Fenton Law Group | Fraud and Abuse

Allegations of healthcare fraud or abuse, whether alleged by state or federal government or private entities, can be devastating. There has been a steady expansion in the definition of what constitutes “fraud;” what was once considered a “billing error” is increasingly treated as fraud and abuse. In the face of this trend and the increasing aggressiveness of the State of California, the federal government, and health insurers, the need for experienced and sound counsel is greater than ever.

Few law firms have as much experience as Fenton Law Group in defending healthcare providers against allegations of fraud and abuse. On a daily basis, we counsel healthcare providers on how to avoid allegations and how to respond when they arise. Charges of healthcare fraud and abuse are inevitably challenging and sensitive; there are many areas of healthcare regulatory compliance where providers are at risk of such charges. For example, we have represented multiple providers in major “civil RICO” lawsuits brought by out-of-state health insurance companies against California physicians accused of cooperating with dishonest clinic managers in performing unnecessarily. In the area of insurance law, it is important to hire an insurance fraud attorney who knows the ins and outs of healthcare insurance. We have defended countless fraud investigations by federal and state government agencies. Our experience includes defense of:

·         Federal civil RICO lawsuits by out-of-state insurance companies

·         Medicare investigations by Office of the Inspector General (OIG)

·         Medi-Cal fraud investigations by the Department of Health Care Services (DHCS) or Bureau of Medi-Cal Fraud and Elder Abuse (BMFEA)

·         False Claims Act and qui tam lawsuits

·         California Department of Insurance investigations

·         Medical Board of California fraud investigations

We have successfully represented countless individual physicians and healthcare facilities against such allegations in many of the leading cases filed in Southern California. We have won significant victories at trial and on appeal. When in our clients’ best interests, we have also negotiated favorable settlements with federal and state regulatory agencies.

In handling such cases, we are able to draw upon our vast knowledge and experience of healthcare compliance issues, including Medicare, Medi-Cal, and private insurance coverage. Our track record of good results in these cases are a testament to our ability to leverage that knowledge and experience. In addition, our experience provides us ample resources to assist in development of compliance programs to minimize the risk of fraud and abuse litigation.