one the patient underwent
  • Was a resubmitted claim that was already paid off
  • Included false supporting documentation to support it

The penalties for healthcare fraud will depend on the amount of financial loss sustained as a result of the fraud. 

It is also unlawful for a healthcare professional to submit a false or fictitious workers’ compensation claim or documents. Lastly, it is a crime for a person to dispense or authorize a false prescription that prescribes a drug for a condition the patient does not have.

Suspension and Revocation of Medical License

The Medical Practice Act permits the Medical Board of California and the Office of the Attorney General to impose discipline on individuals who violate the rules and laws applicable to medical professionals. This can include:

  • Denying an applicant a license to practice medicine
  • Reprimanding the individual publicly
  • Levying sanctions or fines against the individual
  • Ordering the person to undergo remedial treatment
  • Suspending the individual’s medical license for a period of time
  • Revoking the person’s medical license

These penalties and consequences would be in addition to any criminal penalties imposed by a court if the person was convicted of a crime.

Speak with S J Harris Law Today About Your Medical License Defense

If you have been informed you may have violated any of the laws, rules, or regulations that apply to the practice of medicine, your license may be at stake. Protect your livelihood and your reputation by turning to an experienced medical license defense attorney. 

Our compassionate and skilled team at S J Harris Law can develop an effective and personalized strategy to safeguard your license in California. We can provide the aggressive representation you need to face an investigation, whether the issue arose from your mistake or a wrongful allegation of a mistake. Contact us today.

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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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