Medi-Cal is designed to help people. Nonetheless, countless individuals find themselves targeted by accusations of fraud. They range from regular healthcare patients confused by the system to providers and patients who made a bad mistake. If you face Medi-Cal fraud charges, do not risk facing the charge alone.
You need to talk to a Medi-Cal fraud lawyer in Los Angeles. The Simmrin Law Group can help you. We understand the complex Medi-Cal system, and we know how to defeat fraud charges. We have dedicated our firm to helping those who have been accused, and we have a history of winning cases.
What Is Medi-Cal Fraud?
Medi-Cal is a state-run program (not federal) that helps people get access to affordable medical care. To be eligible for Medi-Cal, you either need to qualify as low-income, or you need to fit certain other categories, such as:
- Senior citizens
- Women who are pregnant
- Foster children
For these groups, Medi-Cal effectively acts as a free insurance program. That means there is a benefit both to the patient (who gets free or reduced-cost care) and to the medical provider (who receives payment for their services from the state). This setup creates the possibility for both patients and providers to abuse the system.
Under the law, individuals (patients) can commit Medi-Cal fraud in several ways:
- Knowingly making false statements so that you (or someone else) can qualify for Medi-Cal benefits
- Knowingly making false statements regarding a claim in order to get it paid
- Knowingly submitting a claim for a benefit you never used, i.e., collecting the money but not getting the medical care in question
Medical providers (and other businesses) can also commit Medi-Cal fraud by:
- Requesting or offering a kickback in exchange for referrals or purchases covered by Medi-Cal
- Presenting false or misleading claims for medical services or products to defraud Medi-Cal
- Submitting fraudulent information to get more compensation than you would otherwise get under Medi-Cal
- Misrepresenting a business, or attempting any scheme to defraud Medi-Cal
Depending on the circumstances, Medi-Cal fraud can be charged under several different laws. Occasionally it is prosecuted as general health care fraud or even as workers compensation fraud. However, in most cases, it is tried under one of the charges that specifically relate to Medi-Cal fraud. We’ll cover each one and its penalties below.
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What Are the Penalties for an Individual Committing Medi-Cal Fraud in California?
If you are a patient accused of Medi-Cal fraud, you will usually be charged under a law known as California Welfare and Institutions Code Section 14014. Being charged with this kind of fraud does not necessarily mean that you personally benefited from the action.
It’s common for someone to lie on behalf of a family member, for example, to help them get approved. In this case, it is the person who committed the fraud, not the family member who received benefits, that faces criminal charges. Likewise, you can be charged even if you never received money or benefits. Simply the attempt to defraud the system is enough.
Medi-Cal fraud is a type of white-collar crime. Charges under this law can be either a felony or a misdemeanor. The deciding factor is (mostly) the amount of money involved.
If the amount was $950 or less, it’s always a misdemeanor. If the amount was over $950, it’s up to the prosecutor to decide whether to charge it as a misdemeanor or a felony. They will consider your criminal history as well as the circumstances of your case.
Misdemeanor Penalties
If charged with a misdemeanor, the consequences will be far lighter than if you are facing a felony charge. Don’t expect to get off lightly, though. Even misdemeanor charges can result in harsh penalties. A misdemeanor conviction could mean:
- Up to six months in jail (or one year if the amount was over $950)
- A fine of up to $1000
- Informal (unsupervised) probation
Felony Penalties
If you are facing a felony charge, be prepared for hefty fines and a substantial prison sentence if convicted. A felony conviction can result in:
- Up to three years in prison
- A fine of up to $10,000
- Supervised probation
Additionally, you will be required to repay the amount “defrauded” from California. A Medi-Cal fraud attorney in Los Angeles can help to reduce or eliminate your charges.
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What Are the Penalties for Medical Professionals Who Commit Medi-Cal Fraud in Los Angeles?
The main circumstance where medical professionals are charged is when they submit false or exaggerated claims to Medi-Cal. These cases can include outright falsifying the claim or changing minor details like whether the doctor saw the patient personally or whether a PA under them saw the patient.
