Medicare & Medi-Cal Audits, Appeals & Fraud Prosecutions

by Kevin Cauley on July 14, 2013

Healthcare reform is currently at the forefront of both the Federal and State governments’ agendas. In an effort to curtail government spending on federal healthcare programs, the government has stepped up enforcement by increasing provider audits in order to collect payments it feels were erroneously paid to healthcare providers. Healthcare providers and facilities, especially those located in Los Angeles, have reported a surge in audit notices from Recovery Audit Contractors (RAC) working for the Center for Medicare and Medicaid Services (CMS).

Adverse healthcare audits of providers and facilities can result in a civil recoupment action to collect payments alleged to be erroneous or a criminal fraud prosecution.

Common recoupment and fraud allegations include:

▪   Up-coding medical services rendered

▪   Fraudulent billing for medical services

▪   Improper billing of medical services rendered

▪   Double billing/overbilling for medications or medical equipment

▪   Providing unnecessary medical treatment

▪   False claims submitted

Kevin Cauley, P.C. defends healthcare providers in Medicare audits and Medi-Cal audits, CMS RAC audits, recoupment actions and appeals, and white collar criminal prosecutions.


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