Health Care Fraud Laws in California
Explained by Criminal Defense Lawyers

Health care fraud is also commonly called medical insurance billing fraud, health insurance fraud, HMO fraud, Medicare fraud or Medi-Cal Fraud. These are booming areas of both criminal and law enforcement activity these days. 1

It's not hard to see why. A lot of the health care people receive in America today is paid for by someone other than the patient-whether it's a private medical insurance company or a government medical insurance program like Medicare or Medi-Cal.

To make matters worse, the systems for processing payment are often very complicated. This creates plenty of opportunities for fraud.

But the confusing bureaucracy of medical bills also leads to plenty of opportunities for the authorities to accuse innocent people of health care fraud...often for behavior that is just the result of honest mistakes.

A fair amount of health care fraud cases involve government programs like Medi-Cal (California's government-provided health insurance program for low-income, elderly, and disabled individuals). So it can be seen as "ripping off the taxpayers." Because of this, prosecutors can score big political points by going after people they suspect of committing health care fraud  2. . . including people who may have done nothing wrong.

Here are some examples of behavior that could lead to California health care fraud charges:

  • Billing for medical services or procedures that the patient never actually received.
  • Billing for more expensive services than the ones the patient received (this is known as "upcoding").
  • Submitting a so-called duplicate claim for the same procedure-in other words, billing the medical insurance provider for a service that actually was delivered to a patient, but then submitting a second claim for the service even though the patient only received it only once.

As the above examples indicate, health care fraud charges are usually filed against medical professionals (like doctors, nurse practitioners, or therapists) or other people who work in medical offices or hospitals (like medical secretaries or records clerks).

Penalties

Penal Code 550(a) PC prohibits most forms of health care and medical billing fraud in California. 3

If the allegedly fraudulent claims are worth no more than nine hundred fifty dollars ($950) in total, then the offense is a misdemeanor.  4 In this case, the potential penalties are imprisonment in a county jail for up to six (6) months, a fine of not more than one thousand dollars ($1,000), or both.  5

But if the claims in question total more than nine hundred fifty dollars ($950), then the offense of health care fraud is a wobbler. This means that it may be prosecuted as either a misdemeanor or a felony.  6

If it is charged as a felony, the maximum penalties are:

  • a fine of up to fifty thousand dollars ($50,000) or double the amount of the fraud, and/or
  • imprisonment for two (2), three (3) or five (5) years in county jail.  7
Defenses

Important legal defenses that you can assert against a charge of California health care fraud include mistake of fact and lack of intent to defraud.

A California criminal defense attorney who is familiar with health care fraud cases can help you assert these defenses.

In this article, our California criminal defense attorneys 8 explain Penal Code 550 PC, California's health care fraud law, by addressing the following:

1. Types of health care fraud

1.1. Submitting claims for benefits that were not delivered

1.2. Submitting false or fraudulent claims

1.3. Multiple claims

1.4. Submitting undercharges without overcharges

1.5. Preparing a writing in support of a fraudulent claim

2. Other elements of the offense of health care fraud

2.1. Knowledge that the claim was false or fraudulent

2.2. Intent to defraud

3. Legal defenses against health care fraud charges

3.1. Lack of knowledge / mistake of fact

3.2. Lack of intent

4. Penalties

4.1. Claims of $950 or less

4.2. Claims of $950 or more

4.3. Loss of professional license

5. Related Offenses

5.1. Aiding, abetting, soliciting, or conspiring in health care fraud

5.2. Medi-Cal fraud

5.3. Prescription fraud

5.4. Workers' compensation fraud

If you would like more information after reading this article, we invite you to contact us at Shouse Law Group.

1. Types of health care fraud

Health care fraud falls within California's insurance fraud laws. It generally involves the claims for payment of benefits that health care providers (like doctors and therapists) submit to health insurance companies or government health insurance programs.

1.1. Submitting claims for benefits that were not delivered

Penal Code 550 makes it illegal to submit a claim for any sort of health care service or procedure that was not actually used by the person in whose name the claim is made.  9 In other words, if you submit claims to a health insurance company for services that were never actually rendered, it is considered health care fraud.

