How Can I Learn How To Bill Medi-Cal Properly And Get My Billing Staff Trained?

For Medi-Cal providers, one of the most important things is for your biller, billing staff and office manager to understand the program, the rules and the upcoming changes. 

If you are a Medi-Cal provider, even one that only does occasional billing to the program, it is important to have your staff and biller as well. As a provider, you will be held responsible for what they do in billing.  So, what can you do that is cost effective?

First, even if your biller (third party or in-house) tells you what experts they are - remember that the rules and the way they apply them change constantly.  Anyone who says they know it all is to be regarded with caution. Change is the name of the game in healthcare billing.

Second, have your staff and even you sign up for the Medi-Cal Learning Portal. Anyone can sign up (even students or lawyers like me) and have access to recorded webinars, eLearning tutorials, quick links to provider manuals, information on upcoming seminars, contact information for regional representatives, and so on. You can even ask for a custom workshop through Medi-Cal. 

Third, have your billing staff attend Medi-Cal training seminars. For example, next month, on April 16 and 17, 2013, the Department of Health Care Services (DHCS) and Xerox State Healthcare, LLC [the DHCS fiscal intermediary] will conduct Medi-Cal training seminars.  This is also available for sign-up on the Medi-Cal Learning Portal linked above. On April 16, the training will for Allied Health, Long Term Care and CCS/GHPP providers only.  On April 17, the training will be for Medical, Inpatient/Outpatient, HAP, and  CCS/GHPP providers.

In order to be compliant and not have audits or accusations of fraudulent billing, keep records of the training and be vigilant about having your staff and outside billers staying on top of these issues. All too often, people are relying on old rules and the way things used to be and are not staying on top of or ahead of the issues.


  

Jury Convicts Orange County Doctor Of Health Care Fraud In Federal Court

In the Central District of California, on March 6, 2013, a federal jury convicted an Orange County doctor Dr. Augustus Ohemeng, 62, of six counts health care fraud following a five-day trial. (CR No. 12-00415-CAS)

The conduct alleged to have taken place occurred from February 2005 to September 2009. The Indictment was not filed until May 2012. It has obviously taken years to get these cases charged and taken to trial. 

The codefendants in this case, which included another physician George Tarryk, all plead guilty. This case, like many others, involved marketers paying patients for visits and allegedly unnecessary wheelchairs and nutritional supplements being ordered for the patients. Judge Snyder allowed Dr. Ohemeng to remain on bond pending sentencing. 

Tracy Green Interviewed On Plea Bargain Agreements In Criminal Justice System By Santa Monica Daily Press

Tracy Green was interviewed in the Santa Monica Daily Press  as part of their story entitled "Family fights plea bargain in deadly hit-and-run" regarding the role of plea bargains in the criminal justice system. The fact is that approximately 95% of all cases plea before trial.  While most clients come to our office looking to prevent or defend a case, it is important to understand the role of plea negotiations in the criminal justice system -- both federal and state.

The article touched briefly on some of Ms. Green's beliefs and strategy as it relates to negotiating and/or considering a plea bargain for her clients, as part of case strategy.  The article did not quote Ms. Green's statement to the reporter that she "believes the system is broken" and that pleas are used to process the huge numbers of cases that are filed each year. Often pleas are offered in weak state cases that offer a "guaranteed" result and help avoid the risk and expense of trial.

Scott Burns, the executive director with the National District Attorneys Association, explained it well in the article: “The reality is that there are between 15 and 20 million non-misdemeanor cases prosecuted in America every year.” Mr. Burns added: “If each of those, or frankly half or a third of those, went to trial, we would need a much, much larger criminal justice system.” Instead, attorneys forge plea bargains, agreements that offer a potentially lighter sentence in exchange for a guilty or no-contest plea.

