Healthcare fraud is the submission of false claims or disinformation of healthcare insurers about care or services that may or may not have been provided.
What Does Penal Code 550(a) PC Prohibit?
Penal Code 550(a) PC prohibits most forms of health care and medical billing fraud in California. Under Crimes Against Insured Property and Insurers Penal Code 550 (a) PC it is unlawful to aid, abet, solicit, or conspire with any person to do any of the following:
(1) Knowingly present or cause to be presented any false or fraudulent claim for the payment of a loss or injury, including payment of a loss or injury under a contract of insurance.
(2) Knowingly present multiple claims for the same loss or injury, including presentation of multiple claims to more than one insurer, with an intent to defraud.
(3) Knowingly cause or participate in a vehicular collision, or any other vehicular accident, for the purpose of presenting any false or fraudulent claim.
(4) Knowingly present a false or fraudulent claim for the payments of a loss for theft, destruction, damage, or conversion of a motor vehicle, a motor vehicle part, or contents of a motor vehicle.
(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.
(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.
If the false claims equal $950 or less, then the offense is a misdemeanor and is punished as follows:
- Up to 6 months in county jail; and/or
- A fine of up to $1,000
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 court. A felony healthcare fraud conviction in California is punishable by:
- 2, 3, or 4 years in prison; and/or
- A fine of up to $50,000
California Healthcare Fraud Defense Attorney
If you or someone you know has been charged or accused of healthcare fraud, it is very important that you seek the legal counsel of an experienced California healthcare fraud defense lawyer. Contact the Manuelian Law Firm today to schedule a free consultation at (213) 401-2777.