Example: Dr. K. has a practice delivering babies, but he often does not show up at the delivery and instead just sends an assistant. Still, he bills his patients' insurance companies for his services at
the delivery.  10

Example: Donna is an in-home health care worker. She submits claims to Medi-Cal for services she says she performed for a client...but that in fact she never performed, because the client is dead.  11

1.2. Submitting false or fraudulent claims

You can also be charged with California health care fraud for submitting a "false or fraudulent" claim for health care benefits.  12

This can include:

    • Performing a service that the patient didn't need and billing insurance for it.  13

      Example: Dr. Davis is a dentist. He tells patients they need fillings and root canals even when they don't, performs these procedures, and then bills their insurance. He can be prosecuted for billing insurance for these services.
    • So-called "upcoding," or billing insurance for a more expensive procedure or service than what the patient actually received.

      Example: Chris is a chiropractor. He charges less for a therapeutic massage than for a full chiropractic treatment. Sometimes when he performs a massage he will submit a claim to insurance stating that he performed a chiropractic treatment instead, and so he'll receive payment at the higher rate.
  • Applying charges to patients with insurance that are not applied to patients that pay out of pocket.

    Example: Chris the chiropractor has some patients who pay out of pocket and some who pay with insurance. When an out-of-pocket patient misses an appointment, Chris will reschedule without charging a fee. But when an insurance patient misses an appointment, Chris will submit a claim to the insurance for a "missed appointment fee."  14

1.3. Multiple claims

Another form of health care fraud under Penal Code 550 is submitting multiple claims for the same medical service-basically, double billing the insurance provider.  15

Example: Oliver is an oncologist (a doctor who specializes in cancer). When he suspects a patient might have cancer, he runs a whole series of tests including a CT scan (a full-body X-ray) and bills the patient's insurer for all of those tests. But then he also sends the insurer a separate bill for the CT scan, even though it was included in the bundle of tests. Oliver is billing the insurance company twice for the same CT scan.

1.4. Submitting undercharges without overcharges

Penal Code 550 specifically makes it a crime to send a bill to a health insurer for services that were undercharged for in the past, without also sending at the same time a bill for services that were overcharged for in the past.  16 This is best explained with an example.

Example: Dr. Dennis is the primary care doctor for Pete the Patient. Pete has a number of physical complaints and visits Dr. Dennis several times over the course of a year. When he is going over his accounts for the year, Dr. Dennis discovers two mistakes:
  1. Pete visited him in March for a physical exam and allergy shots, which together should have cost $500. But Dr. Dennis's office only billed Pete's insurance company for $300, which was the cost of just the exam (not the shots). So he has underbilled the insurance company by $200 ($500-$300).
  2. Pete visited Dr. Dennis's office again in October to have his vital signs taken. Dr. Dennis's office billed the insurance company for $300, which is the cost of an office visit with Dr. Dennis. But in fact Pete did not see Dr. Dennis on that visit. He only saw the nurse, which costs just $150.  So Dr. Dennis had overbilled the insurance company by $150 ($300-$150).
If Dr. Dennis now submits to the insurance company a claim for $200 (the amount that was underbilled in March)...but does not tell them about the $150 extra that he got paid in October...he has committed health care fraud.

1.5. Preparing a writing in support of a fraudulent claim

It is also considered criminal health care fraud to prepare any document that will be used to support a fraudulent health care claim.  17

According to Riverside criminal defense lawyer Michael Scafiddi:  18

"The fact that being involved in document preparation can lead to criminal liability is one of the toughest parts of California's health care fraud law. It means that people like a secretary in a doctor's office or a medical billing assistant can face criminal charges for scams that they did not initiate or get any money from. If you happen to work for a medical provider who chooses to commit fraud, you could be charged with health care fraud just for doing what you were told was your job."
2. Other elements of the offense of health care fraud

To convict someone of health care fraud, the prosecutor has to do more than just show that they engaged in one of the behaviors described above. The following two additional "elements" of the crime have to be proven beyond a reasonable doubt before the authorities can get a conviction.

2.1. Knowledge that the claim was false or fraudulent

You can only be convicted of California health care fraud if you knew that the claim you were submitting was a fraudulent or duplicate claim, or that the document you prepared would be used to submit a fraudulent claim.  19

Example: Earlier we discussed Oliver the oncologist, who submits two claims to a patient's insurer for one CT scan. One claim is for the CT scan by itself, and the other is for the same scan as part of a bundle of tests. Let's say Oliver does not know that the CT scan is included in the bundle of tests and thinks that he is only submitting one claim, not two, for it. Because he is not knowingly submitting multiple claims for one service, he is not guilty of health care fraud.