The article also stated: "They also offer security, said Tracy Green, a private defense attorney based in Los Angeles.  Whereas plea deals are negotiated between the attorneys involved, jury trials rely on a body of 12 unknowns, making the process a roll of the dice for both sides." I hate to tell people it's like going to Las Vegas, but justice can come at a price," Green said." 

"Defense attorneys also look at the merits of the case, but also determine if it’s a financial possibility for their client to go through the expensive trial process and if they’re capable of serving time, even a reduced amount, Green said."

“What are the client’s goals? Can they risk, handle or afford emotionally or lifestyle-wise any threat of incarceration, or having a conviction of what’s been charged?” she asked. “What’s the downside risk if you go to trial and lose?”

While neither attorney believes that the system is broken, Burns was more apt to defend it than Green, who felt that defendants risk getting a harsher sentence if they go for a trial and lose." It is now considered "below the standard of care" for an attorney not to explain the benefits of early plea negotiations to targets of investigations and persons charged with a crime -- especially in the federal system. Thus, any experienced criminal defense attorney should explore these issues and explain the system to their client without fear of looking "weak" or that they are "not a fighter." These are complex issues and each person's case and situation may be different. 

Some clients are concerned that discussing plea bargains is a sign of weakness but it is a tool to be used. For example, if we have a professional client who is charged with a felony it is important to address all potential strategies including going to trial, the risks if the trial is not successful and whether a certain result (such as a misdemeanor plea by a corporation) may make sense given the facts and risks. Each person or business entity have different goals and different ability to absorb risks. 

To be conscious of the role of plea negotiations is important. It is unfortunate that there are many people who plea because it is in their best personal and business interest rather than risk going to trial, but if it is to be done it should be explored in detail, addressed throughout the process and not simply done at the last minute when there is fear of going to trial. This requires an assessment of the facts, legal exposure and personal issues faced by the client.

Posted by Tracy Green, Esq. 
To speak with Ms. Green, you can email her at tgreen@greenassoc.com or call for an appointment at 213-233-2260.

Practical Tips For Those Who Face Federal Custody Time, Part II: How To Minimize Problems In Custody And Stay Under The Radar

Most of our clients are college educated, are businessmen or professionals, have never been charged with a crime before and have never been incarcerated. For those individuals who are facing federal prison time -- even if it appears they should be eligible for probation -- one of the biggest fears is how they would cope with being in federal prison or camp and mingle with the general population on a daily basis. We have interviewed several of our white collar clients who have spent time in federal custody on tips for how they were able to successfully serve their time if the federal judge decides to impose a custody sentence.

In addition, we have received requests for representation after they have been sentenced when they were surprised by a 6-month or 1 year custody time because the federal judge did not accept the prosecutor’s recommended sentence set forth in the plea agreement. The fear that some clients have is best addressed in advance and for everyone to work for the best possible result and prepare for the worst.

For some clients who are facing a 10-year sentence and where the evidence is overwhelming, there are cases where an early plea disposition is the best result possible.  Sentencing in the federal system is similar to a small trial and is an art. We have other clients where a plea is not a possibility and trials are necessary. However, in either case, there is a risk of incarceration if the case is not a reject or the case is not dismissed before trial. As of March 23, 2013, there are 217,929 incarcerated in federal prison according to the Bureau of Prisons. In California alone, there are 163,000 in state prisons.

For those who need some guidance on what to expect for federal custody, we offer our clients guidance. Of course, the best result is for a rejected case, a win at trial or motion phase or a probationary sentence. If there is the possibility of federal prison time, preparation helps. Especially since our clients who have had almost no exposure to the criminal justice system cannot believe how the prison industrial complex has become a major industry in the United States and how there are routine deprivations of rights and privileges. This is even more common in the county and state facilities.  Almost every client we have had feels they need to write a book or make a movie on the criminal justice system. However, when the politicians and public think that we need to be “tough on crime,” these are not easy issues to raise with the public during an election.

