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Defending Medical Fraud Charges in California

Defense of California State and Federal Medical Fraud Charges

There are many laws, both on the federal and state level, that make criminal conduct relating to medical, health care, and insurance fraud very clear.

A conviction for any type of medical fraud, health care fraud, or related insurance fraud carries significant penalties.

Defending Medical Fraud Charges in California
There are numerous state and federal statues defining medical insurance fraud.

If you are under a criminal investigation for medical fraud, you need to retain experienced defense lawyers to start planning a strategy moving forward.

In California, most of the relevant legal language is contained in one section.

California Penal Code 550 PC makes it a crime for anyone to knowingly submit fraudulent insurance claims.

However, it also includes presenting multiple claims for same loss and presenting false information to an insurance company.

The statute language clarifies many relevant unlawful actions, including:

  • presenting a false or fraudulent claim to an insurance company,
  • submitting several claims for the same injury or loss,
  • causing a car accident in order to submit a false claim,
  • writing any statement with the purpose of supporting a false claim,
  • submitting a claim for an unused benefit,
  • requesting payment for health care under or over charges without basis.

A Penal Code 550 violation is charged as a felony crime and punishable by up to five years in jail and a fine up to $50,000 or double the amount of fraud.

Our Los Angeles criminal defense attorneys are providing an overview below on the various types of state and federal insurance fraud charges below.

Federal Health Care Fraud

The definition of health care fraud on a federal level is in 18 U.S.C. § 1347, which refers to the following illegal activity:

  • "When a person knowingly executes or attempts to execute a scheme that defrauds any health care benefit program through false pretenses, representations, or promises, they commit a federal crime."

One of the integral qualifying factors of medical fraud is the intent to defraud.

Federal Health Care Fraud Charges -  18 U.S.C. § 1347
Federal health care fraud is primarily described under 18 U.S.C. 1347.

A defendant demonstrates this with the aforementioned false pretenses, promises, or misrepresentations.

There are other illegal actions may qualify as medical fraud. Some of the most common related criminal activities and laws include:

18 U.S.C. 287 – false claims acts,

42 U.S.C. 1320a-7b – anti-kickback statute,

18 U.S.C. 1033 – insurance fraud.

Medi-Cal: The Government Funded Health Insurance Program in California

In California, many related illegal medical or healthcare actions involve defrauding Medi-Cal, the government-funded health insurance program in the Golden State.

Medi-Cal works to provide insurance for many people in the state who may not have access to insurance benefits. These include children, as well as low-income people, the elderly, and the disabled.

Penalties for Medical Fraud in the State of California

The penalties for medical fraud in the state of California will depend on the amount of the loss.

Penal Code 550 is a “wobbler” meaning the case can be filed as either a misdemeanor or felony crime.

A medical fraud misdemeanor charge for a claim of more than $950 could result in:

Penalties for Medical Fraud in the State of California
Penalties for a medical fraud conviction in California will vary depending on several different factors.
  • fine that could be as high as $10,000,
  • maximum of one year in jail.

A medical fraud felony charge, on the other hand, could net the offender:

  • up to five years in jail,
  • probation,
  • fine of up to $50,000, or
  • a fine equal to double the amount of the fraud in question.

If the relevant claims add up to an amount less than $950, the following penalties may apply:

  • a misdemeanor charge in the state of California,
  • up to a $1,000 fine,
  • no more than six months in jail.

Also, if the person accused of medical fraud have a medical license, as a result of the California medical fraud process, they may receive a revocation or suspension of their professional licenses.

For medical personnel, the lifelong consequences of such a revocation can be permanently and professionally devastating.

Related California offenses for PC 550 

Penal Code 548 PC – damaging or abandoning a vehicle,

Penal Code 549 PC – soliciting auto insurance fraud business,

Penal Code 551 PC – kickbacks from auto repair shop.

Defenses for California Medical Fraud Charges

If you are facing charges for medical fraud in the state of California, it's clear that you stand losing your career and a lot of capital.

You need experienced professionals to help you build a strategic and successful case for your innocence.  Our Los Angeles criminal defense lawyers will review the details to develop a relevant strategy to fight the charges.

Some common defenses for medical and insurance fraud charges include:

  • Statute of Limitations: There is a finite period during which the government can charge a person for this crime - generally just a few years. We may be able to take advantage of this fact.
  • Lack of Knowledge: If the patient gave you false information or you were not aware that the insurance company received incorrect information, you may be able to use your ignorance as a defense.
  • Lack of Intent: If the prosecuting team cannot demonstrate that you had a clear intent to defraud, you may be able to work towards the dismissal of these charges.

In any case, one thing is clear: If you stand accused of medical fraud in California, there's too much at stake for you to take on your defense alone.

We may be able to negotiate with the prosecutor for reduced charges or even get the case dismissed. 

Defenses for California Medical Insurance Fraud Charges
Contact the law firm of Eisner Gorin LLP to learn how we can defend you.

Further, we may be able to persuade the prosecutor from filing charges through prefiling intervention.

Rely on legal professionals with years of experience navigating the nuance of medical fraud cases to take your case.

We have spent years providing excellent defense for professionals seeking to protect their careers and their future.

Eisner Gorin LLP is a top-rated criminal defense law firm serving people throughout Southern California courts, including Los Angeles County, Orange County, Long Beach, Anaheim, Santa Barbara County, Ventura County, Riverside, and San Bernardino.

Our firm is located at 1999 Avenue of the Stars, 11th Fl., Los Angeles, CA 90067.

Our main office is next to the Van Nuys Superior Court at 14401 Sylvan St #112 Van Nuys, CA 91401.

Contact our firm for an initial consultation at (310) 328-3776.

We speak English, Russian, Armenian, and Spanish.

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