2.2. Intent to defraud

Similarly, you can only be convicted of health care fraud if it can be proven...beyond a reasonable doubt...that you intended to defraud the medical insurance company or insurance program.  20

Intent...that is, the requirement that you intended to commit fraud...is a common element of most California criminal fraud laws. In almost all cases, if you did not specifically intend to commit fraud, you are not guilty of fraud, including health care fraud.

3. Legal defenses against health care fraud charges

If you are accused of health care fraud, there are a number of criminal defenses in California law that you can use to defend yourself. Two of the most important are:

3.1. Lack of knowledge / mistake of fact

As we explained above, you cannot be convicted of fraud unless you knew that you were involved in submitting a fraudulent or duplicate claim.  21

The well-known legal defense of mistake of fact can therefore be very helpful. Because medical billing and health insurance are extremely complicated, it is easy for even intelligent and experienced professionals to make mistakes about how the billing process works. If you were mistaken about a key fact (like Oliver in the example above), you may not have known that a claim was fraudulent...and therefore did not commit a crime.

3.2. Lack of intent

Lack of intent is another important legal defense to health care fraud charges. If the prosecutor can't show intent to defraud, then the accused should be exonerated.  22

Example: Ann is Dr. Frank's assistant. She helps him prepare the paperwork for submitting claims to patients' insurance. Over time, she figures out that a number of the claims he is submitting are fraudulent.

Ann is supporting two children on her own and cannot quit her job. She is also afraid that she will lose her job if she confronts Dr. Frank. So she starts looking for another job. She continues to help Dr. Frank prepare the paperwork for fraudulent claims. But she plans to contact the authorities and the insurance companies to tell them what is going on as soon as she finds another job and can quit this one.

However, the authorities find out about Dr. Frank's fraudulent claims before this happen. They arrest both him and Ann. Ann may be able to show that she did not intend to defraud the insurance companies, since she planned to leave her job and blow the whistle as soon she could.
4. Penalties

The potential criminal penalties for California health care fraud depend on whether the amount of the fraudulent claims is greater than nine hundred fifty dollars ($950).  23

If the charges involve more than one claim, then the key question is whether all the claims add up to more than $950 over a period of twelve (12) months.  24

4.1. Claims of $950 or less

If the claims at issue add up to $950 or less, then health care fraud is a misdemeanor in misdemeanor in California law. 25

Misdemeanor penalties for California health care fraud are:

  • a fine of up to one thousand dollars ($1,000), and/or
  • up to six (6) months in a county jail. 26

4.2. Claims of more than $950

If the claims at issue add up to more than $950, then the crime of health care fraud becomes a "wobbler" in California law. This means that the prosecutors may choose to file it as either a misdemeanor or a California felony charge.  27

If health care fraud involving more than $950 is charged as a misdemeanor, the penalties are:

  • up to one (1) year in county jail, and/or
  • a fine of up to ten thousand dollars ($10,000). 28

But if it is charged as a felony, then the potential penalties are either:

  • probation with up to one year county jail, or
  • two (2), three (3), or five (5) years in county jail.

You may instead -- or in addition -- be fined for a felony health care fraud conviction in an amount equal to:

  • up to fifty thousand dollars ($50,000), or
  • double the amount of the fraud (whichever amount is larger).  29

4.3. Loss of professional license

People accused of health care fraud are typically health care professionals. If convicted of health care fraud, they may have their professional licenses revoked
or suspended.  30

If you are a doctor, the professional and personal consequences can be devastating if the medical board revokes or suspends your California medical license due to a criminal conviction. For nurses, the consequences of a nursing license revocation because of a criminal conviction are just as devastating.

5. Related offenses

5.1. Aiding, abetting, soliciting, or conspiring in health care fraud

Penal Code 550 doesn't just make it a crime to prepare or submit fraudulent claims yourself. It is also a crime to:

  1. assist someone else in submitting a fraudulent claim,
  2. solicit someone else to submit a fraudulent claim for you, or
  3. engage in a the the California crime of "conspiracy" (Penal Code 182) with others to submit a fraudulent claim.  31

If you do any of the above, you may be convicted and punished just as if you had submitted the fraudulent claim yourself.  32

5.2. Medi-Cal fraud

Medi-Cal is California's public health insurance program for low-income individuals including families with children, seniors, the disabled, pregnant women, and people with specific diseases. Because Medi-Cal is a health insurance program, defrauding Medi-Cal can lead to charges for health care fraud.

