Health Care Fraud Laws in California - Penal Code 550(a)
California Penal Code 550(a) PC prohibits most health care and medical billing fraud. In California, healthcare fraud is a broad term frequently called insurance fraud, medical billing fraud, Medicare fraud, or Medi-Cal fraud.
Most patients pay their health care expenses through either a private insurance company or government medical insurance. Since making health care payments is complex, it is much easier to commit fraud. Some of the most common schemes that violate Penal Code 550(a) PC healthcare fraud laws include the following:
- submitting false health care claims,
- preparation of a document in support of a false claim,
- submitting multiple claims for the same procedure,
- billing for services that a patient never received,
- billing for more expensive services a patient did receive.
For a prosecutor to obtain a conviction for health care fraud, they will have to prove, beyond any reasonable doubt, that you knew the claim was false or fraudulent and that you had a specific intent to defraud the medical insurance company or the insurance program.
What Primary Factors Are Prosecutors Looking At?
Whenever it comes to messing around with government money, stealing from the government in the form of something related to healthcare fraud, you can bet the prosecutors and judge on your case are going to be looking to punish you in kind for what you did:
- They're going to look at the amount of healthcare fraud involved;
- They're going to look at the sophistication level;
- They're going to look at how many victims there were and
- they're going to formulate a plan to try to put you away for as long as possible.
These healthcare fraud schemes can often be prosecuted at either the state or federal level, depending on the sophistication, how much money was involved, and who was involved. Suppose you're talking about doctors being involved or lawyers being involved. More than likely, that case will go federal, and they're going to be looking to put the person away in federal prison at an 85% rate of the time they're doing. So, you can see that these cases are handled very harshly by the best prosecutors.
Defending California Health Care Fraud Cases
So, if you're looking to defend yourself, you'll want to get the best criminal defense attorney on your side. Your choice of legal representation can make a significant difference in the outcome of your case. I've been doing this now for almost three decades, and I understand the importance of a strong defense in healthcare fraud cases.
I've seen how they prosecute healthcare fraud cases in Los Angeles and how judges evaluate instances when formulating their decision-making process.
I've defended cases at the federal level. I've defended cases at the state level. I've handled thousands of healthcare fraud-related cases in LA County for many years. The first thing I have you do is come to my office, sit down, and go over everything.
Once I have all the details from you—the stuff that helps your story and the stuff that might hurt your account-I can start formulating a defense strategy. This involves analyzing the evidence, identifying potential legal defenses, and preparing for any arguments the prosecution might make. I'll work with you to develop the best game plan for your circumstances if you're charged with healthcare fraud in California.
Once we've got that plan together, we'll start talking about what you're looking at, what you're facing, what you can do to help me achieve the best result, and what I'm going to do for you moving forward in your case.
Health Care Fraud Prosecutors in Los Angeles
Healthcare fraud is treated very seriously because the whole healthcare system is at stake. So, if people steal money from the government—and many people are doing it—it will break the system. The consequences of healthcare fraud can be severe, including hefty fines, loss of professional license, and even imprisonment. This is why it's crucial to have a strong legal defense if you're facing healthcare fraud charges.
It will cause the system to collapse, and that's why the feds have put an office in Los Angeles County. All they do is prosecute healthcare fraud cases. The District Attorney's office in Los Angeles County has healthcare fraud prosecutors. They've got a separate section with a head prosecutor, an assistant prosecutor, and many deputies who go after people who commit healthcare fraud.
Best Health Care Fraud Criminal Defense Attorney in California
In California, healthcare fraud is a broad term that includes many misdemeanor and felony crimes, including medical billing fraud, insurance fraud, and Medicare or Medi-Cal Fraud.
Most patients pay for their health care using a private insurance company or a government-run medical insurance program. The routine procedure for processing payments related to health care is often complex, which creates the opportunity for someone to commit fraud.
This complex medical billing processing also allows entirely innocent patients to face criminal healthcare fraud accusations when they commit an honest mistake. While America's health care system is often the primary topic of discussion and debate, most people will agree that it's complicated and confusing.
For example, a routine annual checkup with your family doctor often includes a requirement to complete many forms. On the flip side, the physicians also have paperwork to complete, and their patient billing is based on actuary tables. Our Los Angeles criminal defense lawyers provide a review below for more information.
What are Common Types of California Health Care Fraud?
Some people make a living creating new fraudulent schemes, but there are many types of everyday healthcare fraud criminal conduct, including:
- doctor's billing for medical services patient never received;
- patient or doctor submitting false or fraudulent claims;
- health care clinics billing for more expensive services than the patient received;
- health care professionals are submitting duplicate billing claims for the same procedure.
California Penal Code 550 PC is the ordinary statute used by prosecutors to file charges against someone who submits a claim for health care procedures that were never actually performed, a prevalent type of insurance fraud.
Yet another standard fraudulent health care fraud scheme under PC 550 occurs when multiple claims are submitted for the same medical service, which the insurance provider calls “double billing. "
In most cases, healthcare providers, such as physicians, nurses, clinics, and therapists, face criminal charges.
Elements of the Crime for California Health Care Fraud Cases
The doctors and clinics make honest mistakes with so much paperwork and confusion, but many are intentional acts of health care fraud for financial gain.
