Health care fraud can involve any number of false claims, typically committed by a health care provider.
If there is one thing that many Americans know for certain, it is that the insurance system is complicated. Most of us barely even glance at the bills that we receive from our doctor’s offices or hospital stays, knowing that our insurance will cover it — and that we probably won’t understand half of what is on the document anyways.
The complex nature of the health care system can often make it easy for certain health care providers to commit what is known as health care fraud. This type of fraud can take make forms, such as submitting claims for treatments or benefits that were never provided, making multiple claims, submitting false or fraudulent claims, or preparing a document in support of a fraudulent claim.
California health care fraud can be charged as either a misdemeanor or a felony, depending on the amount of money involved. If the allegedly fraudulent claims are worth $950 or less, then it is charged as a misdemeanor, with a penalty of up to six months in jail and/or a fine of $1,000. If the allegedly fraudulent claim was for over $950, then the charge will be a felony, with a fine of up to $50,000 or double the amount of the fraud, and/or up to five years in jail.
In order to prove the charge of health care fraud, a prosecutor has to demonstrate the facts of the underlying charge. For example, if the state alleges that a doctor charges patients for services that he does not perform, then the prosecutor would have to prove that the doctor did not perform those services. In addition, the prosecutor would have to prove two additional elements: that the defendant (1) knew that the claim was false or fraudulent and that he or she had an (2) intent to defraud.
As an experienced criminal defense attorney in San Bernardino, CA can tell you, there are many potential defenses to a health care fraud charge. A lack of knowledge or mistake of fact defense is a primary defense to this charge. If the doctor’s office in the example above simply made a billing error, then it was a mistake of fact —after all, insurance is complicated, and mistakes do happen. A skilled criminal defense attorney in San Bernardino, CA can also argue that this shows lack of intent. If the “false” claim was actually just a billing error, then there would not be an intent to defraud — it would just be a mistake.
At the Chambers Law Firm, our criminal defense attorneys in San Bernardino, CA have experience handling a wide variety of cases, including those involving health insurance fraud. Contact us today at 714-760-4088 or dchambers@clfca.com to schedule a free initial consultation and learn how we can help you if you have been charged with a crime.
