To most professionals, a clerical error or a misunderstood billing code might seem like a minor hiccup—an honest mistake in a sea of paperwork. But in the eyes of licensing boards and state regulators, it could be interpreted as healthcare fraud—an allegation that can trigger a formal investigation and put your professional license at risk.
At Simmons Wagner, LLP, we’ve seen firsthand how good doctors, nurses, and healthcare providers can find themselves the target of disciplinary action over simple administrative missteps. If you’re facing scrutiny from your licensing board due to a billing issue, it’s crucial to take the matter seriously—and to get experienced legal help immediately.
The Line Between Mistake and Misconduct Is Thin
Medical professionals deal with mountains of documentation. From insurance authorizations and billing codes to patient charts and treatment notes, it’s easy for something to be misfiled, miscoded, or misunderstood. But state licensing boards often approach these errors with suspicion.
You may face allegations like:
- Upcoding or billing for a more expensive procedure than was performed
- Billing for services that weren’t actually rendered
- Submitting duplicate claims
- Inaccurately documenting patient care
- Failing to correct known billing mistakes
In many cases, these actions weren’t intended to deceive—but that doesn’t stop licensing boards from treating them as willful fraud.
The Consequences Extend Far Beyond Fines
When a billing issue triggers a formal accusation, it’s not just about potential repayment or fines. If you’re a licensed healthcare professional, your entire career may be on the line.
Depending on the nature of the accusation and the findings of the board, you could face:
- License suspension or revocation
- Probationary monitoring or mandated retraining
- Reporting to the National Practitioner Data Bank (NPDB)
- Loss of employment or credentialing with hospitals and insurers
- Damage to your professional reputation and referrals
For immigrants or visa holders, these accusations may also trigger immigration consequences.
Why Legal Representation Matters—Even If You’re “Innocent”
You may believe that because your intentions were honest, you can simply explain your side of the story and resolve the issue. Unfortunately, licensing boards are not neutral parties. Their mandate is to “protect the public”—and they often interpret that to mean pursuing discipline aggressively.
At Simmons Wagner, LLP, we understand how these boards operate. We know how to challenge the evidence, highlight the context, and negotiate outcomes that protect your license and your livelihood.
We can help you:
- Respond strategically to letters of inquiry or formal accusations
- Navigate interviews or board hearings
- Gather evidence to demonstrate your intent and mitigate harm
- Work with expert witnesses to explain billing practices
- Negotiate for probation, retraining, or alternative outcomes
- Fight for dismissal or reduced penalties whenever possible
A Personalized Strategy for Complex Allegations
Every professional license defense case is unique, and a one-size-fits-all approach simply doesn’t work. Our attorneys take the time to understand the full story behind your case—whether it’s a genuine misunderstanding, a systemic billing issue, or a mistake by support staff. From there, we build a defense that aligns with your goals, protects your license, and keeps your career on track.
Don’t Wait Until You’re Facing Discipline
If you’ve received a letter from your licensing board—or suspect one may be coming—contact us now. Early intervention can make all the difference in the outcome of your case.
Call (949) 439-5857 today to schedule a confidential consultation with the professional license defense team at Simmons Wagner, LLP. We’re here to protect what you’ve worked so hard to build—your license, your reputation, and your future.