Jones Law | DUI & Criminal Defense | Fresno, CA

Health Care Fraud

Health care fraud is also commonly called medical insurance billing fraud, health insurance fraud, HMO fraud, Medicare fraud or Medi-Cal Fraud.

These violations include:

  • Performing medical procedures that are not medically necessary for that particular patient
  • Not performing certain procedures but actually billing for them as if they were performed (commonly known as phantom billing)
  • Overcharging for certain medical care
  • Providing medical supplies to patients that do not need them
  • Paying kickbacks to entities that refer each other business in the medical field
  • Submitting false claims to the Medi-Cal program (federal Medicaid program) and to private insurance carriers
  • Billing for more expensive services than the ones the patient received (this is known as “up-coding”).

Penalties

If the allegedly fraudulent claims are worth no more than nine hundred fifty dollars ($950) in total, then the offense is a misdemeanor. The potential penalties are imprisonment in a county facility for up to six months, a fine of a up to $1,000 or both.

If it is charged as a felony, the maximum penalties are a fine of up to $50,000 or double the amount of the fraud, imprisonment for 2, 3, or 5 years, or both.

You can also lose your professional license.

If you have been charged or are under investigation for Health Care Fraud, it is crucial to have an experienced attorney working for you.

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