But in addition to charges for health care fraud generally, Medi-Cal fraud can lead to additional charges as well. Medi-Cal fraud is specifically prohibited by Welfare and Institutions Code 14107 WIC, which sets out its own penalty scheme.  33

It is also considered Medi-Cal fraud for a patient to lie about something that affects his or her eligibility for Medi-Cal benefits.  34

5.3. Prescription fraud

Prescription fraud (doctor-shopping in California) is another variation on health care fraud.

There are two major forms of prescription fraud. These are:

  1. So-called "doctor shopping," where a patient uses multiple doctors or pharmacies to get multiple prescriptions for controlled substances,  35 and
  2. Doctors issuing prescriptions for reasons other than legitimate medical purposes.  36

5.4. Workers' compensation fraud

A California worker who is injured on the job may collect workers' compensation insurance. Workers' compensation fraud is very common and can overlap with health care fraud.

Penal Code 550 makes clear that it covers fraudulent claims submitted for workers' compensation benefits.  37 So you can be charged with health care fraud under that law for submitting such claims.

Other forms of workers' compensation fraud include:

  • A worker lying about an injury or employment status in order to receive workers' compensation benefits;
  • An employer lying about conditions at their workplace to reduce their insurance premium; and
  • Health care providers lying to help someone receive workers' compensation benefits.
Call us for help...
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If you or loved one is charged with health care fraud and you are looking to hire an attorney for representation, we invite you to contact us at Shouse Law Group. We can provide a free consultation in office or by phone. We have local offices in Los Angeles, the San Fernando Valley, Pasadena, Long Beach, Orange County, Ventura, San Bernardino, Rancho Cucamonga, Riverside, San Diego, Sacramento, Oakland, San Francisco, San Jose and throughout California.

For information about Nevada health care fraud, go to our page on Nevada health care fraud laws.

Legal References:

1 See "To Save on Health Care, First Crack Down on Fraud," The New York Times, Sept. 26, 2011.

2California Governor Jerry Brown brags on his webpage about his record of prosecuting health care fraud while he was Attorney General of California.

3Penal Code 550(a) PC. ("(a) It is unlawful to do any of the following, or to aid, abet, solicit, or conspire with any person to do any of the following: . . . (6) Knowingly make or cause to be made any false or fraudulent claim for payment of a health care benefit. (7) Knowingly submit a claim for a health care benefit that was not used by, or on behalf of, the claimant. (8) Knowingly present multiple claims for payment of the same health care benefit with an intent to defraud. (9) Knowingly present for payment any undercharges for health care benefits on behalf of a specific claimant unless any known overcharges for health care benefits for that claimant are presented for reconciliation at that same time. (10) For purposes of paragraphs (6) to (9), inclusive, a claim or a claim for payment of a health care benefit also means a claim or claim for payment submitted by or on the behalf of a provider of any workers' compensation health benefits under the Labor Code.")

4Penal Code 550(c) PC. ("(2) Every person who violates paragraph (6), (7), (8), or (9) of subdivision (a) is guilty of a public offense. . . . (B) When the claim or amount at issue is nine hundred fifty dollars ($950) or less, the offense is punishable by imprisonment in a county jail not to exceed six months, or by a fine of not more than one thousand dollars ($1,000), or by both that imprisonment and fine, unless the aggregate amount of the claims or amount at issue exceeds nine hundred fifty dollars ($950) in any 12-consecutive-month period, in which case the claims or amounts may be charged as in subparagraph (A).")

See also Penal Code 17(a) PC. ("(a) A felony is a crime that is punishable with death, by imprisonment in the state prison, or notwithstanding any other provision of law, by imprisonment in a county jail under the provisions of subdivision (h) of Section 1170. Every other crime or public offense is a misdemeanor except those offenses that are classified as infractions.")

5Penal Code 550(c)(2)(B) PC.

6Penal Code 550(c) PC. ("(2) Every person who violates paragraph (6), (7), (8), or (9) of subdivision (a) is guilty of a public offense. (A) When the claim or amount at issue exceeds nine hundred fifty dollars ($950), the offense is punishable by imprisonment pursuant to subdivision (h) of Section 1170 for two, three, or five years, or by a fine not exceeding fifty thousand dollars ($50,000) or double the amount of the fraud, whichever is greater, or by both that imprisonment and fine, or by imprisonment in a county jail not to exceed one year, by a fine of not more than ten thousand dollars ($10,000), or by both that imprisonment and fine.")