For a prosecutor to convict someone of health care fraud, they will have to prove some critical factors called by the legal profession the “elements of the crime.” These factors have to be proven beyond any reasonable doubt:
- defendant knew the health care claim was false or fraudulent;
- defendant had a specific intent to defraud.
You can't be convicted of health care fraud unless the prosecutor can prove that you knew the claim you were submitting was fraudulent or a duplicate claim or that the documents you prepared would be used to introduce a false claim.
Further, it must also be proven that you intended to defraud the medical insurance company or the insurance program. Like most fraud-related crimes in California, the primary factor that must be proven is “intent.” If your criminal defense attorney can create reasonable doubt on this crucial element, you stand a better chance of avoiding a conviction.
Punishments for a Health Care Fraud Conviction
The penalties for a healthcare fraud conviction can be harsh. Most cases involve a loss of over $950, which can be filed as either a misdemeanor or a felony offense (wobbler).
If you are convicted of felony healthcare fraud, the penalties include the following:
- two, three, or five-year sentence in county jail;
- fines up to $50,000 or double the amount of fraud;
- probation that includes up to one year in county jail.
If the defendant is a doctor or health care professional, they will be subjected to having their professional license suspended or revoked. Related crimes for Penal Code 550 PC health care fraud in California include Health and Safety Code 11173 prescription fraud and workers' compensation fraud.
How to Get the Best Result in Health Care Fraud Cases
I've been defending those individuals charged with healthcare fraud now for almost three decades in all of the Los Angeles County criminal courts at the state and federal levels. To be the best:
- you have to understand the crime;
- you have to understand why the government prosecutes it;
- you have to understand how to defend it, and
- you have to understand if your client is guilty of the crime;
- how to get the best resolution possible under the circumstances;
- how to protect their rights, freedom, reputation, and all the important things to them.
If you or a loved one is charged with a healthcare fraud-related matter in Los Angeles, either at the state or federal level, you've come to the right place. Your first move should be to pick up the phone and ask for a meeting with Ron Hedding. I've been doing this for a long time and have had a lot of success for my clients.
You have to understand that the government is very similar to the mafia-related to health care. If anybody takes government funds, the government will make sure that you're taking them lawfully.
If you are either a doctor, someone who works in the healthcare profession, a nurse, or anybody connected to healthcare in Los Angeles, you'd better not be taking money from the government that does not belong to you. That's the primary premise behind these healthcare fraud cases.
People are using Medical and Medicare. I've represented drivers; I've represented doctors, pharmacists, nurses — the list goes on and on and on. They all have one common threat to them: taking the government's money unlawfully. Sometimes, that's difficult for the government to prove; sometimes, it's easy to prove.
Sometimes, people don't understand why they're being prosecuted. They think it's somebody else's responsibility, and they see other people doing it, so they figure out why they can't do it. What's the problem with it?
Developing a Strategy to Fight Health Care Charges
So, that's one of the first things we have to sit down in a confidential environment and discuss:
- number one, what did you do that's causing the government to either investigate or prosecute you for healthcare fraud?
- number two, is what you did unlawfully?
Sometimes, that requires some digging. We will look at the California Penal Code Section they are trying to say you violated. Once we have that, we can compare it to the facts and circumstances surrounding your case and determine whether or not you've done something wrong.
If you haven't done anything wrong, then it's my job to convince the government you didn't and either not file a criminal case against you or dismiss the criminal case they have pending against you. Finally, if the government won't do those two things and you're innocent, we'll go to jury trial and beat the government.
Sometimes, it's going to be a situation where you're getting swept up by a net, and you're innocent. Other times, it's going to be a situation where you're guilty, and they've got the evidence, but maybe they're not looking at the case the right way.
Maybe they think you're more involved than you are. Other times, they'll have it exactly right, but that doesn't mean the sentence and punishment will be the same every time.
It would help if you had someone who would fight for you. You need someone who will go to bat for you and figure out what can be done to get you the result you must have—not just for you but also for your family and your future.
For example, do you want to go into custody for three to five years, and then you can't pay the money back because you can't work? The prosecutors will consider this. If you can get that money upfront to pay them back, whatever it is you're involved with, you're now in a good position. You currently have some leverage.
If you have no prior criminal record, never been in trouble before, you've got some leverage. If you've got a great criminal defense attorney by your side, you've got some power because that attorney will figure out what it takes to get the result you must have.
So, first, you need to dissect the problem, then examine how you're going to attack it, and finally, you and your attorney need to work together to put together a plan that puts you in the best possible position.
If, on the other hand, they're able to prove that you did commit some form of healthcare fraud, then we're going to have to:
- figure out what we can do to keep you out of jail/prison;
- protect your freedom;
- protect your rights;
- protect your reputation and your family, and
- all of the things that are important to you.
That's why we'll sit down in that first meeting and, first, decide where we stand and, second, come up with a plan to get you out of the criminal justice system as fast as possible.
Check out my reviews on the internet and the videos I've put out there so people can see who I am and what I'm all about. Then pick up the phone and set a meeting with Ron Hedding. I stand at the ready to help you.
So, with that type of organization lined up against you, act immediately if you or a loved one is charged or being investigated for healthcare fraud. Take the first step. Pick up the phone. Ask for a meeting with Ron Hedding. Hedding Law Firm is based in Los Angeles County at 16000 Ventura Blvd #1208 Encino, CA 91436. Contact our office for a free consultation at (213) 542-0940.
