What is the Punishment for Health Insurance Fraud?

Healthcare fraud is one of the most common types of fraud crimes committed in California. Most people get their health insurance from private medical insurance companies or government agencies. Healthcare fraud is committed when people (patients or medical professionals) falsely bill these organizations for medical services for the purpose of financial gain.

If you or a loved one is facing healthcare fraud charges, it is important to have an experienced fraud attorney fighting to protect your legal rights.

Health Insurance Fraud (California Penal Code Section 550)

The punishment for health insurance fraud in California is very severe.

Under California Penal Code Section 550, it is illegal to do any of the following:

• Submit a claim for any sort of health care service or procedure that was not actually used by the person in the name the claim is made.
• Submit false or fraudulent claims. Examples include:
  • A doctor performing a service that a patient does not need and billing insurance for it;
  • A doctor billing insurance for a procedure or service that was more expensive than what a patient actually received;
  • A doctor charging a patient who has insurance a fee but not charging a patient who pays out of pocket the same fee for the same procedure or service.
• Submit multiple claims for the same medical service (also known as double-billing).
• Bill a health insurance provider for any services that were undercharged without billing for any services that were overcharged.
• Prepare a document in support of a fraudulent claim.

How Does the Prosecution Prove That You Committed Health Insurance Fraud?

To be convicted of health insurance fraud under California Penal Code Section 550, the prosecution must prove that you:

• Knew that the claim was fraudulent or duplicated or knew that a document prepared would be used to submit a fraudulent claim; AND
• Had an intent to defraud the medical insurance company or program.

Punishment for Health Insurance Fraud in California

Our fraud attorneys can help you today.

The penalties for healthcare fraud under California Penal Code Section 550 depend on whether the amount of the fraudulent claims is more than $950. If multiple claims are involved, health care fraud depends on whether the fraudulent claims add up to over $950 in one year.

If the fraudulent claims add up to less that $950, health care fraud is charged as a misdemeanor and is punishable by up to six months in county jail and a $1,000 fine upon conviction.

If the fraudulent claims add up to more than $950, health care fraud can be charged as a misdemeanor or felony depending on the circumstances of your case. If health care fraud involving claims of more than $950 is charged as a misdemeanor, a conviction is punishable by up to one year in county jail and a $10,000 fine. If health care fraud is charged as a felony, a conviction is punishable up to five years in prison and a $50,000 fine (or double the amount of fraud, whichever is greater).

In addition to prison time, fines, restitution and probation, you could lose your professional license (doctor’s, nurse practitioner’s, therapist’s, etc.) if you are convicted of healthcare fraud.

Call Wallin & Klarich Today if You are Charged with Healthcare Fraud

If you or a loved one is facing a healthcare fraud charge, it is critical that you speak to an experienced criminal defense attorney as soon as possible. At Wallin & Klarich, our attorneys have over 40 years of experience in defending healthcare fraud charges. Our attorneys will fight to get you the best possible outcome in your case.

With offices in Los Angeles, Sherman Oaks, Torrance, Tustin, San Diego, Riverside, San Bernardino, Ventura, West Covina and Victorville, there is an experienced Wallin & Klarich Southern California criminal defense attorney near you no matter where you work or live.

Call us today at (877) 4-NO-JAIL or (877) 466-5245 for a free phone consultation. We will get through this together.