See also Penal Code 17(b) PC.

7 Penal Code 550(c)(2)(A) PC.

8 Our California criminal defense attorneys have local Los Angeles law offices in Beverly Hills, Burbank, Glendale, Lancaster, Long Beach, Los Angeles, Pasadena, Pomona, Torrance, Van Nuys, West Covina, and Whittier.  We have additional law offices conveniently located throughout the state in Orange County, Newport Beach, Santa Ana, Fullerton, San Diego, Riverside, San Bernardino, Ventura, San Jose, Oakland, the San Francisco Bay area, Sacramento, and several nearby cities.

9 Penal Code 550(a)(7) PC. ("(a) It is unlawful to do any of the following, or to aid, abet, solicit, or conspire with any person to do any of the following: . . . (7) Knowingly submit a claim for a health care benefit that was not used by, or on behalf of, the claimant.")

10 Based on Klvana v. California, (C.D.Cal. 1995) 911 F.Supp. 1288.

11 See Brown Files Criminal Charges Against 25 Individuals who Defrauded Medi-Cal (press release).

12 Penal Code 550(a)(6) PC. ("(a) It is unlawful to do any of the following, or to aid, abet, solicit, or conspire with any person to do any of the following: . . . (6) Knowingly make or cause to be made any false or fraudulent claim for payment of a health care benefit.")

13 People v. Singh, (1995) 37 Cal.App.4th 1343, 1373. ("When a caregiver causes an insurance company to part with money on the basis of medical procedures that, though actually conducted, were not necessary, [health care] fraud occurs.")

14 Based on the same, at 1372.

15 Penal Code 550(a)(8) PC. ("(a) It is unlawful to do any of the following, or to aid, abet, solicit, or conspire with any person to do any of the following: . . . (8) Knowingly present multiple claims for payment of the same health care benefit with an intent to defraud.")

16 Penal Code 550(a)(9) PC. ("(a) It is unlawful to do any of the following, or to aid, abet, solicit, or conspire with any person to do any of the following: . . . (9) Knowingly present for payment any undercharges for health care benefits on behalf of a specific claimant unless any known overcharges for health care benefits for that claimant are presented for reconciliation at that same time.")

17Penal Code 550(a)(5) PC. ("(a) It is unlawful to do any of the following, or to aid, abet, solicit, or conspire with any person to do any of the following: . . . 5) Knowingly prepare, make, or subscribe any writing, with the intent to present or use it, or to allow it to be presented, in support of any false or fraudulent [health insurance] claim.")

18 Riverside criminal defense lawyer Michael Scafiddi is a former police officer and police sergeant. He knows how the police put together criminal cases, which helps him understand how to defend those cases. He represents clients in all San Bernardino County courthouses and Riverside County courthouses.

19 Penal Code 550 PC. ("(a) It is unlawful to do any of the following, or to aid, abet, solicit, or conspire with any person to do any of the following: . . .  (5) Knowingly prepare, make, or subscribe any writing, with the intent to present or use it, or to allow it to be presented, in support of any false or fraudulent claim. (6) Knowingly make or cause to be made any false or fraudulent claim for payment of a health care benefit. (7) Knowingly submit a claim for a health care benefit that was not used by, or on behalf of, the claimant. (8) Knowingly present multiple claims for payment of the same health care benefit with an intent to defraud. (9) Knowingly present for payment any undercharges for health care benefits on behalf of a specific claimant unless any known overcharges for health care benefits for that claimant are presented for reconciliation at that same time.") (emphasis added)

See also Judicial Council of California Criminal Jury Instruction ("CALCRIM") 2000 - (Health) Insurance Fraud: Fraudulent Claims. ("To prove that the defendant is guilty of this crime, the People must prove that: . . . 2 The defendant knew that the claim was false or fraudulent; . . . .")

See also CALCRIM 2001 - (Health) Insurance Fraud: Multiple Claims. ("To prove that the defendant is guilty of this crime, the People must prove that: . . . 2 The defendant knew that (he/she) was submitting two or more claims for the same ((loss/ [or] injury)/health-care benefit); . . . .")

