California Penal Code 550(a) PC
PC 550(a) – Healthcare Fraud in California
Healthcare Fraud in California – Table of Contents
Healthcare fraud in California occurs in a number of contexts, but most often occurs in relation to Medi-Cal, and ensnares doctors, nurses, and other healthcare professionals.
Healthcare Fraud in California Section 550(a) lists a range of unlawful conduct. An example of some, but not all forbidden conduct, is as follows:
- Knowingly presenting any false or fraudulent claim for the payment of a loss or injury
- Knowingly presenting multiple claims for the same loss or injury
- Knowingly causing or participating in a vehicular collision, or any other vehicular accident, for the purpose of presenting any false or fraudulent claim.
- Knowingly presenting 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.
- Knowingly preparing, making, or subscribing 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.
- Knowingly making or causing to be made any false or fraudulent claim for payment of a health care benefit.
Keys of Fraud
The key to understanding the above is the definition of fraud. Fraud is lying to, or misleading, someone about important facts in order to obtain a benefit one would not otherwise be entitled to. This includes lying to obtain coverage or medical devices, even if you are very sick and need care.
The above also makes it possible for billing clerks to be punished for fabricating or processing knowingly false claims. The bottom line is if you are involved with preparing or submitting false information to collect from an insurance company, you should consult a licensed criminal defense attorney.
Example: Alice, a billing clerk at a doctor’s office, feels bad for one of the patients that she encounters at her office who suffers from severe leg pain. To ensure that the patient will be able to get a walker she otherwise would not have gotten, Alice improperly bills the patient’s insurance company.
Alice has likely committed healthcare fraud in California. She submitted false information to ensure that the needy patient got the equipment the patient needed. It is irrelevant that the patient was in pain, or that the patient needed it, the clerk submitted false information to obtain a benefit for someone that would not have been given otherwise.
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
- A fine of up to $1,000
- Or both
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 prosecutor depending on the circumstances. If charged as a healthcare fraud in California felony it is punishable by:
- 2, 3, or 4 years in prison
- A fine of up to $50,000
- Or both
This does not include any probation or restitution that may be ordered.
Consult a licensed criminal defense attorney to determine how your case will be charged, to discuss possible defenses, and to discuss how to exercise your constitutional rights.
If you or a loved one is being charged with PC 550(a), Healthcare Fraud in California, we invite you to contact us immediately for a free case review. Schedule an appointment to meet with us in person, or feel free to submit an evaluation online and we will get in contact with you ASAP. We can provide a free consultation in our office located in Century City, or by phone. Our experienced and assiduous Los Angeles Criminal Defense Lawyers will be sure to fight until the end to reduce or drop your charges completely.
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How to Win Your Case
We cannot stress enough that you read, understand and follow these 10 basic rules if you are criminally charged or under investigation:
- Don’t ever talk to the police
- Do not discuss your case with anyone
- Everything you tell your lawyer is confidential
- Tell police you need to contact your attorney
- Never consent to any search by the police
- If the police knock on your door, don't answer!
- Realize the consequences of a criminal conviction
- Your lawyer (not you) will contact any witnesses
- Information on your cell phone is evidence
- Early Intervention is the key