In California, Penal Code 550 (a) prohibits various forms of health care and medical billing fraud and committing these crimes could result in a misdemeanor or felony charge depending on the severity. But, you may ask, what is health care fraud and why is it taken so seriously? This is a crime where someone will use deception when filing a health care claim to profit or receive some other type of benefit. It is estimated that as much as 10% of all money spent on health care is paid out on fraudulent claims at any given time, which is why these crimes are charged severely.

1Many health care fraud cases will include government programs like Medi-Cal (put in place for low-income, elderly, and disabled individuals) and is seen as stealing from the taxpayers of the state. This year, the nation’s largest healthcare fraud crime netted over 300 people and involved more than $900 million in fraudulent billing. 22 of the people who were in the midst of the crime, including doctors, a psychiatrist, and pharmacist were from southern California and quickly became part of the investigation. The fraud case involved prescriptions that were written for “patients” who did not even want the medications in many cases. These prescriptions were written for profit rather than to treat the patient.

Was it Fraud or a Mistake?

In some cases, health care fraud wasn’t actually fraud but, instead, an accident. If a person commits fraud, they knowingly engaged in a plan, scheme, or activity to provide falsehoods with the intent to gain financially. This is an illegal act and not just a mistake, omission, or improper payment. In a mistake, for instance, a person may be accidentally billed for treatment that they did not receive. However, upon making proper phone calls, it is found that there was a mistake. However, if it can be proven that the provider knowingly provided treatment that the patient did not need, fraud has occurred.

Criminal Acts to Obtain Patient Insurance Information

If you were part of a fraud scheme, you may have engaged in fraudulent activities to steal information or scam a patient into giving you information that you can benefit from financially. Some of the most common methods of health care fraud include the following:

  • Providing an inducement to beneficiaries to visit a location to obtain an identity, such as money or a gift
  • Obtaining patient information when patients obtain a free screening
  • Inducing medical personnel to involve them in fraud schemes
  • Purchasing information from others involved in fraud

Penalties

If you have been involved in one of these criminal acts, you may serve time in prison, face fines up to $250,000 for every offense, pay back restitution to victims, and even serve immense sentences of probation. This is why it is pertinent to speak to an attorney about your case, because this crime is far from minor. Call us today for more information.