Let us hope that you or your family member’s case will not result in incarceration. However, if it occurs – whether while awaiting trial or post-trial or plea agreement – there are unwritten rules to be considered. For example, one of our physician clients was in custody pending trial and had two bail motions denied when we were retained. The client filed numerous complaints with the Los Angeles County Sheriff’s Office about treatment, moldy food, violation of regulations and policies, and unfair treatment. Our client was correct on all these issues, however, the complaints resulted in something called “diesel therapy” and other administrative sanctions. Somehow, the client was taken to the wrong facility for a court appearance and made to wait in a freezing room all day in handcuffs. Even a court order was not followed on the transport. The judges only have so much jurisdiction over the federal Bureau of Prisons or the County Jails or the Department of Corrections. We were able to obtain results by going to the legal department, obtaining court orders, negotiating with staff ourselves and persuading our client that making complaints will be detrimental unless it is done properly.

The staff at facilities believe that this is their house and you are a guest following their rules. Even if it is taxpayer supported, they do not want complaints about the food, the soap, the facilities, and so on. This does not mean that we agree with the prison administrators but we want those in custody to know that viewpoint so they do not cause themselves additional aggravation. 

For educated persons who are not experienced in the jails and prisons, how are they to navigate this new territory? This is a different planet. Often it is not so dangerous and interminably boring and isolating. There is a risk of becoming institutionalized and depressed. There is also a race based culture (especially in state prisons) that needs to be navigated. If you or your family member is educated, that can be a great benefit to the other inmates who are not well-educated. Finally, there are new terms to learn.

Tracy Green Quoted On Physician Accused Of Second Degree Murder And Excessive Prescribing Due To Accidental Overdoses by Patients

Tracy Green was quoted in the Los Angeles Times regarding her newest former physician client who pleaded not guilty to all counts (including second degree murder and excessive prescribing) on Friday, September 27 before Judge Schnegg. The article entitled "RowlandHeights Physician Charged With Murder Pleads Not Guilty" states as follows:

"Tracy Green, a Los Angeles attorney who recently began representing Tseng, said she is "extremely confident" her client will be acquitted."

"This isn't a murder case," Green said. "In America, we believe in personal responsibility.... When [Tseng] prescribed these medications to the three patients at issue, they … had their own agenda, which was to seek drugs."

For more information, feel free to contact Tracy Green at tgreen@greenassoc.com or at her office at 213-233-2260. The firm's website also has additional information about her and her firm. 

Los Angeles Times Reports On Lawyers Who Defend Doctors - Attorney Tracy Green Quoted

(Liz O. Baylen / Los Angeles Times)

Attorney Tracy Green was interviewed by the Los Angeles Times for an article regarding a case against a former physician Lisa Tseng presently pending in Los Angeles County Superior Court. This article is entitled "Prosecution of Doctor in Overdose Cases Worries Physicians."

Ms. Tseng who surrendered her license last year has been charged with manslaughter for allegedly prescribing painkillers with little or no medical examination to three patients who later overdosed. For the record, Ms. Green does not and has not represented Ms. Tseng and would never comment on a current or former client.

Given the emphasis on the rise of prescription drug abuse and addiction in the United States, physicians who prescribe narcotics for pain management are caught in the cross-hairs of this "war" against prescription drug addiction. Any physician who prescribes pain medication -- even on occasion -- should keep up on this issue and ensure that their medical record keeping and protocols meet the standard of care.

Ms. Green just finished a Medical Board trial this week on a physician who prescribed pain medication to an undercover DEA agent and was facing an Accusation due to the deficiencies in his physical examination and record keeping. It is our belief that the DEA is reviewing CURES reports on physicians and checking to see if any patients in their 20s and 30s are receiving scheduled pain medication and other narcotics and are referring cases to the Medical Board for record review.

For more information, contact:
Green and Associates, Attorneys at Law
213-233-2260
Email: tgreen@greenassoc.com
Website: www.greenassoc.com