If the goal was to get more money than allowed by Medi-Cal, it can count as fraud. This kind of fraud will be charged under Welfare and Institutions Code Section 14107, which can be either a misdemeanor or a felony, as chosen by the prosecutor.
Misdemeanor Penalties
Again, the misdemeanor penalties are far less severe. If charged with a misdemeanor, you could be looking at:
- Up to one year in county jail
- A fine of up to 300% of the amount defrauded
- Informal (unsupervised) probation
Felony Penalties
These harsher penalties could include:
- Up to five years in state prison
- A fine of up to 300% of the amount defrauded
- Supervised probation
You will face additional penalties if the accusation involves any fraud scheme that has put people at risk of great bodily injury.
An example would be if a doctor at a small practice routinely has her assistant see patients in order to maximize how many people the office can see. This doctor then charges Medi-Cal as if they saw all the patients personally.
If one of these patients then develops a serious condition or complication (potentially because of a misdiagnosis or not getting proper care), the physician may face an enhanced sentence. The enhancement is an extra four years in prison for every patient who was harmed.
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What Are the Penalties for Medi-Cal Bribes and Kickbacks?
The Medi-Cal system creates many opportunities for kickbacks. Salespeople, healthcare suppliers, and drug manufacturers could offer bribes if doctors use their products. Doctors or providers could then repeatedly prescribe the drug or procedure even if patients don’t need it.
In these cases, the supplier typically gets paid by Medi-Cal and shares some of that profit with the doctor. These types of cases are charged under Welfare and Institutions Code Section 14107.02, which may be a misdemeanor or a felony if it’s a first offense, but is always a felony for repeat offenders.
Misdemeanor Penalties
Misdemeanor penalties for this offense start pretty high, with the potential of up to a one-year jail term if convicted.
Felony Penalties
Felony penalties are once again much tougher, with the potential of up to three years in prison for a conviction.
Both misdemeanors and felonies can also carry substantial fines and fees as well as probation. And you don’t want to fight either of them without a Medi-Cal fraud lawyer in Los Angeles on your side.
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How Can a Lawyer Fight a Medi-Cal Fraud Charge?
“Fraud” is not as open-and-shut as it often looks. Both patients and providers do get mistakenly targeted with fraud accusations, and there are defenses that both can use. A Los Angeles Medi-Cal fraud attorney can determine which strategy works best in your case. The most common arguments are:
- Lack of fraudulent intent
- Lack of evidence
- Evidence improperly obtained or handled
Lack of Fraudulent Intent
Intent is a key element of any fraud case. If you didn’t know your statements were false, you were not acting fraudulently by making them. Likewise, if the false claims were a product of poor record-keeping or another honest mistake, fraud was not committed. However, while this defense can free you from a fraud charge, it may open you up to other legal action.
Even if you were not acting fraudulently, you could still be held liable for poor bookkeeping as well as other errors.
Lack of Evidence
If the prosecutor does not have sufficient evidence to prove their case, you cannot be convicted, and the charges could even be dismissed. Remember, the burden of proof is with the prosecution. Their evidence must be able to prove beyond a reasonable doubt that you are guilty.
Evidence Improperly Obtained or Handled
The police and other law enforcement officers must follow a strict set of rules when it comes to obtaining and handling evidence. If they do not follow the proper procedures, your lawyer can fight to get the evidence they have against you suppressed.
If all the evidence they gathered followed an original violation of your Fourth Amendment rights protecting against illegal search and seizure, you may be able to get the case thrown out entirely.
When we take on a Medi-Cal case, we start by launching our own investigation into what happened. In some cases, the evidence against you was not gathered legally or contains errors. We can use that to your advantage and help you win your case.
Talk to a Los Angeles Medi-Cal Fraud Lawyer for Free
Medi-Cal fraud is not a minor charge. One conviction can ruin a career or a life. Let us help you. The Simmrin Law Group will fight for your rights and help protect you against this charge.
Give us a call or fill out our online contact form to schedule a free, no-obligation case evaluation today. One of our Los Angeles Medi-Cal fraud attorneys will review your case and advise you of your legal options.
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