Healthcare fraud in California occurs in a number of contexts, but most often occurs in relation to Medi-Cal, and ensnares doctors, nurses, and other healthcare professionals.
Healthcare Fraud in California Section 550(a) lists a range of unlawful conduct. An example of some, but not all forbidden conduct, is as follows:
Prosecutors will tend to put special emphasis on Extortion cases because of their complex nature. They are often categorized as violent crime if the ‘criminal threats’ that are made involve physical harm to people or property.
The key to understanding the above is the definition of fraud. Fraud is lying to, or misleading, someone about important facts in order to obtain a benefit one would not otherwise be entitled to. This includes lying to obtain coverage or medical devices, even if you are very sick and need care.
The above also makes it possible for billing clerks to be punished for fabricating or processing knowingly false claims. The bottom line is if you are involved with preparing or submitting false information to collect from an insurance company, you should consult a licensed criminal defense attorney.
Example: Alice, a billing clerk at a doctor’s office, feels bad for one of the patients that she encounters at her office who suffers from severe leg pain. To ensure that the patient will be able to get a walker she otherwise would not have gotten, Alice improperly bills the patient’s insurance company.
Alice has likely committed healthcare fraud in California. She submitted false information to ensure that the needy patient got the equipment the patient needed. It is irrelevant that the patient was in pain, or that the patient needed it, the clerk submitted false information to obtain a benefit for someone that would not have been given otherwise.
If the false claims equal $950 or less, then the offense is a misdemeanor and is punished as follows.
If the false claims total $950 or more, then the offense is a “wobbler,” meaning it can be charged as a misdemeanor or a felony at the sole discretion of the prosecutor depending on the circumstances. If charged as a healthcare fraud in California felony it is punishable by:
This does not include any probation or restitution that may be ordered.
Consult a licensed criminal defense attorney to determine how your case will be charged, to discuss possible defenses, and to discuss how to exercise your constitutional rights.
If you or a loved one is being charged with PC 550(a), Healthcare Fraud in California, we invite you to contact us immediately for a free case review. Schedule an appointment to meet with us in person, or feel free to submit an evaluation online and we will get in contact with you ASAP. We can provide a free consultation in our office located in Century City, or by phone. Our experienced and assiduous Criminal Defense Lawyers will be sure to fight until the end to reduce or drop your charges completely.
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