California Penal Code Section 550(a) covers and defines healthcare fraud, which sometimes is also referred to as health insurance fraud and medical billing fraud. Healthcare fraud is submission of false claims or disinformation of healthcare insurers about care or services that may or may not have been provided. Penal Code Section 550(a) lists a range of unlawful conduct and here are some examples that could lead to California health care fraud charges:
- Presenting fraudulent or false claim for the payment of an injury or loss
- Presenting several claims for the same injury or loss
- Participating in a vehicular collision or any other accident, for the purpose of presenting fraudulent or false claim.
- Presenting a fraudulent or false claim for the payments of a loss for destruction, damage, theft
- Causing a fraudulent or false claim for payment of a health care benefit.
What is Required to Convict a Person of Healthcare Fraud Penal Code 550(a)?
To convict a person in health care fraud, the prosecutor has to do prove his engagement in one of the unlawful behaviors described in Penal Code Section 550(a) and also two additional elements of the crime.
- Defendant knew that the claim was fraudulent or false
- Defendant intended to defraud the medical insurance program or insurance company
These types of crimes are usually committed by health care providers including chiropractors, physical therapists, nurses, nurse practitioners, dentists, and administrators. If convicted of health care fraud, professional licenses can be suspended or revoked.
Penalties for Penal Code Section 550(a)
In California penalties for health care fraud depend on the amount of the fraudulent claim. Health care fraud claims of $950 or less. In case the claim is $950 or less then the health care fraud is a misdemeanor.
Penalties for a Misdemeanor Medical Fraud Conviction
Penalties for misdemeanor medical and or health care fraud depend on the amount of the fraudulent claim, but may include the following:
- a fine of up to one thousand dollars and/or
- up to six months in a county jail.
Health Care Fraud Claims for More than $950
In case the fraud was more than $950, then the crime of health care fraud is considered a wobbler. The defendant can be charged with either a misdemeanor or a felony conviction. Penalties for a misdemeanor conviction are:
- up to one (1) year in county jail, and/or
- a fine of up to $10,000
Penalties for a Felony Medical Fraud Conviction
Penalties for felony medical and or health care fraud include the following:
- Probation with up to one year county jail,
- Two, three, or five years in county jail and/or
- Fine up to $50,000 or double the amount of the fraud whichever is larger
In case the charges involve more than one claim, then the key question is whether all the claims add up to more than $950 in twelve months period.
California Medical Fraud Defense Lawyer
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