20 CALCRIM 2000 - (Health) Insurance Fraud: Fraudulent Claims.  ("To prove that the defendant is guilty of this crime, the People must prove that: . . . 3 When the defendant did that act, (he/she) intended to defraud.")

See also CALCRIM 2001 - (Health) Insurance Fraud: Multiple Claims. ("To prove that the defendant is guilty of this crime, the People must prove that: . . . 3 When the defendant presented the claims, (he/she) intended to defraud.")

21 CALCRIM 2000 - (Health) Insurance Fraud: Fraudulent Claims. ("To prove that the defendant is guilty of this crime, the People must prove that: . . . 2 The defendant knew that the claim was false or fraudulent; . . . .")

See also CALCRIM 2001 - (Health) Insurance Fraud: Multiple Claims. ("To prove that the defendant is guilty of this crime, the People must prove that: . . . 2 The defendant knew that (he/she) was submitting two or more claims for the same ((loss/ [or] injury)/health-care benefit); . . . .")

22 CALCRIM 2000 - Insurance Fraud: Fraudulent Claims.  ("To prove that the defendant is guilty of this crime, the People must prove that: . . . 3 When the defendant did that act, (he/she) intended to defraud.")

See also CALCRIM 2001 - Insurance Fraud: Multiple Claims. ("To prove that the defendant is guilty of this crime, the People must prove that: . . . 3 When the defendant presented the claims, (he/she) intended to defraud.")

23 Penal Code 550(c) PC. ("(2) Every person who violates paragraph (6), (7), (8), or (9) of subdivision (a) is guilty of a public offense (health insurance fraud). (A) When the claim or amount at issue exceeds nine hundred fifty dollars ($950), the offense is punishable by imprisonment pursuant to subdivision (h) of Section 1170 for two, three, or five years, or by a fine not exceeding fifty thousand dollars ($50,000) or double the amount of the fraud, whichever is greater, or by both that imprisonment and fine, or by imprisonment in a county jail not to exceed one year, by a fine of not more than ten thousand dollars ($10,000), or by both that imprisonment and fine. (B) When the claim or amount at issue is nine hundred fifty dollars ($950) or less, the offense is punishable by imprisonment in a county jail not to exceed six months, or by a fine of not more than one thousand dollars ($1,000), or by both that imprisonment and fine, unless the aggregate amount of the claims or amount at issue exceeds nine hundred fifty dollars ($950) in any 12-consecutive-month period, in which case the claims or amounts may be charged as in subparagraph (A).")

24 Same.

See also CALCRIM 2003 - Insurance Fraud: Health Care Claims - Total Value. ("If you find the defendant guilty of insurance fraud in connection with health-care claims, you must then decide whether the People have proved that the total value of the (claim[s] involved/ [or] amount at issue) was more than $950 [within a period of 12 consecutive months]. The People have the burden of proving this allegation beyond a reasonable doubt. If the People have not met this burden, you must find that this allegation has not been proved.")

25 Penal Code 550(c) PC. ("(2) Every person who violates paragraph (6), (7), (8), or (9) of subdivision (a) is guilty of a public offense. . . . (B) When the claim or amount at issue is nine hundred fifty dollars ($950) or less, the offense is punishable by imprisonment in a county jail not to exceed six months, or by a fine of not more than one thousand dollars ($1,000), or by both that imprisonment and fine, unless the aggregate amount of the claims or amount at issue exceeds nine hundred fifty dollars ($950) in any 12-consecutive-month period, in which case the claims or amounts may be charged as in subparagraph (A).")

See also Penal Code 17(a) PC. ("(a) A felony is a crime that is punishable with death, by imprisonment in the state prison, or notwithstanding any other provision of law, by imprisonment in a county jail under the provisions of subdivision (h) of Section 1170. Every other crime or public offense is a misdemeanor except those offenses that are classified as infractions.")

26 Penal Code 550(c)(2)(B) PC.

27 Penal Code 550(c) PC. ("(2) Every person who violates paragraph (6), (7), (8), or (9) of subdivision (a) is guilty of a public offense (health care fraud). (A) When the claim or amount at issue exceeds nine hundred fifty dollars ($950), the offense is punishable by imprisonment pursuant to subdivision (h) of Section 1170 for two, three, or five years, or by a fine not exceeding fifty thousand dollars ($50,000) or double the amount of the fraud, whichever is greater, or by both that imprisonment and fine, or by imprisonment in a county jail not to exceed one year, by a fine of not more than ten thousand dollars ($10,000), or by both that imprisonment and fine.")

See also Penal Code 17(b) PC.

28 Penal Code 550(c)(2)(A) PC.

29 Same.

30 Business & Professions Code 810 BPC - False or fraudulent claims; disciplinary action. ("(a) It shall constitute unprofessional conduct and grounds for disciplinary action, including suspension or revocation of a license or certificate, for a health care professional to do any of the following in connection with his or her professional activities:(1) Knowingly present or cause to be presented any false or fraudulent claim for the payment of a loss under a contract of insurance. (2) Knowingly prepare, make, or subscribe any writing, with intent to present or use the same, or to allow it to be presented or used in support of any false or fraudulent claim. (b) It shall constitute cause for revocation or suspension of a license or certificate for a health care professional to engage in any conduct prohibited under Section 1871.4 of the Insurance Code or Section 549 or 550 of the Penal Code.")

31 Penal Code 550(a) PC. ("(a) It is unlawful to do any of the following, or to aid, abet, solicit, or conspire with any person to do any of the following: . . .") See also Penal Code 182, California's conspiracy law.

32 Same.

33Welfare & Institutions Code 14107 WIC. ("(a) Any person, including any applicant or provider as defined in Section 14043.1, or billing agent, as defined in Section 14040.1, who engages in any of the activities identified in subdivision (b) [health care fraud] is punishable by imprisonment as set forth in subdivisions (c) , (d), and (e), by a fine not exceeding three times the amount of the fraud or improper reimbursement or value of the scheme or artifice, or by both this fine and imprisonment. (b) The following activities are subject to subdivision (a): (1) A person, with intent to defraud, presents for allowance or payment any false or fraudulent claim for furnishing services or merchandise under this chapter or Chapter 8 (commencing with Section 14200). (2) A person knowingly submits false information for the purpose of obtaining greater compensation than that to which he or she is legally entitled for furnishing services or merchandise under this chapter or Chapter 8 (commencing with Section 14200). (3) A person knowingly submits false information for the purpose of obtaining authorization for furnishing services or merchandise under this chapter or Chapter 8 (commencing with Section 14200). (4) A person knowingly and willfully executes, or attempts to execute, a scheme or artifice to do either of the following: (A) Defraud the Medi-Cal program or any other health care program administered by the department or its agents or contractors. (B) Obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, the Medi-Cal program or any other health care program administered by the department or its agents or contractors, in connection with the delivery of or payment for health care benefits, services, goods, supplies, or merchandise.")

34 Welfare & Institutions Code 14014 WIC. ("a) Any person receiving health care for which he or she was not eligible [health care fraud] on the basis of false declarations as to his or her eligibility or any person making false declarations as to eligibility on behalf of any other person receiving health care for which that other person was not eligible shall be liable for repayment and shall be guilty of a misdemeanor or felony depending on the amount paid on his or her behalf for which he or she was not eligible, as specified in Section 487 of the Penal Code.")

35 Health & Safety Code 11173 HS. ("(a) No person shall obtain or attempt to obtain controlled substances, or procure or attempt to procure the administration of or prescription for controlled substances, (1) by fraud, deceit, misrepresentation, or subterfuge; or (2) by the concealment of a material fact.")

36 Health & Safety Code 11153 HS. ("(a) A prescription for a controlled substance shall only be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his or her professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. Except as authorized by this division, the following are not legal prescriptions: (1) an order purporting to be a prescription which is issued not in the usual course of professional treatment or in legitimate and authorized research; or (2) an order for an addict or habitual user of controlled substances, which is issued not in the course of professional treatment or as part of an authorized narcotic treatment program, for the purpose of providing the user with controlled substances, sufficient to keep him or her comfortable by maintaining customary use. (b) Any person who knowingly violates this section [health care fraud] shall be punished by imprisonment pursuant to subdivision (h) of Section 1170 of the Penal Code, or in a county jail not exceeding one year, or by a fine not exceeding twenty thousand dollars ($20,000), or by both that fine and imprisonment.")

37 Penal Code 550(a) PC. ("(10) For purposes of paragraphs (6) to (9), inclusive, a claim or a claim for payment of a health care benefit also means a claim or claim for payment submitted by or on the behalf of a provider of any workers' compensation health benefits under the Labor Code.")

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